The quality and adequacy of cancer therapy delivery remains a critical but understudied area in sub-Saharan Africa (SSA). Recent editions of the World Health Organization (WHO) Model List of Essential Medicines (EML) have been expanded to include more cancer medicines, however there is limited data demonstrating the capability and adequacy of how these medicines are being utilized to deliver cancer care in SSA. Implementation of cancer care delivery models are needed to ensure the administration of standard guideline recommended therapy, coupled with close toxicity monitoring, documentation and assessment of treatment outcomes. In several countries in SSA, health
system, provider and patient factors result in deviation from standard therapy including prolonged delays in initiating and continuing therapy, frequent switches, premature discontinuation of therapy, poorly-managed adverse events and incomplete treatment documentation. National governments need to play a central role in cancer control including provisions for high quality and safe chemotherapy delivery for cancer patients. Foremost, cancer medicines on the WHO EML should be prioritized on national EMLs and covered as part of universal health coverage plans. Furthermore, national resource-specific treatment guidelines should be developed to ensure care is based on population needs and linked to chemotherapy available on national EMLs. This would also help in forecasting medicines to provide a sustainable supply of cancer medicines. Finally, the critical shortage of medical and/or clinical oncologists necessitates newer models of chemotherapy delivery by non-oncologists in SSA. Trials of novel chemotherapy delivery models should be conducted within an implementation science framework, including rigorous audit and evaluation of outcomes to identify gaps and successes that lead to better patient care and opportunities to replicate best practices in other countries in the SSA region. This knowledge is needed to ensure that resources invested in chemotherapy delivery translate to improved patient outcomes for cancer patients in SSA.

While the burden of cancer in Africa is rapidly rising, there is a lack of investment in healthcare professionals to deliver care. A lack of well-trained clinical oncologists can result in significant cancer health disparities. A comprehensive regional survey of the clinical oncology workforce in Africa was conducted. An online survey was distributed within Africa through a network of physicians associated with the African Organisation for Research and Training in Cancer (AORTIC).