A recent article in The Economist revealed a striking statistic: in poor countries, cancer is responsible for more deaths than malaria, tuberculosis, and HIV combined. The cancer burden is particularly heavy across sub-Saharan Africa, where approximately 100,000 children are affected each year. Currently, 90 percent of these children die due to lack of a proper diagnosis, unavailability of needed anti-cancer medications, and inadequate health care infrastructure (J Clin Oncol 2015;33(27):3065-3073).
In particular, there is a near-complete absence of trained pediatric hematology-oncology (PHO) specialists in this area of the world, further compounding the problem. In contrast, for the nearly 15,000 U.S. children who develop cancer each year, the availability of state-of-the-art treatments, ample medical resources, and a fully trained cadre of PHO specialists in the U.S. affords them an 80 percent cure rate. These facts exemplify the global crisis founded in childhood cancer.
This crisis surrounding childhood cancer in Africa has the attention of major global organizations, including the United Nations. In 2015, the UN published their Sustainable Development Goals: 17 goals designed to end poverty, protect the planet, and ensure prosperity for all. Goal 3 involves objectives related to improving global health and pediatric survival and treatment of non-communicable diseases (such as cancer and blood disorders) (www.un.org/sustainabledevelopment/health/). The incredible disparity in patient survival, along with rationale from the global initiatives taken by the UN and its member states, led to the development of Global HOPE, a unique initiative to improve pediatric cancer care in the underserved countries of sub-Saharan Africa.
A Comprehensive Solution: Global HOPE
The Global HOPE (Hematology-Oncology Pediatric Excellence) program's vision is to transform care for children with cancer and blood diseases in sub-Saharan Africa. This vision will be reached by achieving excellence in the care and treatment of children with cancer and blood disorders in Africa. The Global HOPE program represents a partnership between Texas Children's Cancer and Hematology Centers, Baylor College of Medicine's International Pediatric AIDS Initiative (BIPAI), and the Bristol-Myers Squibb Foundation. Texas Children's Cancer and Hematology Centers is one of the largest pediatric hematology-oncology centers in the U.S. BIPAI has been operating for over 17 years, establishing and managing seven successful Centers of Excellence that have treated over a million children with HIV/AIDS in six sub-Saharan African countries (Lesotho, Botswana, Swaziland, Malawi, Uganda, and Tanzania).
The BIPAI model functions under formal agreements with the Ministries of Health and within established non-government organizations in each country. This model has been extraordinarily successful and recognized by the WHO, UNICEF, and other international agencies as a leading model in the battle against HIV/AIDS. BIPAI has established a health care infrastructure in its Centers of Excellence that provides high-quality, high-impact, highly ethical pediatric and family centered health care and health professional training. BIPAI was a capacity building effort such that all BIPAI Centers of Excellence are led by Africans. Global HOPE has modeled its strategic plan off BIPAI's model and is building on BIPAI's established, successful infrastructure to address the extreme need for PHO care in sub-Saharan Africa. Hence, a primary goal for Global HOPE is capacity building through the on-site education and training of local African physicians, nurses, and other health care workers.
Training the African Health Care Workforce
Although the PHO Centers of Excellence will encompass a multi-faceted strategy to improve PHO outcomes in Africa, one major focus will be on the education and training of PHO specialists, nurses, medical officers, and other critically important subspecialties (e.g., surgery, pharmacy). By doing so, Global HOPE will enable the local workforce to provide the highest level of care and the multidisciplinary approach that is characteristic of PHO care. To achieve this goal, Global HOPE has implemented the “train the trainer” approach. It will be used not only for the training that occurs at each PHO Center of Excellence, but also a major approach used to train health care workers at outreach sites in the various countries.
In 2016, Global HOPE partnered formally with the Uganda Ministry of Health, Makerere University College of Health Sciences, Uganda Cancer Institute, Mulago National Referral Hospital, and Baylor College of Medicine Children's Foundation-Uganda through a Memorandum of Agreement. Among several objectives, this agreement represents a commitment to establish and conduct the East Africa PHO Training Program in Uganda. This 2-year program began in September 2016, with its first class of four Ugandan pediatric fellows. In September 2017, a second class of four fellows was selected from an applicant pool of 14 from five countries in East Africa. The most-recent class of fellows represent Uganda, Kenya, and Tanzania. In the coming years, Global HOPE plans to establish a second training site in Botswana to represent Southern Africa. As a demonstration of true capacity building and global collaboration, Global HOPE holds weekly video teleconferences that bring together physicians, fellows, nurses, and other health care workers to discuss patient care plans in depth.
Because optimal PHO care is multidisciplinary, specialized training is required for physicians in other subspecialties as well (e.g., surgery, palliative care). Global HOPE has engaged expert physicians and leaders at Texas Children's Hospital to develop capacity-building plans in these specialties.
In addition to specialty training for PHO fellows, Global HOPE has developed key training strategies to augment the skill sets and knowledge of other health care workers, including nurses, pharmacists, laboratory technicians, and diagnostic specialists, as well as training for management and support roles. This involves the development of a portfolio of curricula targeted to the unique learning needs of each profession and role. U.S.-trained PHO physicians and nurses, ancillary experts, and health care administrators will provide on-site training at each of the chosen sites, working in partnership with the major medical schools and hospitals in these countries.
PHO Centers of Excellence
Global HOPE's long-term vision is to launch PHO Centers of Excellence as flagship institutions of excellence in PHO care, fully self-sustainable, fully integrated into the health systems of each respective country, and staffed by specially trained African health care professionals. As such, Global HOPE and its partnering non-government organizations in Africa have engaged the Ministries of Health and local governments to cultivate resilient, constructive relationships that nurture long-term success.
Eventually, Global HOPE is aiming to bring the cancer and blood disorder care in these countries to the point where excellent outcomes, equivalent to those in the U.S., are achieved at each sub-Saharan PHO Center of Excellence. This excellence in care will be vastly improved nationwide (and, indeed, regionwide) through decentralization of specialty care wherever possible. Thus, this program will have a transformative impact by saving the lives of thousands of children with cancer and blood disorders.
DAVID POPLACK, MD, is Director of Texas Children's Cancer and Hematology Centers, Houston. Texas Children's Hospital is a top 10 pediatric cancer hospital according to U.S. News & World Report.