Ethiopia has only one radiotherapy machine, but the country’s new government commenced office 16 months ago and has determined plans to change that with the support of the IAEA and other development partners.

The government is acquiring new equipment, constructing a new, 8-floor oncology center in the capital Addis Ababa, and is assigning doctors trained through IAEA fellowships to regional hospitals, where some of the radiotherapy machines will go.

“Excessively time had been spent with little progress and we are working to change that,” said Wendmagegn Gezahegn, Head of the St Paul’s Hospital in Addis Ababa, which looks as much as a construction site in a boomtown as a functioning hospital. Founded by Emperor Haile Selassie in the 1960s to cater to the poor, it is the country’s second-largest hospital and once the current expansion project is completed in the coming years, it will be the largest, with close to 5000 beds, fit to treat half a million patients per year.

The new wing will include an oncology center with 350 beds and 5 linear accelerators (Linac) machines and brachytherapy units for cancer treatment, as well as a new cyclotron facility to produce radiopharmaceuticals for diagnosis and treatment of diseases. The construction of the bunkers that will house the radiotherapy machines for the safe operation will begin in the coming months, while the room to hold the cyclotron is already being built.

Wendmagegn Gezahegn, Head of the St Paul’s Hospital in Addis Abeba, and his colleagues reviewing the plans for a new cyclotron facility to be installed in a hospital wing currently under construction.

“The key to planning is to make sure that every machine has a maintenance plan, we need to budget more than just the purchase cost,” Gezahegn said. And indeed, one of the country’s two Cobalt-60 radiotherapy machines has been out of service since 2015 in Addis Abeba’s Black Lion Hospital due to lack of funding to repair it.

In parallel with the construction and procurement of the machines, the country also needs well-trained oncologists, medical physicists and radiology technicians and has turned to the IAEA for support.

Radiotherapy machines in two of these centers, Jimma and Harar, have been purchased and are being set up, while another three centers are under preparation.

The Government of Ethiopia plans to decrease waiting times for radiotherapy treatment by acquiring more equipment and train its staff with IAEA support.

Oncologists and public health officials are well aware that Ethiopia has a lot of catching up to do: the IAEA recommends four radiotherapy machines per one million people, a ratio that will take many expansion projects and several decades to reach. As of now, authorities hope the country will soon have nine functioning machines.

Gezahegn said that “Ethiopia is evolving rapidly and it is important that the economic growth means an improved standard of living nationwide.” “Providing access to cancer services, including radiotherapy, is a key component of that.”

A challenge that remains is the training of radiotherapy technicians. A curriculum for local training has been under approval for years, so in the meantime, technicians need to be sent abroad to be trained to operate radiotherapy machines, said Wolemariam.

“Development of local training schemes is key to the implementation of the services,” explained Kirsten Hopkins, Radiation Oncologist at the IAEA. “It is not feasible to provide expatriate training for the numbers of staff required for all the planned facilities.”

The IAEA has provided Ethiopia with training and expert advice on the new course curriculum and will continue to provide support through its technical co-operation program, she added.

The country’s radiation protection authorities are gearing up for the licensing of the new equipment, said Solomon Mekonnen, Director General of the Ethiopian Radiation Protection Authority. “We have been involved since the early stages of the radiotherapy expansion process and will do our best to authorize the equipment quickly, assuming all safety conditions are met,” he said.

Almost all of the Authority’s 40 technical staff, including those in the licensing department, have received training via IAEA fellowships and courses, Mekonnen said.

Having all stakeholders, ministries, authorities, health experts work together is key to making a difference, said Sandokan Debebe, Director General of the Technology and Innovation Institute of Ethiopia, which coordinates the IAEA’s projects in the country. “We have a holistic view to make sure that all angles are covered, and no future machine will sit idle due to lack of funds for repair or expertise to operate or license them,” he said.

