ORIGINAL ARTICLE / ARTICLE ORIGINAL

Collaborative Activities of United Nations Agencies and Partnersin Support of Cancer Control in Africa

Activités communes des agences du système des Nations unies et autres partenaires pour la luttecontre le cancer en Afrique

R. Camacho · J.M. Dangou · D. Neves · S. Morgan · M. Piñeros · J.P. Cayol

Received: 3 December 2013; Accepted: 5 December 2013© Springer-Verlag France 2013

Abstract Introduction: In most low and middle incomecountries (LMICs), including the majority of African coun-tries, cancer burden is increasing rapidly and poses enormouschallenges to the health systems. This foresees the need forurgent action and the establishment of strategic partnerships,as well as mobilizing resources and coordinating effortsamong counterparts for the development and strengtheningof cancer control interventions.Methods: Here below we describe the collaborative activitiesbetween the International Atomic Energy Agency (IAEA)and the World Health Organization African regional office(WHO AFRO) and other partners regarding the major pro-jects of the IAEA’s Programme of Action for Cancer Ther-apy (PACT) since its creation until the end of 2013.Results: National cancer control capacity has been assessedin 24 Member States within the WHO Africa region throughintegrated missions of PACT (imPACT Reviews); in addi-tion, two countries have been elevated to PACTModel Dem-onstration Site (PMDS) status and are receiving the relevantexpansion of needed radiotherapy; an e-learning project, the

Virtual University Cancer Control network (VUCCnet), hasbeen established and African health professionals have beensponsored in various educational activities and threeregional and one sub-regional coordination meetings havetaken place.Conclusions: The collaboration between IAEA/PACT andWHO AFRO stands out as a model for United Nations agen-cies as an effective collaboration for programmatic deliveryto Member States.

Keywords Cancer control · Africa · National CancerControl Programmes

Résumé Introduction : Dans la plupart des pays à revenufaible ou moyen, y compris la majorité des pays africains,le fardeau du cancer s’accroît rapidement et pose d’énormesdéfis aux systèmes de santé. Cela nécessite des actionsurgentes. L’établissement de partenariats stratégiques, ainsique la mobilisation des ressources et la coordination desefforts entre les différents acteurs sont d’une importancecapitale pour le développement et le renforcement des inter-ventions de lutte contre le cancer.Méthodes : Nous décrivons les activités de collaborationconcernant les principaux projets du Programme d’actionpour la thérapie du cancer (PACT) de l’Agence internatio-nale à l’énergie atomique (AIEA) menées à partir de la créa-tion du PACT jusqu’à la fin de 2013 par l’AIEA, le bureaurégional de l’Afrique de l’Organisation mondiale de la santé(OMS/AFRO) ainsi que d’autres partenaires.Résultats : Les missions imPACT ont permis d’évaluer lescapacités nationales de lutte contre le cancer dans 24 Étatsmembres de la région africaine de l’OMS ; deux pays ayantconnu une expansion de leurs infrastructures de radiothéra-pie ont été établis comme sites de démonstration du pro-gramme PACT (PMDS). Un projet d’enseignement à dis-tance (VUCCnet) a été mis en place et des professionnelsde la santé (d’Afrique) ont été parrainés à diverses activités

R. Camacho (*) · D. Neves · S. Morgan · M. PiñerosInternational Atomic Energy Agency,Programme of Action for Cancer Therapy,Vienna International Centre, PO Box 100,A-1400 Vienna, Austriae-mail : camacho.rolando@yahoo.com

J.M. DangouWorld Health Organization, Regional Office for Africa,Division of Prevention and Control of NoncommunicableDiseases, BP 06 Cité Djoué, Brazzaville, Congo

J.P. CayolInternational Atomic Energy Agency,Department of Nuclear Sciences and Applications,Vienna International Centre, PO Box 100,A-1400 Vienna, Austria

J. Afr. Cancer (2014) 6:3-10DOI 10.1007/s12558-013-0302-9

de formation. Trois réunions de coordination régionales etune sous-régionale ont eu lieu.Conclusions : La coordination entre l’AIEA/PACTet l’OMS/AFRO a été essentielle pour la réalisation des différentes acti-vités et elle constitue, avec l’engagement de tous les autrespartenaires et des États membres, un exemple de collaborationréaliste et de travail en synergie de deux agences des Nationsunies afin d’aider les pays dans le domaine de la lutte contre lecancer.

