Tackling breast cancer where almost no care is available. A Europe-Africa partnership

BACKGROUND: African and European societies share similar challenges, such as the growing cancer burden, and are committed to equity and women's health, as highlighted at the 2022 EU - African Union summit. Breast cancer - the most common cancer worldwide and the leading cause of cancer death among women - disproportionately affects individuals in low-resource settings such as Malawi, where only 9.5% of patients survive beyond 18 months. Early detection and treatment could bring hope and extend the healthy lives of these women. The Akazi project, a collaboration between partners from Ireland and Malawi, is implementing a health systems platform to achieve this goal. METHODS: Based on the six WHO health systems building blocks framework, a mixed methods health systems capacity assessment was done in Malawi in 2022 to inform the development of a national breast cancer strategy. RESULTS: Major gaps were identified in all building blocks, critically in human resources, as no training in breast health was available in the country, and the number of trained health workers was critically low. Only five breast surgeons, five oncologists and one pathologist practice nationwide. In response, a breast health course was developed, tested and implemented with endorsement from MoH. Two cohorts of frontline workers have been trained (n = 37). Local health authorities have designed and implemented community breast care awareness activities. CONCLUSIONS: This simple intervention provides the basis for critical improvements in national breast cancer services in Malawi. Akazi-funded breast health training needs to be rolled out country-wide by the Ministry of Health and significant infrastructure and human resources investments. Technical and financial support from the global North is essential to ensure progress towards Universal Health Care in Africa. KEY MESSAGES: • Bridging inequities in breast cancer outcomes requires systematic health systems strengthening. • EU-Africa research collaborations can fill critical knowledge gaps through systems analyses to guide national cancer control strategies.