Implementing cancer care in rwanda: Capacity building for treatment and scale-up

Paul H. Park*, Cyprien Shyirambere, Fred Kateera, Neil Gupta, Christian Rusangwa, Joia Mukherjee, Alex Coutinho, Leslie Lehmann, Lori Buswell, Lawrence N. Shulman, Joel M. Mubiligi, Francois Uwinkindi, Lisa R. Hirschhorn

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: The majority of countries in sub-Saharan Africa are ill-prepared to address the rising burden of cancer. While some have been able to establish a single cancer referral center, few have been able to scale-up services nationally towards universal health coverage. The literature lacks a step-wise implementation approach for resource-limited countries to move beyond a single-facility implementation strategy and implement a national cancer strategy to expand effective coverage. Methods: We applied an implementation science framework, which describes a four-phase approach: Exploration, Preparation, Implementation, and Sustainment (EPIS). Through this framework, we describe Rwanda’s approach to establish not just a single cancer center, but a national cancer program. Results: By applying EPIS to Rwanda’s implementation approach, we analyzed and identified the implementation strategies and factors, which informed processes of each phase to establish foundational cancer delivery components, including trained staff, diagnostic technology, essential medicines, and medical informatics. These cancer delivery components allowed for the implementation of Rwanda’s first cancer center, while simultaneously serving as the nidus for capacity building of foundational components for future cancer centers. Conclusion: This “progressive scaling” approach ensured that initial investments in the country’s first cancer center was a step toward establishing future cancer centers in the country.

Original languageEnglish (US)
Article number7216
Issue number13
StatePublished - Jul 1 2021


  • Cancer
  • Implementation science
  • Rwanda
  • Sub-Saharan Africa
  • Sustainable development goals
  • Universal health care
  • Universal health coverage

ASJC Scopus subject areas

  • Geography, Planning and Development
  • Renewable Energy, Sustainability and the Environment
  • Environmental Science (miscellaneous)
  • Energy Engineering and Power Technology
  • Management, Monitoring, Policy and Law


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