Training Needs Assessment for the East African Centre of Excellence in Oncology

Abstract

The East African Centre of Excellence in Oncology (EACO), formerly the Uganda Cancer Institute (UCI) was originally founded as a collaborative research institution. The Institute holds a global legacy of providing the first description of Burkitt’s lymphoma and pioneering the first delivery of combination chemotherapy for treatment of primary cancer of the liver. Today, the EACO remains active in training and conducting research on cancer with particular relevance to Uganda and the East African region. The institute has become a regional referral centre for cancer care serving the East African countries: Uganda, Kenya, Tanzania, Rwanda, Burundi and Southern Sudan. However, the UCI also receives patients that require specialized cancer treatment and care from as far as Sudan and the Democratic Republic of Congo (DRC). Worldwide, more than half (56.8%) of the 14.1 million cases and almost two-thirds (64.9%) of the 8.2 million cancer deaths that occurred in 2012 were in the less-developed regions of the world (Torre et al., 2015, GLOBOCAN, 2012). The trend in global cancer burden is projected to increase by 50% by 2030 with most of the increases occurring in the low- and middle-income countries (LMICs) (Torre et al., 2015, Parkin et al., 2014). There is increasing incidence of cancers diagnosed late and accompanying mortality with unacceptably high mortality: incidence ratio in the low-income Sub-Saharan African countries compared to high income countries (HICs) countries (Caplan, 2014, Sainsbury et al., 1999, Richards et al., 1999, Saadatmand et al., 2015, Porta et al., 1991, Neal et al., 2015). Cancer already accounts for more deaths in the developing world than tuberculosis, malaria, and HIV/AIDS combined (Kerr and Midgley, 2010). In 2008, the American Cancer Society estimated that 56% of incident cases and 64% of deaths due to cancer occurred in LMICs, and in paediatrics, the numbers are even more skewed, with 80% of incident cases and deaths due to childhood cancers in LMICs (ACS, 2010). Within the next decade, global cancer rates are predicted to more than double, but this burden will not be borne equally; death rates in LMICs are expected to be five-fold higher than in HICs (Rastogi, Hildesheim and Sinha, 2004). Cancer therefore remains one of the leading causes of mortality in Sub-Saharan Africa. Training of health care workers in effective cancer care knowledge and skills has been identified as one way of improving cancer health care and reducing cancer-related mortality in Sub-Saharan Africa. Cognizant of the need for enhancing the capacity of health workers to offer improved cancer care services in the region and in order to validate the needs of health workers involved in cancer care, the East African Centre of Excellence in Oncology under the auspices of the African Development Bank undertook a training needs assessment. The primary focus of this training needs assessment/analysis was to identify gaps in the knowledge, skills and attitudes of health workers that are involved in the provision of cancer care services at the UCI in order to formulate appropriate training interventions. The Training Needs Assessment was conducted through consultation and engagement with various stakeholders through surveys, in-depth interviews and focus group discussions. These stakeholders included the health workers involved in cancer care especially at UCI, MaKCHS, other training institutions, medical students, directors of regional referral hospitals, officials from MoH and MoES, directors of private hospitals, cancer patients and their care givers and the rest of the wider community. In addition, reviews of documents that included newspapers were done. Benchmarking visits to the other East African countries that included Kenya and Tanzania were also carried out to identify best practices as well as bottlenecks that were essential in formulating appropriate training interventions for the UCI staff. All these engagements with various stakeholders assisted in studying the current situation and identifying training gaps of the health workers involved in cancer care. This thus provided a 3600 degree analysis of the existing gaps that would require training to enhance the health workers capacity to deliver the much-needed comprehensive cancer care in the region. Analysis of the findings indicated that the health workers were making great effort to provide the much-needed comprehensive cancer care. However, there were significant gaps between what is currently provided and what would be ideally required. It is these gaps where urgent training interventions are needed to improve the capacity of the health workers. Key areas such as cancer-related research, pain management, counselling, communication and inter-personal skills, skills in palliative care, specialized oncology-specific Fellowships, psychiatric oncology as well as ethics and professionalism among health workers reflected training gaps and hence the need to address them through capacity building training packages. Cognizant of these findings that include knowledge and skills gaps, responsibilities and needed competencies of various cadres of health workers involved in cancer care and the preferred mode and duration of training, a CME/CPD guideline has been proposed that can potentially address the identified gaps and improve the capacity of health workers to offer better cancer care service.