Mots clés Lutte contre le cancer · Afrique · Programmenational de lutte contre le cancer

Introduction

In the majority of low and middle income countries (LMICs),cancer incidence is on the rise as the global population isliving longer; there exists a better control of communicablediseases and an increased exposure to cancer risk factors dueto lifestyle changes. The demographic and epidemiologicaltransition that these countries are undergoing implies theneed to face a double burden of communicable and non-communicable disease (NCD) [1].

Most African countries are currently facing this scenario.Though cancer is not yet among the leading diseases in theglobal burden of disease of most of the countries from theWorld Health Organization (WHO) African region, the rela-tive increase of cancer incidence expected for 2030 will be asmuch as 71% compared with the estimates for 2012) [2] andas such deserves priority actions.

Attention to the growing cancer situation in Africa has beenpreviously addressed by several authors) [3–5] and describedwith special attention in a series of recent papers published inthe Lancet Oncology) [6–8].

The common cancer control challenges shared by Africancountries include insufficient epidemiological information,lack of adequate policies, severe shortage of trained profes-sionals and infrastructure, underdevelopment of cancer diag-nosis and treatment services and late presentation of cancerpatients at diagnosis) [5]. A substantial burden of cancercould be prevented and early detection contributes to theprevention of cancer deaths if provision of adequate treat-ment services is addressed simultaneously. Regarding radio-therapy facilities, reports from the International AtomicEnergy Agency (IAEA) show that the number of radiother-apy machines in Africa more than doubled from 1991 to1998) [9]. Following a similar trend, there was a 75%increase in terms of number of machines available between1998 and 2010. Despite this, external beam radiotherapy wasavailable only in 23 African countries in 2010 and it wasestimated that there is a demand of around 700 additional

machines. Brachytherapy resources (high-dose rate or low-dose rate) were only available in 20 out of the 52 Africancountries, reflecting a critical situation for treatment of cer-vical cancer which is one of the highest prevalent cancers inthe region [10].

In this critical situation, establishing strategic partner-ships as well as mobilizing resources for the developmentof cancer control interventions is of the utmost importance.Within their specific mandates, several United Nations orga-nizations and specialized agencies have addressed the prob-lem of cancer control. To assist countries with their cancercontrol activities, the WHO has provided a framework forthe development of National Cancer Control Programmes/Plans (NCCP), with the aim of reducing cancer incidenceand mortality and improving the quality of life of cancerpatients in a defined population. The WHO recommendsthat planning of NCCP should start with a needs assessmentof all aspects of the cancer continuum in the country, inorder to implement evidence-based strategies in a specificcontext, understanding the related barriers and challenges[11]. Complementarily, IAEA has provided assistance overthe last 40 years to its low and middle-income MemberStates in enhancing radiotherapy capabilities, through pro-curement of equipment and training of professionals [12].Based on this experience, the IAEA has recognized that pro-viding radiotherapy equipment and training are insufficientto address a country’s cancer burden. For radiation medicineinvestments to be appropriate and sustainable, it is impera-tive that they are integrated within a comprehensive cancerapproach. To facilitate this, the IAEA launched the Pro-gramme of Action for Cancer Therapy (PACT) in 2004.PACT’s objective is to build strategic partnerships withpre-eminent cancer control organizations and institutionsin order to leverage the effectiveness of these radiation med-icine services in LMICs by integrating them into compre-hensive cancer control plans.

In 2009, with the view of aligning strategies, the IAEAand the WHO, including the International Agency forResearch on Cancer (IARC), joined forces and signed anarrangement for the implementation of the WHO–IAEAJoint Programme on Cancer Control in order to facilitatethe coordination of activities and resources of all organi-zations in providing evidence-based and sustainable sup-port for the establishment of comprehensive NCCP inLMICs.

This article highlights the collaborative activities devel-oped since PACT’s inception until the end of 2013 betweenthe IAEA and the WHO African regional office (AFRO),regarding the major IAEA/PACT projects. These projectsinclude:

• cancer control assessment missions (imPACT Reviews);

• model demonstration sites (PMDS);

4 J. Afr. Cancer (2014) 6:3-10

• human resources development through a pilot e-learningproject (VUCCnet) and sponsorship of (African) healthprofessionals in various educational activities;

• and regional coordination meetings.

