Building a sustainable future: Closing the gap in radiotherapy and brachytherapy resources to achieve the sustainable development agenda 2030 goals for cervical cancer control in Africa

Though radiation therapy services have been launched or expanded in several countries, there have also existed brief or seemingly ongoing infrastructure gaps. The purpose of this health policy study is to provide an overview of the radiation therapy resources available in Africa and to assess how well they align with the agenda 2030 goals, with a specific focus on the role of radiation therapy (both radiotherapy and brachytherapy) in reducing the incidence of cervical cancer. The study consulted publicly accessible datasets to gather information on each nation's radiation therapy equipment, cervical cancer mortality and incidence, gross domestic product (GDP), gross national income (GNI) and population size. This information was used to generate a final dataset for analysis across various African nations, identifying any gaps or areas where improvement is needed. We compared the external beam units (or brachytherapy afterloaders) and unmet needs across nations that had access to either external beam radiation therapy or brachytherapy using a straightforward linear regression. R studio was used for the statistical analysis. Africa's overall unmet need for radiotherapy service was 71.5%. Megavoltage units per cancer incidence and megavoltage units per million population had a strong significant association with economic status (GDP [r(2) = 0.83; p < .001]: and GNP [r = 0.83; p < .001]). Additionally, the unmet cervical cancer needs based on the available brachytherapy capacity is about 60%. Interestingly, there was a strong correlation between cervical cancer incidence and brachytherapy capacity. Overall, the study provides valuable insights that can inform policy and decision-making related to the provision of radiation therapy services in Africa. We expect that international organisations, African Union entities and governments will utilise the Directory of Radiotherapy Centres (DIRAC) initiative as a blueprint for establishing benchmarks and invest in radiotherapy and brachytherapy services in Africa.