Purpose of Review
As medical knowledge and innovation reaches new heights, there is a growing gap in medical advancements between low- and middle-income countries (LMICs) and high-income countries (HICs). The former has lack of basic health care and preventive or diagnostic services for early cancer while the latter has access to novel diagnostic and therapeutic modalities.
Key to overcoming this disparity is finding ways to bridge this divide across distances and continental divides through innovative technology and sharing of knowledge by committed individuals and through public private partnerships. Many initiatives that include onsite and online training programs for regional healthcare providers have shown that the gap in medical training between HICs and LMICs can be narrowed.
The following article shines a light on this disparity and provides exemplary case studies of ways in which this gap between LMICs and HICs can be bridged.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
WHO. Global strategy on human resources for health: workforce 2030: World Health Organization; Available from: https://www.who.int/hrh/resources/pub_globstrathrh-2030/en/.
•• Chen C, Buch E, Wassermann T, Frehywot S, Mullan F, Omaswa F, et al. A survey of sub-Saharan African medical schools. Hum Resour Health. 2012;10(4). https://doi.org/10.1186/1478-4491-10-4. The results of the Sub-Saharan African Medical Schools Study (SAMSS) survey increases the level of data and understanding of medical schools in Sub-Saharan Africa.
Mills EJ, Kanters S, Hagopian A, Bansback N, Nachega J, Alberton M, et al. The financial cost of doctors emigrating from sub-Saharan Africa: human capital analysis. BMJ. 2011;343:d7031. https://doi.org/10.1136/bmj.d7031.
Tsofa B, Goodman C, Gilson L, Molyneux S. Devolution and its effects on health workforce and commodities management - early implementation experiences in Kilifi County, Kenya. Int J Equity Health. 2017;16(1):169. https://doi.org/10.1186/s12939-017-0663-2.
Pust R, Dahlman B, Khwa-Otsyula B, Armstrong J, Downing R. Partnerships creating postgraduate family medicine in Kenya. Fam Med. 2006;38(9):661–6.
Luk R, Zaharia M, Ho M, Levine B, Aoki PM, editors. ICTD for healthcare in Ghana: two parallel case studies. 2009 international conference on information and communication technologies and development (ICTD); 2009 17-19 April 2009. https://doi.org/10.1109/ICTD.2009.5426714.
MRCPUK. About MRCP (UK) and Federation of Royal College of Physicians of the UK. 2015 Available from: https://www.mrcpuk.org/sites/default/files/documents/MRCPUK-international-brochure-web-final.pdf. Accessed 1 June 2019.
College of Surgeons of East CaSA. Training 2015 Available from: http://www.cosecsa.org/training. Accessed 1 June 2019.
Labrique AB, Vasudevan L, Kochi E, Fabricant R, Mehl G. mHealth innovations as health system strengthening tools: 12 common applications and a visual framework. (2169-575X (Print)). https://doi.org/10.9745/GHSP-D-13-00031.
de Francisco Shapovalova N, Meguid T, Campbell J. Health-care workers as agents of sustainable development. (2214-109X (Electronic)). https://doi.org/10.1016/S2214-109X(15)70104-X.
AKDN. Service Delivery: Aga Khan Development Network; 2018 Available from: https://www.akdn.org/what-we-do/health/akdn-digital-health-resource-centre/service-delivery. Accessed 1 June 2019.
Horton S, Sullivan R, Flanigan J, Fleming KA, Kuti MA, Looi LM, et al. Delivering modern, high-quality, affordable pathology and laboratory medicine to low-income and middle-income countries: a call to action. (1474-547X (Electronic)). https://doi.org/10.1200/JGO.2015.000943.
Sayed S, Lukande R, Fleming KA. Providing pathology support in low-income countries. J Clin Oncol:2378–9506 (Print).
Wilson ML, Fleming KA, Kuti MA, Looi LM, Lago N, Ru K. Access to pathology and laboratory medicine services: a crucial gap. (1474-547X (Electronic)). https://doi.org/10.1016/S0140-6736(18)30458-6.
Mpunga T, Tapela N, Hedt-Gauthier BL, Milner D, Nshimiyimana I, Muvugabigwi G, et al. Diagnosis of cancer in rural Rwanda: early outcomes of a phased approach to implement anatomic pathology services in resource-limited settings. 2014. 541–5 https://doi.org/10.1309/AJCPYPDES6Z8ELEY.
