Eswatini Finalizes Funding Framework For Its First Public Radiotherapy Centre
By Ellen Swabey-Van de Borne and Karagu Maina, IAEA Department of Technical Cooperation
Eswatini is taking tangible steps to prepare for its first public radiotherapy centre to enable cancer patients to be treated in-country, according to a team of international experts.
The experts, appointed by the IAEA, World Health Organization (WHO) and the International Agency for Research on Cancer (IARC) to carry out an imPACT Review in the country, found that Eswatini has finalized a strategic funding proposal, enacted a Nuclear and Radiation Safety Law, and surveyed potential sites for geotechnical suitability.
The mission in August 2024 built on a 2017 imPACT Review that laid the foundations for the development and implementation of the National Cancer Control Plan 2019-2023.
Other achievements since that period include the establishment of the National Cancer Control Unit at the Ministry of Health; the introduction of human papillomavirus (HPV) vaccination into the National Immunization Programme; the recruitment of a clinical oncologist and a medical physicist; the creation of a 60-bed chemotherapy unit operating at Manzini Government Hospital; and the development of a draft Nuclear Bill that currently awaits approval by the National Assembly.
Of Eswatini’s 1.2 million people, over 1000 were diagnosed with cancer in 2022, and close to 700 people died of the disease (Globocan). Cancers of the breast, cervix and prostate accounted for more than 50 per cent of these cases. With no radiotherapy services available within the country, the government currently helps patients access this treatment in South Africa using the country’s Phalala Medical Referral Fund.
“This solution is not sustainable,” said Mduduzi Matsebula, Eswatini’s Minister of Health. “Our government is working hard to build a first radiotherapy facility so that our patients can be treated at home, committing already one million euros to the success of this project,” he added.
In support of this goal, Eswatini is in the process of finalizing a strategic funding document to mobilize domestic and international funds. The imPACT Review mission was an opportunity to update key sections of this ‘bankable’ document, including the country’s cancer profile and available infrastructure, as well as requirements for equipment and human resources, and estimated preliminary costs.
The development of strategic funding documents is one of the ways the IAEA provides support to countries. These documents come under the ownership of the country, and are validated by the IAEA through technical and economic feasibility assessments. They provide comprehensive insights into the requirements of proposed projects – tailored to the country’s cancer profile, control plan, existing physical infrastructure and human resource capabilities. They help government decision-makers and funding partners to identify the needs and funds required to set up a radiotherapy facility. In the case of Eswatini, the bankable document represents an important preliminary step towards the establishment of the country’s first radiotherapy centre.
During the mission, the imPACT Review team visited six health facilities across the country and performed a siting analysis for the new radiotherapy centre location. Experts provided inputs on the proposed plan and conducted preliminary observations on its geotechnical suitability. The team also met Members of Parliament to discuss financing and cancer control regulatory frameworks.
With eight of the 12 international experts coming from Africa, the mission was a clear demonstration of regional expertise and South-South collaboration. The imPACT Review team also explored opportunities for synergies with stakeholders involved across the cancer control continuum, including the Clinton Health Access Initiative, United Nations Population Fund (UNFPA), the United Nations Children’s Fund (UNICEF) and the World Bank.
With cervical cancer accounting for more than 50 per cent of all cancers affecting women diagnosed in 2022, this was another priority area of focus during the mission. “The imPACT Review provided a platform for us to explore potential synergies in strengthening cervical cancer control under the Global Cervical Cancer Elimination Initiative,” said Susan Tembo from the WHO Country Office. “We are working closely with the Government of Eswatini and other partners to enhance the health system’s capacities to comprehensively address the growing cancer burden, including the development of a national roadmap for eliminating cervical cancer,” she added.
On the last day of the mission, the Principal Secretary for Health, WHO Country Representative, Director of Health Services, implementing partners and all Ministry of Health programme managers were debriefed on the imPACT Review preliminary findings and recommendations. These recommendations are expected to contribute to the development of future technical cooperation projects and to support potential participation in the IAEA’s Rays of Hope initiative.
“I see great hope for the socio-economic development of Eswatini,” said the Director for Africa in the IAEA’s Technical Cooperation Department Shaukat Abdulrazak,. “The recent signing of the Country Programme Framework for the period 2024–2029 is an opportunity to align IAEA technical cooperation efforts with the Eswatini National Development Plan and the promulgation of the nuclear law. In addition, with Eswatini formally requesting to join two flagship IAEA initiatives – Rays of Hope and Atoms4Food – the IAEA will continue to support the Kingdom for the establishment of the first public radiotherapy facility on the one hand, and food safety and security on the other,” he added.
The IAEA profiles employees to provide insight into the variety of career paths that support the Agency’s mission of Atoms for Peace and Development and to inspire and encourage readers, particularly women, to pursue careers in STEM (science, technology, engineering and mathematics) or STEM-adjacent fields. Read more profiles of women at the IAEA.