The price of TB antibiotic medicine – rifapentine, was cut down by 66% by its manufacturer Sanofi. When combined with another antibiotic (isoniazid), rifapentine can prevent tuberculosis (TB) disease. This good news was broadcast at the Union World Conference on Lung Health.

Talks to lower the price from US$45 to US$15 for a three-month course took more than a year to complete and involved Sanofi, Unitaid and the Global Fund to Fight Aids, Tuberculosis, and Malaria, in collaboration with the Stop TB Partnership’s Global Drug Facility and the United States PEPFAR initiative.

Advocates have been insisting on price lower the price of rifapentine medicine since the scientific effect of this medicine was proven in peer-reviewed journals. Three months of treatment with rifapentine plus isoniazid was shown to be just as effective as and less toxic than one year of therapy with isoniazid alone (the previous standard). The reduction in treatment time alone provides an obvious improvement.

The World Health Organisation (WHO) reviewed its guidelines for preventing TB disease. The guidelines now include three months of rifapentine and isoniazid taken weekly for people living in countries with a high TB burden. This routine is known as 3HP.

The WHO recommends that anyone living with HIV and those living in the same household as a person with TB disease should receive TB preventive therapy. The theme of 2019’s World AIDS Day was “Ending the HIV/AIDS epidemic: Communities make the difference”. Reaching this goal requires that preventive treatment programs engage with communities to develop, refine and bring to scale interventions designed to meet the needs of people with and vulnerable to HIV and TB.

Importantly, the 3HP regimen can be administered along with dolutegravir, a better antiretroviral drug that is now being provided in South Africa and globally. A combination is an effective tool for keeping vulnerable people as healthy as possible.

All prevention programmes must begin by finding people who need TB preventive therapy. People living with HIV can be identified through HIV clinics. Contacts of people with TB disease can be identified by investigating affected households. People must always be screened for TB before starting TB preventive therapy.

In 2018, the member states of the United Nations committed to expanding the number of people receiving preventive treatment to at least 30 million by 2022. But the world is nowhere close to meeting that goal. It will take a lot of work to achieve these targets.

As the price of Sanofi’s rifapentine product Priftin cut down, now it can be more accessible to the public. If Priftin has not been approved for use in a country that needs this treatment, national TB programmes can work with the WHO and local regulatory authorities to process waivers.

Treatment for latent TB infection has been available since the 1950s, yet very few people who could benefit from TB preventive therapy are taking it. This price break making a shorter and equally effective treatment more affordable and perfect opportunity to make a dent in these numbers.

First Lady Margret Kenyatta led the nation in marking the 31st World Aids Day in a colorful function at Gusii Stadium in Kisii County.

Speaking during the event the First Lady said the community and families need to sacrifice in the fight against the global menace noting that everybody needs to contribute towards the country’s challenge of achieving an HIV/AIDS-free nation by 2030.

She said efforts to eliminate HIV are central to the government’s health promise for Universal Health Coverage (UHC) and strengthening health systems and increasing access is essential to the government’s program.

Cabinet Secretary for Health, Cecily Kariuki said that they recognize how the HIV/AIDS epidemic in Kenyan counties has been managed with great milestones recorded by the government.

Kisii Governor James Ongwae said the county has given 50% towards the health sector in the county adding that the county is working hard to ensure there is quality health service delivery to Kisii residents.

He noted with the Sh2.5 billion funds they are soon launching the construction of a cancer center facility to help residents cut on travel expenses to Kenyatta National Hospital or the Moi Teaching and Referral Hospital.

Dr. Nduku Kilonzo, the Chief Executive Officer, National Aids Control Council (NACC) said that Kenya had taken bold steps towards tackling HIV/AIDS.

Newly installed cancer treatment equipment at the Ocean Road Cancer Institute (ORCI) has for the past one year facilitated the treatment of over 200 patients whose conditions were supposed to get the service abroad.

If referred to hospitals abroad, particularly India, it could have cost the government between 50m/- and 70m/- for each patient, which implies that a considerable amount of money ranging from 10bn/- to 14bn/ was rescued.