Cancer control assessment missions

The imPACT Review is an IAEA service which assesses thestatus of cancer control plans and activities of a Member Stateand its readiness to develop and implement a long-term radi-ation medicine infrastructure and capacity building plan,including the relevant safety, regulatory and quality assurancerequirements [13], within the framework of a NCCP. Itsimplementation is coordinated by PACT Programme Officewith the WHO and other partners and technically supportedby IAEA’s Division of Human Health (NAHU) and Divisionof Radiation, Transport and Waste Safety (NSRW), WHOregional and country offices and IARC.

During an imPACT Review, a team of international expertsassesses the Member State’s radiation medicine capacity andhuman resource development; and examines the status ofexisting plans, strategies, policies, safety practices, regula-tions, capacities and infrastructure related to cancer services.The international expert team is usually composed of various

medical and public health specialists covering different areasof cancer control. While the IAEA provides radiation medi-cine expertise, WHO and IARC nominate experts to cover theareas of cancer control planning, cancer registration, preven-tion, early detection and palliative care.

Once the mission is completed, IAEA/PACT assemblesthe different reports from the various experts involved and,after consultation with the WHO regional office, delivers themission findings and the subsequent recommendations to theMinistry of Health of the Member State where the missionhad been conducted. The recommendations aim to supportthe local authorities in the development of sustainable, effi-cient and tailored national strategies and/or in the design ofsuitable project proposals, multidisciplinary assistancepackages and the identification of potential sources of fund-ing for prioritized actions.

Since the creation of PACT, the national cancer controlcapacity has been assessed in 24 Member States in WHOAfrica region through imPACT Reviews (Fig. 1). Overall,the 24 imPACT Reviews conducted in Africa had the repre-sentation of IAEA, WHO and IARC in 100%, 70.8% and45.8% of the missions, respectively. After the formaliza-tion of the arrangement for the implementation of theWHO–IAEA Joint Programme on Cancer Control in 2009,coordination between UN partners improved significantly.

Fig. 1 IAEA/PACT cancer control assessment missions (imPACT Reviews) in WHO Africa region, 2005–2013

J. Afr. Cancer (2014) 6:3-10 5

As a consequence, the communications and involvementwere reinforced and both WHO regional office and IARCwere requested to participate in imPACT Reviews in a sys-tematic way since 2011 (Fig. 2). The nominated externalexperts were preferably regional experts or specialists withoutstanding experience in working in cancer control in simi-lar resource settings; of the 55 external experts nominations,over 61.8% originated from the African region (34) and9.1% from LMICs from other regions of the world.

Major findings of the 24 imPACT Reviews show that the13 countries visited had a draft NCCP and only four had theirnational plans officially endorsed by the Ministry of Healthat the time of the assessment. In the case of cancer registra-tion and information, 13 countries had at least one functionalpopulation-based registry in place covering a small portion oftheir population. The availability of reliable national cancerepidemiological data is a crucial tool to the development,monitoring and evaluation of activities. Hence, the creationof new cancer registries and improvement of the quality ofthe existing ones has been acknowledged as a high priorityon the agenda of African health policy makers [14]. Theparticipation of IARC-nominated experts in the imPACTReviews is in turn useful and in line with the ongoing effortsof increasing capacity on cancer registration in the MemberStates through a recently launched Global Initiative for Can-cer Registry Development in Low and Middle Income Coun-tries (GICR) by IARC [15]. The development and strengthen-ing of cancer registries will contribute to the measurement ofcancer-related indicators and targets included in the WHONCD Global Monitoring Framework [16]. This constitutesan enormous challenge considering that presently the existingcancer registries in the region cover only one per cent of thepopulation [17].

Model demonstration sites

To place cancer on the global health agenda and help develop-ing countries attract new resources, the IAEA/PACT, in collab-oration with WHO, launched in 2006 an initiative of advocacyof comprehensive cancer control as a crucial element of opti-mizing Member States’ radiation medicine investments. Theinitiative was designed to promote a comprehensive cancercontrol approach when planning radiation medicine services,showcase the synergies to improve cancer control capacitythat international partners can achieve by working togetherand with national counterparts, and mobilize resources for theimplementation of projects targeting identified needs andpriorities.

Countries taking part of this initiative were identified asPMDS’s. Two of the eight PMDS’s across all WHO regionsare located in the WHO Africa region, namely the UnitedRepublic of Tanzania and Ghana.

