Provision of Radiation Oncology Services In Limited Resources Setting. a Moi Teaching and Referral Hospital Case Study
Abstract
Purpose
Access to radiation therapy remains a major challenge in many low‑ and middle‑income countries (LMICs), where limited infrastructure and workforce shortages hinder timely cancer treatment. Moi Teaching and Referral Hospital (MTRH) in Eldoret, Kenya, is an Academic Model Providing Access to Healthcare (AMPATH) site serving a large population across northwestern Kenya, as well as patients from Uganda and South Sudan. This study evaluates the current capacity, challenges, and opportunities within the radiation oncology services at MTRH.
Methods
A structured facility assessment was conducted to document available technology, clinical workflows, staffing levels, patient volumes, and treatment patterns. MTRH currently operates two linear accelerators (Varian TrueBeam and Varian VitalBeam), a Siemens Somatom Confidence CT simulator, an Elekta Flexitron HDR brachytherapy afterloader, a full suite of quality assurance tools, and a variety of immobilization devices. Workforce roles were reviewed to characterize task‑sharing approaches necessitated by resource constraints.
Results
The department treats approximately 150 patients daily across its two linear accelerators, yet the waiting time for radiotherapy remains approximately three months due to high demand. Staffing consists of two medical physicists, one trainee, three clinical oncologists, and six radiation therapists. Given limited personnel, physicists also perform dosimetry duties, and clinical oncologists provide both radiation and medical oncology services. Most patients present with advanced‑stage cancers, resulting in predominantly palliative treatment intent. Esophageal and cervical cancers are the most common diagnoses, followed by breast, head and neck, prostate, rectal, vulvar cancers, and bone metastases.
Conclusion
The demand for radiotherapy at MTRH significantly exceeds current capacity. Adoption of hypofractionated treatment protocols, integration of automation and AI‑assisted planning, and expansion of staffing through targeted training initiatives could substantially improve access. Investment in infrastructure and workforce development is essential to strengthen radiation oncology services and reduce waiting times in this high‑burden, limited‑resource setting.