Sayed S, Field A, Rajab J, Mutuiri A, Githanga J, Mungania M, et al. Task sharing and shifting to provide pathology diagnostic services: the Kenya fine-needle aspiration biopsy cytology and bone marrow aspiration and trephine biopsy training program. (2378–9506 (Electronic)). https://doi.org/10.1200/JGO.18.00094.
Ondoa PA-O, van der Broek A, Jansen C, de Bruijn H, Schultsz C. National laboratory policies and plans in sub-Saharan African countries: gaps and opportunities. (2225–2002 (Print)). https://doi.org/10.4102/ajlm.v6i1.578.
Looi LM. The Pathology Laboratory Act 2007 explained. (0126-8635 (Print)).
•• Sayed S, Cherniak W, Lawler M, Tan SY, El Sadr W, Wolf N, et al. Improving pathology and laboratory medicine in low-income and middle-income countries: roadmap to solutions. (1474-547X (Electronic)). https://doi.org/10.1016/S0140-6736(18)30459-8. PALM (pathology and laboratory medicine) package focused on LMIC countries, integrated within a nationally tiered laboratory system, as part of an overarching national laboratory strategic plan was proposed and tested in Uganda and Kenya for retention of workforce in healthcare.
Sayed SA-OX, Lester SA-O, Wilson M, Berney DA-O, Masia R, Moloo Z, et al. Creation and pilot testing of cases for case-based learning: a pedagogical approach for pathology cancer diagnosis. (2225–2002 (Print)). https://doi.org/10.4102/ajlm.v6i1.637.
Wilson ML, Ayers S, Berney D, Eslan A, Guarner J, Lester S, et al. Improving anatomic pathology in sub-saharan africa to support cancer care. (1943–7722 (Electronic)). https://doi.org/10.1093/ajcp/aqx158.
Gimbel DC, Sohani AR Fau-Prasad Busarla SV, Fau-Kirimi JM, Fau-Sayed S, Fau-Okiro P, Fau-Nazarian RM, et al. A static-image telepathology system for dermatopathology consultation in East Africa: the Massachusetts General Hospital Experience. (1097–6787 (Electronic)). https://doi.org/10.1016/j.jaad.2011.12.036.
Kerr DA, Busarla SVP, Gimbel DC, Sohani AR, Nazarian RM. mTOR, VEGF, PDGFR, and c-kit signaling pathway activation in Kaposi sarcoma. (1532–8392 (Electronic)). https://doi.org/10.1016/j.humpath.2017.05.002.
• Kumar N, Busarla SV, Sayed S, Kirimi JM, Okiro P, Okiro P, Gakinya SM, Moloo Z, et al. Telecytology in East Africa: a feasibility study of forty cases using a static imaging system. (1758–1109 (Electronic)). https://doi.org/10.1258/jtt.2011.110308. Pilot study to assess the feasibility of telecytology as a diagnostic tool in difficult cases originating from a hospital in East Africa.
Prasad Busarla SV, Sayed S, Nazarian RM, Gimbel DC, Moloo Z, Sohani AR. Kaposi sarcoma in association with molluscum contagiosum: an uncommon diagnosis in a single biopsy and potential diagnostic pitfall. (1533–0311 (Electronic)). https://doi.org/10.1097/DAD.0b013e31822438c6.
Wawire J, Sayed S, Moloo Z, Sohani AR. Diffuse large b-cell lymphoma in Kenya: MYC, BCL2, and the cell of origin. (2378–9506 (Electronic)). https://doi.org/10.1200/JGO.18.00203.
• Sohani AR, Sohani MA. Static digital telepathology: a model for diagnostic and educational support to pathologists in the developing world. (2210–7185 (Electronic)). https://doi.org/10.3233/ACP-2011-0032. Digital telepathology is a simple, cost-effective, reliable and efficient means to provide diagnostic and educational support to pathologists in the developing world.