Tanzania became a PMDS in 2006 as a consequence ofthe government’s expressed commitment to integrate radia-tion medicine services within a comprehensive national can-cer control strategy. Following an imPACT Review with theparticipation of IAEA, WHO, the American Cancer Society(ACS) and the International Network for Cancer Treatmentand Research (INCTR), a proposal on comprehensive cancercontrol capacity building was prepared.

It was recommended that a plan to expand radiotherapyservices should be determined through a process of formu-lating an NCCP. In line with this, a teletherapy machinewas donated by a Canadian manufacturer (MDS-Nordion),through IAEA/PACT, to Tanzania in 2006. Complementa-rily, the IAEA secured additional funding from Canada to

Fig. 2 Representation of partners in imPACT Reviews

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support the training of radiation medicine professionalsthrough fellowships and to initiate a post-graduate degreeprogramme in Clinical Oncology at the Muhimbili Univer-sity of Health and Allied Sciences. Furthermore, the IAEAalso provided support to Tanzania in the creation of a train-ing programme for radiation therapy therapists at the OceanRoad Cancer Institute in Dar es Salaam through a TechnicalCooperation (TC) project and with technical assistance fromNAHU. In July 2007, the Ministry of Health appointed asteering committee for the development, coordination andimplementation of the national cancer control strategy, inwhich IAEA and WHO have contributed with technical sup-port. A ten-year strategy with an action plan and budget isunder implementation since 2010.

Similarly, Ghana had a draft NCCP covering the period of2007–2011 and a steering committee which was responsiblefor overseeing existent national cancer control activities anddefining strategies to meet the goals of the country, based onrecommendations made in the imPACT Review missionreport of 2005. However, the NCCP lacked an action planwith allocated budget for its implementation.

As a result of increased government commitment and exter-nal awareness building on cancer control, a new NCCP inte-grating a national strategy and a ten-year action plan tailored toselected national priorities became operational in 2012with thesupport of IAEA/PACT and WHO regional and countryoffices. More information on the development of the Ghanaiancancer control plan has been recently reported [7]. Addition-ally, Ghana, using the comprehensive cancer control proposal,secured vital funding from development banks to expand radi-ation medicine services throughout the country (in Accra andKumasi), to improve cancer surveillance systems and to down-stage patients’ presentation at diagnosis through cancer educa-tion and early detection interventions.

The experiences observed in both PMDS’s show thatthere have been considerable achievements in terms ofNCCP planning and implementation, capacity building indifferent areas of cancer control and resource mobilization.This latter is of particular importance in the light of thecosts of specialized diagnosis and treatment, particularlythose related to radiation medicine, and considering nationalexpenditures allocated to health in Africa. The burden ofcancer in Africa calls for dedicated financial resources thatare far beyond those available from national health budgets.

The results in the PMDS countries illustrate the engage-ment of donors to support cancer control projects accordingto identified national priorities. To achieve this, it is essentialthat both organizations continue to maintain permanent con-tact with each other and with their partners as well as closecontact with national counterparts to ensure that the collabora-tions between IAEA, through PACT, and WHO, through itsregional and country offices, are coordinated and aligned withnational strategies.

Human resources development

The shortage of trained workforce is a major bottleneck inincreasing access to health services; according to the WHO,57 countries worldwide are experiencing a critical shortage ofhealth professionals, including 36 in sub-Saharan Africa [18].In order to achieve sustainable cancer control capacity indeveloping countries and in Africa in particular, it has beenrecognized there must be a dramatic increase in the number ofprofessionals trained locally or regionally in the various areasof cancer control, as well as local recruitment and retention ofgraduates.

Considering that the IAEA, through its Human Health Pro-gramme, has developed extensive educational and trainingmaterial and curricula for radiation medicine [19], the PACTProgramme Office, in cooperation with WHO, IARC, theUnion for International Cancer Control (UICC), the USNational Cancer Institute (US NCI), the African Organisationfor Research and Training in Cancer (AORTIC) and otherpartners with expertise in cancer control and experts in radia-tion medicine within the IAEA, developed the Virtual Univer-sity for Cancer Control network (VUCCnet). The VUCCnet isa project that aims at contributing to paving the way for sub-regional cancer control workforce training hubs in addition tothe existing regional VUCCnet. The project builds upon thepotentialities of using modern pedagogical IT-assisted meth-odology and e-learning in addition to traditional teachingapproaches as means to overcome workforce shortages andto accelerate the level of appropriateness in human resourcesin LMICs [20].