The Executive Director of the ORCI, Dr. Julius Mwaiselage, said the facility installed the new radiation therapy machines called medical linear accelerators (LINAC), worth 9.5bn/-, which started functioning from September last year.

He was briefing the media on the achievements that the ORCI made during the four years of President John Magufuli’s regime.

With 80 percent of cancer patients in the country needing radiotherapy, the government took a bold move to strengthen the availability of the services domestically.

The capacity of the hospital has increased from serving 180 patients to 300 patients per day, he revealed, noting that the government has been increasing the allocation of the budget for purchasing medicines.

The budget for anticancer drugs shot up from 790m/- in 2015 to 10bn/- this financial year, which increased the availability of drugs by 95 percent from only 4 percent.

“This is a never-ending achievement and the institute has been an exemplar in the East and Central zone of the region,” he said.

ORCI’s financial measures have helped a steady rise in revenues collections from 569m/- in the 2014/15 fiscal year to 14.7bn/- during the 2018/19 financial year.

Such measures include new sources of revenues such as pharmacy and enhanced service delivery.

On the institute’s future plans, Dr. Mwaiselage said processes are underway to purchase a new Positron Emission Tomography – Computed Tomography (PET-CT), disclosing that the government had already disbursed 14.5bn/- for that purpose.

The PET-CT scan is a diagnostic examination that involves getting images of the body based on the detection of radiation from the emission of positrons.

It gives detailed information, including the exact representation of certain types of cancer and their metastasis. Hence, it is possible to display not only the cancer itself but also its activity.

The method fits very well by checking the effects and success of the therapy used. Through consultation, PET-CT can determine the exact position, size, activity, and development of cancer in the entire body.

The tender process to purchase the PET-CT has started and expected to complete in April next year.

Health Ministers and senior immigration officials of the Democratic Republic of Congo (DRC) and the nine neighboring countries to DRC have resolved and committed their governments to establish the African Ebola Coordination Task Force (AfECT) to undertake cooperation and collaboration for Ebola preparedness and response.

During a ministerial meeting on cross boarder collaboration to prepare for and respond to the Ebola Virus disease in DRC, different health officials resolved that there is a need for the force to support cross boarder joint planning and implementation of Ebola preparedness and response activities.

Dr. Ruth Jane Aceng the Health Minister said this task force will bring on board coordinated support to countries suffering outbreaks. She also said: “We embrace this aspect of avenue in African Ebola coordination task force so that all partners that are supporting the country that has an outbreak are well-coordinated and it will help us avoid waste of resources.”

Establish the AfECT hosted at the African Union Secretariat in Addis Ababa, Ethiopia, under the leadership of the nine-member states with support from Africa Centers for Disease Control and Prevention (Africa CDC), WHO and other relevant partners to support the cooperation and collaboration.

Another resolution is to establish the AfECT. Now this task force will have political oversight over outbreaks like Ebola while WHO maintains technical capacity and advice that it gives to the countries.

Health officials who gathered in Goma DRC Congo to discuss the threat of Ebola have resolved to step up measures to minimize the spread of deadly disease. Ugandan officials subsequently discharged and repatriated the other recovering patients back to Congo.

Some of the other issues the health ministers resolved and committed their governments to do include cross boarder Ebola case and laboratory surveillance, cross border tracing and monitoring contacts among others. Some of the nine countries neighboring DRC include Angola, Burundi, Uganda, Zambia, among others.

Finance and Planning Minister Dr Philip Mpango (pictured) led government delegation to the conference met prospective investors, included OPEC Fund for International Development (OFID) and Korean Kolon Corporation for detailed deliberations in the first day of the forum.

Finance and Planning Minister Dr Philip Mpango (pictured) led government delegation to the conference met prospective investors, included OPEC Fund for International Development (OFID) and Korean Kolon Corporation for detailed deliberations in the first day of the forum.

According to the project description, the government wants to establish the general pharmaceutical plant under a Public Private Partnership under Build Own Operate and Transfer (BOOT) arrangement.

