Initial Experiences Following the Launch of Radiotherapy In a Southeast African Nation
Abstract
Purpose
Malawi, a low-income country in southeastern Africa with a population of more than 20 million, historically lacked access to public radiotherapy services. In July 2025, the country’s first public radiotherapy program became clinically operational at Kamuzu Central Hospital through a partnership between the Government of Malawi, the IAEA, and RAD-AID International. This work describes the early medical physics experience during the first seven months of clinical operation, with emphasis on case mix, workforce development, and operational challenges in a low-resource setting.
Methods
Clinical activity and operational experience were reviewed for the first seven months following go-live. Data included patient volumes, treated disease sites, staffing and training activities, quality assurance workflows, and infrastructure-related disruptions. Program support was provided through an international collaboration coordinated by RAD-AID, including on-site visits by a medical physicist, dosimetrist, radiation therapist, and radiation oncologist to support commissioning, clinical launch, and hands-on training. These efforts were supplemented by ongoing remote education and mentorship to reinforce clinical workflows and build local capacity.
Results
A total of 120 patients were treated during the initial seven months of operation. Cervical cancer accounted for the majority of cases (approximately 54%), followed by vulvar (10%), prostate (7%), and breast cancers (6%). Routine quality assurance procedures were implemented and maintained. Key challenges included limited availability and retention of trained personnel, particularly medical physicists and radiation therapists, as well as intermittent infrastructure disruptions, including periods of CT simulator downtime. Despite these constraints, external beam radiotherapy services were sustained. Preparations are underway to introduce brachytherapy in the coming months.
Conclusion
Early operational experience demonstrates that public radiotherapy services can be delivered in a low-resource setting through sustained international partnership, while underscoring the importance of workforce development, training continuity, and infrastructure reliability. These lessons may inform other countries transitioning from program establishment to sustained radiotherapy delivery.