The VUCCnet African pilot was launched in the sub-Saharan Africa region in 2010. It has been supported bythe Roche African Research Foundation and the US govern-ment and focusses on four Anglophone Member States:Ghana, Uganda, United Republic of Tanzania and Zambia.A French-speaking segment of the project is expected to belaunched as additional funding becomes available.

During the pilot phase, the Republic of South Africa andEgypt have agreed to operate as mentors, as they currentlymaintain considerable educational capacity and can provideaccess to institutions focussed on training cancer profes-sionals. The first year of the VUCCnet African pilot culmi-nated in a test exercise which evaluated a functional proto-type of the e-learning system within the participant countries.The 18-h course, Cervical Cancer Prevention and Screening,was selected because of the high burden of cervical cancer inthe region. A total of 55 doctors and nurses from the fourMember States took part in the exercise in 2011 while57 took part in the course in 2012 (Table 1). Students thatcompleted the course with a passing grade received accredi-tation from the Commission for Continuing Education ofthe Spanish National Health System and the Accreditation

J. Afr. Cancer (2014) 6:3-10 7

Council of Oncology in Europe, as the institution contractedto develop the course was located in Spain (Instituto Catalánde Oncología).

At the 2011 VUCCnet stakeholders meeting, the resultsfrom the “proof of concept” exercise were examined and thepilot countries reviewed existing NCCP or health strategicplans and identified ten priority workforces in oncologytopics: community health workers, screening workers, pathol-ogy technicians, surgeons, palliative care practitioners, cancerregistration workers, radiation therapy technicians, clinicaloncologists, oncology nurses and pathologists. It was agreedthat a dual approach would be followed: in-service levelcourses to upskill existing workers and pre-service coursesto prepare new workers. The e-learning content of some ofthose courses is already available and peer reviewed by keyexperts from participant countries, IAEA, WHO, IARC andother partners.

The VUCCnet maintains an advisory group of technicalexperts who meet quarterly to review project activities. AsWHO AFROmaintains a strong knowledge of the local reali-ties in the pilot countries, it serves as a member of the advisoryboard, thereby playing an instrumental role in the progress andimplementation of the project. The VUCCnet initiative is alsoa sub-network of the broader AFRA-Network for Educationof Nuclear Science and Technology (AFRA-NEST) whichwas established and empowered by AFRA1 Member Statesto implement AFRA strategy on Human Resource Develop-ment (HRD) and Nuclear Management (NKM).

It is envisioned that the VUCCnet will have a Secretariathost country and that its governance will be done throughcoordination among participating countries from the region.This will in turn provide an opportunity to harmonizeregional policies on health care credentials, helping to stan-dardize the path that aspiring African health professionalsmust take to reach certification.

In addition to the VUCCnet project, the IAEA/PACT isalso active in providing for the training of health profes-sionals. This training can be completed through many dif-ferent mediums including in-kind training contributionsand direct sponsorship by IAEA/PACT to attend courses,international training workshops and conferences. A totalof 140 health professionals from a wide range of cancer con-trol specialities have been trained through this mechanismwhich often requires the nomination of participating healthcare professionals by Ministries of Health. For all those can-didates participating in training initiatives, WHO AFROplays an important role in advising national counterparts onthe nomination of potential candidates.

IAEA technical cooperation programmeand the regional meetings

The IAEA TC programme is the main mechanism throughwhich the IAEA delivers services to its Member States. AllIAEA Member States are eligible for support, although inpractice TC activities tend to focus on the needs and priori-ties of less developed countries.

Within each geographic region, TC regional projects sup-port Member States in addressing their priorities in nuclearenergy and applications according to their specific needs, tak-ing into consideration existing capacities and different opera-tional conditions. In 2009, the IAEA had over 130 activeprojects involving radiotherapy in all regions of the world[21]. For Africa, there is currently an active TC regional proj-ect with a dedicated budget to support the establishment ofNCCP in participating Member States with emphasis oncapacity building in radiation medicine and education andtraining of cancer professionals.

One important aspect of the TC regional project is thecreation of a platform which enables Member States toshare experience to improve national cancer control plan-ning through regional coordination meetings. These meet-ings also play a major role in raising awareness amonghealth policy makers and in encouraging South–South coop-eration among African countries. The IAEA and WHO haveorganized three major regional coordination and planning

Table 1 VUCCnet Cervical Cancer Prevention and Screening Course.