The plant will be constructed in Kibaha, Coast region under the Medical Stores Department to produce drugs and other medical equipment for domestic as well as East African Community and SADC markets.

Dr Mpango said, “the project was good and it aligned with sustainable development goals on health. They said they could see the good prospects of the project.”

The government had lined eleven projects to be presented to prospective investors in the three-day Africa Investment Forum organised by the African Development Bank and partners Sandton Convention Centre to advance projects, raise capital and close financial deals.

Dr Mpango said the pharmaceutical plant would also create more jobs and trade opportunities and solve the problem of counterfeit medicines as it would be easier to monitor the quality standard.

The government expects to have signed contracts with investors willing to set up manufacturing sites in Mwanza, Mbeya and Kibaha under public-private partnership (PPP) by next June.

The government has embarked on a Sh1.2 trillion ($517 million) pharmaceutical project that will see three manufacturing plants being established through partnership with private investors.

The feasibility study for the project has been approved, and the next step is to identify partners as part of efforts to reduce the country’s reliance on pharmaceutical imports.

Dr John Mboya, the PPP commissioner in the Ministry of Finance and Planning, told the International Pharmaceuticals Investors Conference in Dar es Salaam that potential investors were assured of a ready market.

He further stated that, “these are feasible projects which may take four to six years to break even. The government has given assurance to the investors. We have the domestic, EAC and SADC markets.”

Dr Mboya added that the feasibility study had considered vital lessons from pharmaceutical industries in Kenya, Uganda and other countries.

A $63 million plant that will produce intravenous fluids is expected to be built in Mbeya, while Mwanza will be the location of a medical cotton wool manufacturing plant whose cost is estimated at $46 million. The general pharmaceutical factory at Kibaha is likely to cost $408 million, according to Dr Mboya.

According to the World Health Organisation, United Nations Comtrade and Business Monitor International, Tanzania’s pharmaceutical market is expected to grow to $700 million by 2021 from $450 million in 2017.

Trade and Industry minister Innocent Bashungwa, said, “Just recently, the government abolished 54 charges in an attempt to reduce the burden on investors. We also have tax incentives provided through the Tanzania Investment Centre, and the government is currently reviewing laws that are seen to impede business. Tanzania is the right place for you to invest.”

The Ethiopian government disclosed that its Chinese-built Kilinto Industrial Park (KIP) has improved the country’s ambition to attract experienced international pharmaceutical companies across the globe.

This industrial park, once fully finalized, will power the East African country’s potential to attract more foreign companies in the pharmaceutical sector as declared by The Ethiopian Investment Commission (EIC).

They also announced the signing of investment agreements with 10 international companies that have “shown great interest” to set up their industrial plants inside the premises of KIP.

With 270-hectares of land on the outskirts of Ethiopia’s capital Addis Ababa, the Kilinto Industrial Park is under construction by Chinese construction giant, Tiesiju Civil Engineering Group Co., Ltd. (CTCEGCL), at a cost of 204 million U.S. dollars.

“The Kilinto Industrial Park is now on the verge of completion, and once completed it will host more than 1,000 pharmaceutical companies.” as stressed by EIC Deputy Commissioner Temesgen Telahun.

This project is completely financed by the World Bank, features 18-km of asphalt road, provision of basic social services, green spaces, warehouses, business centers and car parking space.

Communications Director at the Ethiopian Industry Parks Development Corporation, Adenan Bere, told Xinhua recently that the East African country expects the KIP, which is under construction exclusively for pharmaceutical firms, to attract world-class companies with a view to help Ethiopia’s economy through the export of pharmaceutical products as well as import-substitution.

Bere also noted that incorporation to attracting foreign firms to penetrate Ethiopia’s emerging pharmaceutical sector, the IPDC is also working with local financial institutions to support local firms to invest in the industrial park.

