World Child Cancer – Ghana Programme

Overall goals

Through our partnership with RHSC we aim to

Improve treatment and care
• Provide specialist training for healthcare staff and improve knowledge of early warning signs and symptoms
• Support the costs of diagnosis and treatment for vulnerable families
• Establish shared care centres around the country to improve referral rates
• Facilitate the collection of accurate patient data to allow follow-up
• Support adequate staffing at treatment centres, especially for nursing
• Implement community awareness and engagement activities
• Improve surgical standards and procedures, including laparoscopy techniques
• Improve pathology services

Key UK Colleagues and Partners

Royal Hospital for Sick Children
Edinburgh
UK

International Partners

Korle Bu Teaching Hospital (KBTH)
Accra
Ghana

Komfo Anokye Teaching Hospital (KATH)
Kumasi
Ghana

Sustainable development goals

• SDG 1 - No poverty
• SDG 3 - Good health and well-being
• SDG 4 - Quality education
• SDG 5 - Gender equality
• SDG 10 - Reduced inequalities
• SDG 17 - Partnerships for the goals

Funding source

Department for International Development (DFID)
Tropical Health and Education Trust (THET)
Celgene
British and Foreign School Society (BFSS)
UBS Optimus Foundation

Project origin

When we began work at KBTH there was just one paediatric oncologist who was supported by general paediatricians, there were no trained dedicated paediatric oncology nurses and those involved in the treatment of childhood cancer patients were also working on other wards, there were just 6 dedicated beds and no isolation facilities, there was no outpatient department.
The department saw around 100 patients each year. Around 20% were immediately palliated either as they were diagnosed too late, there was not the skills and wherewithal to treat them or the family refused to start treatment as they could not fund the repeated rounds of treatment required for a child with cancer. Of those that started treatment 47.5% of children abandoned treatment, often due to financial pressures, others died during treatment, often due to its toxicity and just 20% survived until the end of treatment, long term follow up is very difficult in the Ghanaian context with children spread across the country and even into neighbouring countries so one and five year survival rates were not known.
We knew that there were multiple needs that required addressing, firstly to improve the standard of care at KBTH, then to include more hospitals in a national network and to increase the number of children with cancer that were referred. It is likely that nearly 1,500 children develop cancer in Ghana each year, but most were not even receiving palliative care.

Evidence of need

The International Society of Paediatric Oncology (SIOP) have long had a policy to create linkages between hospitals in resource rich countries and hospitals in resource poor countries to develop paediatric oncology services. This is at the heart of our programme – we went to Ghana with paediatric oncologists from the Royal Hospital for Sick Children in Edinburgh to undertake a needs assessment.

Project areas

Healthcare provision
Service improvements
Capacity building
Policy

Project activities

World Child Cancer began working in Ghana in 2010 in partnership with The Royal Hospital for Sick Children, Edinburgh. Initial work focused on managing febrile neutropenia (high fevers common during chemotherapy), basic chemotherapy strategies/toxicity, emphasis on pain management, infection control and description of therapy for most common tumours seen as well as managing data to make incremental impartments and developing palliative care.

In 2013 WCC funded the development of a day care unit for delivering outpatient chemotherapy, freeing up beds on the ward for longer stay patients. WCC took on the funding of the nurses to staff the unit, demonstrating their value to the hospital authorities until they were able to take over funding them at the end of 2018.

In 2014 A DFID grant was secured which allowed a network of shared care centres to be developed that allowed for elements of both diagnosis and treatment could be offered closer to children’s homes, reducing the impact on families and dropout rates, this ran until 2017.

In 2018 WCC and Edinburgh implemented another THET funded project to develop laparoscopy (key hole surgery techniques) with Ghanaian paediatric surgeons. Laparoscopic surgery is less invasive than conventional surgery, reducing both the recovery time and risk of infection.

3 further large grants were secured in 2018, the first was from DFID to develop the shared care network, but also to introduce nationwide training to paediatricians on the early warning signs and symptoms of common childhood cancers, this will increase referrals and ensure diagnosis is earlier. A second grant from the pharmaceutical company Celgene will allow more accurate diagnostic techniques common in the developed world to be introduced in Ghana, this will ensure many more children get the most appropriate chemotherapy first time. A grant from the UBS Optimus Foundation will establish a fellowship programme at Korle Bu that will train the next generation of pedatric oncologists across sub-Saharan Africa.

In addition, WCC have provided treatment funds for those most at risk of abandonment throughout, they have also supported doctors to train in South Africa and India and with Edinburgh has ensured that there has been online training of nurses monthly. Last year they provided a volunteer counsellor who is supporting them to improve the psycho social support they offer to families and each year ensure there is a Christmas party for those who can’t go home or want to come back.

Over the first five years, survival rates at KBTH rose from 20% to 62% and national diagnosis more than tripled from 103 to 310 cases a year, Since the project started in 2010 treatment abandonment has fallen from 47.5% to 9.8%. There has also been a shift in the types of cancers diagnosed and treated with many more complex ones being treated with excellent results. The ward now has 27 beds and a Day Care Unit for outpatient chemotherapy with 8 beds, there are also 5 qualified paediatric oncologists.

We now see a need to train more paediatric oncologists across the West Africa and have secured funding from UBS to set up a fellowship programme at KBTH, establishing them as a regional centre of excellence.

Changes

Over the next 3 years we aim to turn KBTH, our main partner hospital in Ghana into a regional centre of excellence for childhood cancer. Responding to needs identified by the team at KBTH additional projects have been developed focusing on paediatric surgery and advanced pathology. As a centre of excellence KBTH will be able to host paediatric oncology fellows from across sub Saharan Africa. In order to secure a fellowship, they will require support from their own government and receive a commitment from them that there will be funds available to commence paediatric oncology services in their own country on completion of the course.

Next steps

WCC UK has in place 5-year strategic plans that provide our programmes with structure and direction. We continuously review these strategies in close alignment with our partner hospitals. Our work in-country is overseen by a Steering Committee, ensuring that all stakeholders have the opportunity to share their knowledge and contribute towards project implementation. This also ensures that there is a clear and transparent decision-making process.
In-country staff make sure our programmes are well managed and organised, providing clear lines of responsibility.
We have strong relationships within the Ministry of Health (MOH) and the Ghana Health Service to guarantee the long-term suitability of our work.
Our biggest value for money is the donation of time and expertise from doctors, surgeons and nurses who participate in the project on a voluntary basis and at no cost to the project apart from their flight and accommodation in Ghana.

Challenges

At times it has been difficult for healthcare professional at our partner hospitals to get time off to attend twinning visits. This has resulted in volunteers taking personal annual leave to attend training visits.
Past experience has shown us that if a project is properly communicated with staff, volunteers and management, at all levels of our partner hospitals, staff are much more likely to get time off to share their expertise.

Mitigating challenges

WCC is happy to share.

Partnership principles

• strategic
• harmonised
• effective
• respectful
• organised
• responsible
• flexible

Project gains

• leadership
• teamwork
• clinical
• awareness
• academic
• patient
• resilience