How do ImPACT Reviews Help Countries with Cancer Control?

Each year, the IAEA, together with its partners the World Health Organization (WHO) and the International Agency for Research on Cancer (IARC), conducts around ten ImPACT Reviews, designed to support countries in their efforts to improve comprehensive cancer control.

ImPACT Reviews assess a country’s cancer control capacities and needs in order to  prioritize interventions and help governments effectively respond to their country’s cancer burden. This response could involve creating a national cancer control plan, producing feasibility documents – often called ‘bankable documents’- that justify the funding of cancer care facilities to donors, or deciding to join WHO cancer initiatives, such as those on cervical, breast and childhood cancer.

“Controlling cancer in Mozambique is a significant challenge, compounded by limitations in infrastructure, human resources, and access to adequate diagnostics and treatments,” said Tiago, Mozambique’s Minister of Health.

“The imPACT Review represents a valuable opportunity to identify critical gaps and outline concrete strategies to strengthen our capacity to address cancer. We are confident that this collaboration will provide essential guidance to improve cancer care in our country," the Minister of Health added.

What Goes On Behind the Scenes of an ImPACT Review?

Experts participating in the Mozambique mission came from countries in Africa, Europe, North and South America, bringing expertise from fields ranging from palliative care, pathology and public health to oncology and epidemiology. Many were also native speakers of Portuguese, which is widely spoken in Mozambique.

As in other imPACT Reviews, the Mozambique mission experts were nominated by the IAEA, IARC and WHO. IARC recommended experts in cancer registry, an information system that collects, manages and analyses data on people diagnosed with cancer. The IAEA nominated experts in radiation medicine, diagnostic imaging and radiation safety and the WHO nominated experts on all other aspects of cancer control.

Three months before setting foot in Mozambique, the imPACT Review international experts started meeting online to assess the needs of the country. The experts researched the latest available evidence on public health policies and cancer control, provided by IARC, WHO and IAEA, including experts from the IAEA human health programme. They also gathered reports and data from UN staff,  professionals from Mozambique’s Ministry of Health and other national cancer stakeholders to gain a good understanding of the country’s cancer-related infrastructure and capacity. Professionals and stakeholders in cancer control in Mozambique completed questionnaires to help the imPACT Review experts identify needs, challenges and opportunities. A preliminary report was produced ahead of the in-country mission to determine its scope.

Arsen Juric, Mozambique imPACT Review Coordinator said: “These preparatory meetings are part of a strategic process. They help the experts make evidence-based recommendations that aim to strengthen and embed cancer control in Mozambique’s national health system, better serving patient needs across the country.”

The imPACT review is designed to give a broad overview of cancer care in the host country, determining the gaps and needs which are most urgent, to inform decision makers when formulating health policy regarding cancer.

What is Cancer Control?

Prevention includes factors such as diet, smoking cessation and vaccinations against infectious disease. It is estimated it is currently possible to prevent 40 per cent of all cancers.

Detection includes screening and early diagnosis. Early detection means many cancers have a high potential for cure.

Treatment aims to cure disease, prolong life, and improve the quality of remaining life

Palliative care involves addressing the needs of patients and their families from the time of cancer diagnosis to improve quality of life and the ability to cope effectively. 

On the Ground in Mozambique

At the beginning of May, the imPACT Review team experts arrived in Maputo, the capital of Mozambique, to visit hospitals and public health centres. They met cancer care experts, policy and decision makers and technical staff from Mozambique’s Ministry of Health, and the staff of the WHO country office, as well as representatives of civil society organizations

In addition to experts from IARC and WHO, the mission also included an expert from MD Anderson Cancer Center, an IAEA nuclear safety expert, an IAEA cancer control expert and the IAEA’s National Liaison Officer for Mozambique.

ImPACT reviews look at every aspect of cancer control, including how data on cancer is managed, and financing, as well as prevention, early detection, diagnosis, treatment and palliative care. During the review, the experts visited hospitals, primary health care facilities, and met with civil society, patient and cancer advocacy groups in Mozambique to obtain as much data as possible on the cancer control situation in the country.

Prioritizing Women and Children’s Cancers

While imPACT Reviews look at all aspects of cancer control, the Mozambique review gave the team to focus on WHO cancer initiatives, such as those on cervical, breast and childhood cancer.

Severin von Xylander from Mozambique’s WHO Country Office said the WHO was also working with the National Cancer Control Programme in Mozambique to prioritize the prevention and early detection of cancers affecting women and children, in line with global cancer control initiatives.

At the Primeiro Maio healthcare centre, the  imPACT Review team learned more about the scope of services in primary care, such as prevention and early detection, particularly in terms of cancers that affect women and children.

Speaking of positive outcomes, Celina Mate, of the Mozambique Ministry of Health, said that interactions with the imPACT review team during the in-country mission had helped realize that their cervical cancer screening coverage was more comprehensive than they had previously thought.

“In addition to this aspect, we were able to look at our needs and the need to advocate for financial support to increase screening capacity using a high-standard test such as the HPV DNA test,” said Mate.

Lorna Awo Renner, an international expert in paediatric oncology from Ghana taking part in the imPACT Review, used her time in Mozambique to observe and make recommendations on how the country is  addressing childhood cancer.

“Over 80 per cent of childhood cancers are curable, but at a global level we are at about 30 per cent, you take the low- and middle- income countries, they have even lower rates,” she says.

The WHO’s Global Initiative for Childhood Cancers, aims to improve long term cure outcomes for childhood cancer globally to over 60 per cent by 2030. Renner said she hoped  Mozambique would also join the initiative.

At the end of the mission, a report was produced for the Mozambican government, which will support the next national cancer plan to address the growing cancer situation in the country.

The IAEA’s Support to Mozambique

The IAEA has supported Mozambique in providing cancer care at Maputo Central Hospital for over a decade. A Brazilian team of consultants carried out the training and implementation of radiotherapy at Maputo Central Hospital with the support of the IAEA’s technical cooperation programme. Since 2009,14 specialists at Maputo Central Hospital have been trained in radiation oncology and medical physics through the IAEA’s technical cooperation programme, with the aim of strengthening radiotherapy services.

Rays of Hope: Cancer Care for All

While around half of all cancer patients can benefit from some form of radiotherapy, countries such as Mozambique have only limited access to this technology. As just one radiotherapy unit in the capital city of Maputo is available for a population of over 30 million people, many cancer patients in Mozambique are unable to access this life-saving treatment.

Establishing new radiotherapy facilities is a complex project, requiring new infrastructure and equipment (or better use of existing infrastructure and equipment) as well as training to ensure professionals are available to work in the new facilities, and that radiation safety protocols are followed.

 In 2023 Mozambique joined the IAEA’s Rays of Hope initiative, which aims to help bridge the gap in cancer care around the world by expanding access to radiotherapy.

“Through Rays of Hope the IAEA will continue to support the expansion of radiation medicine capacities in Mozambique, in diagnosis as well as treatment, including through support for the development and training of the national cancer care workforce,” said Hua Liu, IAEA Deputy Director General and Head of the Department of Technical Cooperation.

ImPACT Reviews are a vital step in helping countries to improve national radiotherapy services, along with cancer control in general, as they allow international teams of cancer control experts to support national counterparts with cancer control planning and investments.

READ MORE: Mozambique is Prioritizing Cancers Affecting Women and Children