It is remarkable how Ethiopian government in recent years has been attracting foreign firms in the pharmaceutical sector and especially Chinese firms which are becoming among the major foreign firms in exerting their capital and technology in the sector.

Last year, Chinese pharmaceutical giant, Sansheng Pharmaceuticals Plc, also inaugurated its production plant in Ethiopia amid Ethiopia’s higher demand for import substitution in medicines. They began its first phase of production in June 2018 inside the premises of the Eastern Industry Zone on the outskirt of Ethiopia’s capital.

Ethiopia is at present constructing or has commissioned 15 industrial parks as part of a plan to turn the country into a light manufacturing hub in Africa by 2020.

The Turkish Cooperation and Coordination Agency (TIKA) has on many occasions helped Lamu by sending doctors and specialists to undertake various medical camps.

The government of Turkey has pledged to provide financial support towards boosting the health sector in Lamu county.
The pledge was made by Turkish ambassador to Kenya Ahmet Miroglu during his tour of Lamu.

The TIKA programme which was founded in 1992 is responsible for the organisation of the bulk of Turkey’s official development assistance to developing countries.

Miroglu said Turkey would provide both financial help and manpower to help boost the functionality of the health institutions.

Apart from health, TIKA has also been implementing other projects in various counties, particularly in Agriculture, Education and many others.

Miroglu expressed his satisfaction with the management of King Fahad Referral Hospital as well as other health institutions. He lauded Lamu county government for the efforts to improve the sector.

He also said Turkey hopes to continue partnering with the Lamu county government and Kenya as a whole in providing the much needed medical assistance to the local communities.

Deputy Governor Abdulhakim Aboud lauded the Turkish government and the TIKA programme for their dedicated efforts in supporting health care institutions within the country.

Aboud further continued, “We’re happy for the existing cooperation between Lamu and Turkey. TIKA has been of great benefit not only to Lamu but the rest of the counties. We will continue to strengthen the relationship for the benefit of our people.”

In a bid to improve healthcare access, Lamu has enrolled more than 20,000 poor and vulnerable families into the free National Health Insurance Fund cover.

Opening a three – day training on Project ECHO in Dar es Salaam, the Ministry’s Assistant Director for Diagnostic Services, Dr Alex Magesa said that the government was working towards opening more hubs in all zonal hospitals and teaching institutions how to reach more participants.

The government through the Ministry of Health, Community Development, Gender, Elderly and Children is set to open more hubs to facilitate the implementation of a medical education and care management model with the aim of improving health service delivery in the country.

It is a hub-and-spoke educational model that allows subject matter experts in any field of concern to share their knowledge with frontline providers in underserved communities.

Dubbed Extension for Community Healthcare Outcomes (ECHO), the platform is set for practice-based education and training, service delivery, and outcomes research.

Dr Magesa said that currently there are three hubs, which are Kibong’oto, Bugando and National Health Laboratory Quality Assurance and Training Centre “With this rapid expansion, we need to maintain quality of information and programmes offered, that is why we have identified the need of having this training in the country.”

He said that the project was in line with the government intention to promote the use of technology to communicate rather than travelling long distances seeking for information.

Dr Magesa said although it had started as a training model for non -laboratory HIV Rapid testers, currently there were more than five ECHO models in the country focusing on HIV care and treatment, Tuberculosis (TB), safe surgery, HIV rapid testing training and Emergency Operation Centre (ECHO).

He further said, “this initiative is a lifelong learning and guided practice model that revolutionalises medical education and exponentially increase workforce capacity to provide best- practice specialty care and reduce health inequalities.”

Dr Magesa also explained that one class of 25 to 30 participants who travel from four to five districts to the region for a three day training costs about 14m/-, but through project ECHO the training could cost US dollars 3500 only.

He said Tanzania decided to embark on the programme because it was cost effective, reaches many professionals at a short time, a learn by doing modes, a mentoring model and to support President John Magufuli’s vision of utilising resources effectively.

He also noted that the difference between the two was that equipment of Project ECHO can be used repeatedly, hence widening the support.