Participants 2011 (pilot) 2012

n % n %

Participants per inscription 55 100 57 100

Participants who accessed the virtual classroom 47 85.5 42 73.7

Participants who accessed the theoretical material 36 65.5 32 56.1

Participants who successfully passed the exam 30 54.5 30 52.6

1 The African Regional Cooperative Agreement for Research, Devel-opment and Training Related to Nuclear Science and Technology(AFRA) is an inter-governmental agreement, which stems from aninitiative of African Member States who requested the Agency in1988 to help them establish a regional arrangement for cooperation inthe field of nuclear science and technology in Africa similar to theexisting ones in Asia and Latin America. As of January 2013, AFRAmembership includes 39 African countries.

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meetings and one sub-regional meeting for francophonecountries within Africa.

The first meeting that took place in Cairo, Egypt, in 2009aimed at presenting the principles of comprehensive cancercontrol planning at the national level and highlighting theimportance of an integrated public health approach to maxi-mize the investments made in radiotherapy. A second meetingwas held in Dakar, Senegal, in 2010 to review the progressmade in cancer control planning with a view to defining andagreeing on strategic directions to be taken and priorities to beaddressed with regard to all components of cancer control inthe WHO Africa region, with the support of both organiza-tions and other partners.

In 2012, a sub-regional meeting with four West Africanfrancophone countries, namely Burkina Faso, Cote d’Ivoire,Mauritania and Niger, was held in Nouakchott, Mauritania,following up on the progress made since the imPACTReview and reviewing the draft NCCP. Recently, a mid-term regional coordination meeting was held in Nairobi,Kenya.

The regional coordination meetings function as forumsof discussion, dissemination of ideas and identification ofregional priorities for cooperation by the Member Stateswith both organizations and their partners. They have shownto be fruitful in creating awareness on the importance of plan-ning radiation medicine services within a comprehensive can-cer control approach, reflected by the request and implemen-tation of imPACT Reviews in 21 Member States since 2010.

Moreover, regional meetings help bringing together dif-ferent partners, policy makers and programme managers, anaspect that may be very useful in the context of global healthinitiatives, particularly in LMICs [22]. In total, these meet-ings have enabled 48 health professionals from 17 differentAfrican countries and 25 international experts (13 from theWHO African Region) to discuss and share experiences incancer control. Besides IAEA and WHO, other cancer orga-nizations have been represented in these regional coordina-tion meetings, such as IARC, ACS, INCTR, AORTIC andthe International Campaign for Establishment and Develop-ment of Oncology Centers (ICEDOC).

Conclusions

The coordination between IAEA/PACT and WHO AFROhas been essential for carrying out the different activitiesand constitutes, along with the commitment of all other part-ners and Member States, a realistic example of collaborationand synergetic work for assisting countries in the area ofcancer control at the regional level.

Through participation in the cancer control assessmentmissions, IAEA has provided expertise on radiation medicineand radiation safety; WHO AFRO and IARC on cancer con-

trol planning, cancer registration and information, preventionand early detection of cancer, and as such, have contributedto the recommendations delivered to Ministries of Healthfor consideration and possible endorsement. This in turn isexpected to strengthen the planning of countries’ cancer-related IAEA TC projects and WHO Country CooperationStrategy according to their identified priorities for technicalassistance.

The participation of experts in the missions constitutes aunique and valuable opportunity for the Ministries of Healthto obtain an external assessment and recommendations fromthe highest academic and technical level in all areas of can-cer control. Furthermore, using regional expertise enablesthe establishment of links and potential partnerships betweenlocal and regional institutions, creating training opportu-nities within the region and enabling the exchange of practi-cal knowledge among professionals from similar resourcesettings. The experience of the Joint United Nations Pro-gramme on HIV/AIDS (UNAIDS) showed the benefitsof combining efforts in health by establishing partnershipsamong UN agencies, external partners and with existingregional institutions, which was particularly crucial to pro-vide technical support to those countries that had more diffi-culties to prepare high-quality proposals to donors [23]. Theexample and lessons learn from such initiative are expectedto enhance the potential of ongoing interagency collabora-tions in support of cancer control in the African region.

Conflict of interest: R. Camacho, J.M. Dangou, D. Neves,S. Morgan, M. Piñeros and J.P. Cayol have no conflict ofinterest to declare.

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