“I want every country to have a cancer plan and more people to know about the cancer work that the IAEA does,” says Lisa Stevens, who has spent a quarter of a century working in the field of cancer control and now leads the Programme of Action for Cancer Therapy (PACT) at the IAEA.
Stevens’ career has been informed by her background in science. The oldest of three children, she was first inspired to pursue a scientific career by her parents, who both had careers in the STEM disciplines. Her mother worked in the medical and scientific field, having trained as a mammography and X ray technician, and her father was an engineer.
Learning about her parents’ work helped Stevens to understand the opportunities available if she chose a career in science.
“You have to excite the young mind; show and promote opportunities in science while they are young,” she said. “In any field, you want the best. Making sure that young children, girls and boys, have opportunities is important. Diversity is important.”
Stevens always had a deep interest in biology and enjoyed science classes in high school. “I liked studying about the human body, liked chemistry, physics and the scientific methods,” Stevens said.
From a young age, Stevens was also interested in an international career. She earned a bachelor’s degree in biology and Spanish because she thought she might work as a physician overseas one day. She attended a small liberal arts school in the farmlands of Illinois in the United States of America, where she discovered the joys of DJing and philanthropy, as well as scientific studies. She continued her studies in molecular and cellular biology in graduate school at the University of Maryland, carrying out her thesis research at the United States National Cancer Institute (NCI) and graduating with a PhD in 1999.
Although her first position was as a laboratory researcher at NCI, Stevens soon found that her personality was better suited to roles that involved coordinating activities that support science. By 2000, she had started a new job, supporting scientists engaged in cancer research at NCI. This change in career was the stepping stone to her work in global cancer control.
Stevens flourished in her new role, rising quickly through the ranks. She guided the creation and communication of the NCI’s long-range plan, the yearly plan and budget, as well as highlights of scientific progress.
Stevens also joined the NCI’s Center for Global Health (CGH) as the Deputy Director for Planning and Operations in 2012, where she fostered collaborations and oversaw the development of national strategic cancer plans.
As the Senior Lead of the International Global Cancer Control Programme at NCI, Stevens worked with ministries of health and other multi-sectorial groups in all World Health Organization (WHO) regions to include evidence-based policies in cancer control and non-communicable disease control plans.
“When I was asked to join the Center for Global Health, I thought it was a chance to learn about a new field, build new partnerships and support the global community,” Stevens said.
While at CGH, Stevens co-founded International Cancer Control Partnership and coordinated multiple global partners working with stakeholders in cancer control. This partnership focused on collating published cancer control plans, as well as other tools that individuals charged with developing, implementing or evaluating national plans could utilize. In September 2018, a global review of these plans was published in the medical journal Lancet Oncology. A second global review will be published at the end of 2024.
Open to possibilities
Stevens advises early-career professionals who are struggling to find their dream job to stay open minded. “Be open to the possibilities. A closed door may not be a bad thing. There might be something behind a different door,” Stevens said.
“You always have to look out for opportunities that come your way, so do not despair if what you thought was your path is not the path you are on. Build a network to cultivate relationships,” she added.
The experience Stevens gained in international cancer control partnerships was put to good use when she joined the IAEA in June 2019 as the Director of the Programme of Action for Cancer Therapy (PACT) in the Technical Cooperation Department. In this role, she oversees cancer control review missions (imPACT Reviews), the IAEA’s flagship Rays of Hope initiative, and partnership and resource mobilization. This work supports her deepest wish: for every country in the world to have a cancer plan to improve cancer outcomes.
The IAEA, together with the World Health Organization and the International Agency for Research on Cancer, conducts imPACT Reviews, which assess a country’s cancer control capacities and needs, identify priority interventions to respond effectively to the country’s cancer burden and provide analysis and recommendations to help plan for the future. The PACT team coordinates international experts, works with national teams and focal points in the Ministry of Health and maintains relationships with partners.
“I have learned a lot since starting my role,” Stevens said. “I love seeing the impact and change in Member States and interacting with representatives from different parts of the world.”
Besides being the Director of PACT, Stevens is Vice President of the Women in Nuclear (WiN) IAEA chapter, a non-profit organization that aims to promote women in the nuclear and radiation fields. Her particular focus is on mentorship and supporting the WiN IAEA members in building networks.
The IAEA’s commitment to gender equality
The IAEA is committed to gender equality and to supporting the ability of all individuals, regardless of gender, to equally contribute to and benefit from its programmes and activities. To this end, the IAEA strives to achieve gender balance in the Secretariat and to implement gender mainstreaming in its programmes and activities.
Additionally, in 2020, the IAEA launched the Marie Sklodowska-Curie Fellowship Programme (MSCFP) to support the next generation of women nuclear professionals by offering scholarships for master’s degree students in nuclear-related fields. A new IAEA initiative launched in March 2023, the Lise Meitner Programme, offers early- and mid-career women multiweek training visits to nuclear facilities.
