Access to childhood cancer essential drugs in Rwanda

Abstract

Background: Childhood cancers are curable. Access to essential childhood cancer drugs has proven a direct effect on reducing mortality of paediatric cancer in developed countries with an 80% cure rate contrary to 90% of paediatric cancer deaths in LMICs where ineffective care is distributed. To decrease childhood cancer mortality in LMIC, availability of good quality and affordable essential childhood cancer drugs is required. Objectives: This study aimed to identify determinants of paediatric cancer drug access in Rwanda. Methods: Qualitative method using policy and thematic analysis was used. Data collection was done using health policies analysis and semi-structured interviews with fifteen stakeholders involved in paediatric cancer care and cancer drugs procurement in Rwanda. Results: Eight policies and guidelines related to drug procurement and cancer treatment were analysed. Fifteen stakeholders including policymakers with policy preparation, procurement and regulatory roles (n=8), non-governmental organisation (n=1) with cancer treatment center funds, and service providers, with clinical and pharmacy-related roles (n=6), were interviewed. Four major themes emerged from participant interviews that highlighted a number of barriers, solutions, and facilitators as determinants of childhood cancer drug access have been formed that included: (i) Limited prioritization for pediatric cancer; (ii) weak procurement and supply chains; (iii) high childhood cancer drug costs, and (iv) lack of systems to optimize pharmacovigilance. After policies analysis, there are gaps in policies specific to childhood cancer. Policy related to childhood cancer need to be developed as a rapidly growing domain that needs good attention. In Rwanda there is poor access to essential childhood cancer drugs, the barriers expressed by the study mostly is related to a limited budget, disseminated procurement, expensive drugs, and lack of generic anti-cancer drugs. Most of these barriers push procurement for doubtable quality drugs. Solutions given by the study participants to improve access to affordable good quality childhood anti-cancer drugs are pool procurement in the country or combined with other countries based on accurate data and good budget specific to cancer as a rapidly growing domain. Good budget and bulk procurement stimulate cancer drugs suppliers with well-known quality to enter in a tender, good solution to cancer care. Conclusion: This study reveals the need for systemic consideration of childhood cancer at the national level related to greater policy attention and coordination and a more systematized approach to procurement and supply chain management for essential childhood cancer drugs in Rwanda.