Efstathiou JA, Bvochora-Nsingo M, Gierga DP, Alphonse Kayembe MK, Mmalane M, Russell AH, et al. Addressing the growing cancer burden in the wake of the AIDS epidemic in Botswana: The BOTSOGO collaborative partnership. (1879-355X (Electronic)). https://doi.org/10.1016/j.ijrobp.2014.03.033.
Montgomery ND, Tomoka T, Krysiak R, Powers E, Mulenga M, Kampani C, et al. Practical successes in telepathology experiences in Africa. (1557–9832 (Electronic)). https://doi.org/10.1016/j.cll.2017.10.011.
Im H, Pathania D, McFarland PJ, Sohani AR, Degani I, Allen M, et al. Design and clinical validation of a point-of-care device for the diagnosis of lymphoma via contrast-enhanced microholography and machine learning. (2157-846X (Print)). https://doi.org/10.1038/s41551-018-0265-3.
Orringer DA, Pandian B, Niknafs YS, Hollon TC, Boyle J, Lewis S, et al. Rapid intraoperative histology of unprocessed surgical specimens via fibre-laser-based stimulated Raman scattering microscopy. LID - 0027 [pii] LID - https://doi.org/10.1038/s41551-016-0027. (2157-846X (Print)).
Society ARR. Education: ARRS Your Medical Imaging Society; Available from: http://www.arrs.org/ARRSLIVE/Education. Accessed 1 June 2019.
Sande JA, Verjee S, Vinayak S, Amersi F, Ghesani M. Ultrasound shear wave elastography and liver fibrosis: A Prospective Multicenter Study. (1948–5182 (Print)). https://doi.org/10.4254/wjh.v9.i1.38.
Society AC. American Cancer Society and Clinton health access initiative announce collaborations with Pfizer and Cipla to increase access to lifesaving Cancer treatment in Africa: American Cancer Society; 2017 Available from: http://pressroom.cancer.org/2017-06-20-American-Cancer-Society-and-Clinton-Health-Access-Initiative-Announce-Collaborations-with-Pfizer-and-Cipla-to-Increase-Access-to-Lifesaving-Cancer-Treatment-in-Africa. Accessed 1 June 2019.
Dent J. Patients of African descent are being denied the benefits of cancer breakthroughs. We’re changing that: STAT; 2018 Available from: https://www.statnews.com/2018/11/21/cancer-clinical-trials-patients-african-descent/. Accessed 1 June 2019.
Gopal SA-Ohoo. Cancer trials in sub-Saharan Africa: Aligning research and care. (1549–1676 (Electronic)). https://doi.org/10.1371/journal.pmed.1002351.
Saleh M, Naik G. So you want to be a principal investigator. J Oncol Pract. 2018;14(6):e384–e92. https://doi.org/10.1200/JOP.18.00011.
Agulanna C. Informed consent in sub-Saharan African communal culture: the “multi-step” approach. 2008.
Onvomaha Tindana P, Kass N, Akweongo P. The informed consent process in a rural African setting: a case study of the Kassena-Nankana district of Northern Ghana. IRB. 2006;28(3):1–6.
Vischer N, Pfeiffer C, Burri C. Improving efficiency and quality in clinical trials in sub-Saharan Africa. 2015. 135. https://doi.org/10.1136/bmjgh-2016-000260.150
Ellis S. Operational challenges: clinical trial partnerships in Africa newsletter: DND1; 2008 Available from: https://www.dndi.org/newsletters/n16/4_1.php. Accessed 1 June 2019.
Science CfCaT. Clinical investigator training program: University of Alabama at Birmingham; 2019 Available from: https://www.uab.edu/ccts/clinical-translation/trainings/citp. Accessed 1 June 2019.
Papanicolas I, Woskie LR, Jha AK. Health care spending in the United States and other high-income countries. JAMA. 2018;319(10):1024–39. https://doi.org/10.1001/jama.2018.1150.
Conflict of Interest
The authors declare that they have no conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This article is part of the Topical Collection on Global Breast Cancer
About this article
Cite this article
Saleh, M., Naik, G., Mwirigi, A. et al. Bridging the Gap in Training and Clinical Practice in Sub-Saharan Africa. Curr Breast Cancer Rep 11, 158–169 (2019). https://doi.org/10.1007/s12609-019-00322-6
- Medical training
- Low and middle income countries
- Sub-Saharan Africa