The Converging Crises of Cancer and Medical Device Scarcity in Ethiopia: An Investigative Report on Prostate and Breast Cancer

I. Executive Summary

Prostate and breast cancer represent a burgeoning public health crisis in Ethiopia, a situation critically exacerbated by a profound deficit in essential medical devices for diagnosis, treatment, and management. This report details the significant epidemiological burden of these cancers, characterized by high rates of late-stage presentation and consequently poor patient outcomes. The scarcity of medical technology is not an isolated issue but rather a symptom of deeply entrenched systemic failures spanning inadequate policy frameworks, flawed procurement and maintenance lifecycles, severe human resource shortages, and persistent economic constraints, including chronic foreign currency shortages that cripple import capabilities.

The consequences for Ethiopian cancer patients are devastating, manifesting in protracted delays for diagnosis and treatment, compromised quality of care, and alarmingly high mortality-to-incidence ratios that starkly contrast with those in higher-resource settings. While national and international initiatives are underway to bolster oncology services and equipment availability, these efforts contend with the sheer scale of the need and the complexity of the underlying systemic weaknesses.

This report synthesizes evidence to illuminate these interconnected challenges, underscoring that a sustainable solution necessitates more than piecemeal interventions. It calls for a holistic, long-term national strategy focused on comprehensive health system strengthening. Key recommendations advocate for robust governance and policy reforms in health technology management, including the institutionalization of Health Technology Assessment (HTA); radical improvements in medical equipment procurement, maintenance, and supply chain resilience; substantial investment in the training and retention of a specialized oncology workforce; enhanced and ring-fenced domestic financing for cancer control; and strengthened multi-sectoral collaboration. Addressing the medical device gap is paramount and requires a concerted, strategic, and sustained commitment to ensure equitable access to life-saving cancer care for all Ethiopians.

II. Introduction: Understanding the Scope of "Generative Diseases" and the Cancer Challenge in Ethiopia

The term "generative diseases" as used in the initial query warrants clarification. Within standard medical nomenclature, conditions involving uncontrolled cell proliferation are referred to as "cancer" or "neoplasms." While some research explores shared molecular pathways, such as microRNA dysregulation or mitochondrial dysfunction , between certain cancers and neurodegenerative diseases (which are characterized by progressive loss of neuronal structure or function ), "generative diseases" is not a standard classification for cancers like prostate and breast cancer. These cancers are distinct from degenerative diseases such as osteoarthritis or Alzheimer's disease, which involve the deterioration of tissues or organs over time. This report will, therefore, focus on prostate and breast cancer, addressing them under their recognized medical terminology. The potential for public or non-specialist misunderstanding of cancer terminology, as perhaps indicated by the query's phrasing, may itself constitute a subtle barrier to effective health communication and awareness campaigns within Ethiopia, underscoring a need for clear and consistent public health messaging.

Cancer, encompassing prostate and breast malignancies, poses a rapidly escalating public health threat in Ethiopia, mirroring trends observed across many low- and middle-income countries (LMICs) which are grappling with an increasing burden of non-communicable diseases (NCDs). The Ethiopian population faces a rising liability of cancer due to demographic shifts, an alarmingly growing population, and lifestyle changes. The International Agency for Research on Cancer (IARC) estimated nearly 80,000 new cancer cases and 55,000 cancer-related deaths in Ethiopia in 2022, with these figures projected to more than double within the next two decades. Across Africa, cancer is already the fifth leading cause of death. This escalating crisis unfolds within a healthcare system historically oriented towards combating infectious diseases and now striving to address the dual burden of communicable and non-communicable diseases. The challenges faced by Ethiopia, while possessing unique local complexities, are in many ways a microcosm of the broader issues confronting resource-constrained nations in this epidemiological transition. This report investigates the specific concerns surrounding prostate and breast cancer in Ethiopia, with a particular emphasis on the critical deficiencies in medical device availability and the profound implications for patient care and outcomes.

III. The Dual Burden: Rising Cancer Incidence and Critical Medical Device Deficiencies

The confluence of a rising cancer burden and a severe lack of essential medical technology creates a formidable challenge for Ethiopia's healthcare system. This section details the epidemiological characteristics of prostate and breast cancer in the country and assesses the availability of necessary medical devices, highlighting the stark disparities when compared to international standards and better-resourced regions.

A. Epidemiological Landscape of Prostate and Breast Cancer in Ethiopia

Prostate and breast cancers are significant contributors to Ethiopia's overall cancer burden, characterized by concerning trends in incidence, mortality, and late-stage presentation.

Incidence, Prevalence, and Mortality Trends: Breast cancer is the most commonly diagnosed cancer among Ethiopian women and a leading cause of cancer-related mortality. GLOBOCAN 2020 data indicated that breast cancer accounted for 16,133 new cases (20.9% of all cancers) and 9,061 deaths (17.5% of all cancer deaths) in Ethiopia. Other analyses suggest it constitutes 22.6% of all cancer cases and 17% of cancer mortality. A 2024 systematic review confirmed breast cancer as the most common malignancy in women in most reviewed Ethiopian studies. Globally, breast cancer is the second most common cancer, with 2.3 million new cases in 2022. While incidence rates are highest in developed regions like Australia/New Zealand and Northern America, mortality rates are disproportionately high in many African nations , including Ethiopia, reflecting disparities in early detection and treatment access.

Prostate cancer is the third most common cancer among men in Ethiopia. GLOBOCAN 2020 data reported 2,670 to 2,720 new cases and approximately 1,600 deaths annually. The World Health Organization (WHO) data for 2020 indicated 1,244 prostate cancer deaths in Ethiopia. Globally, prostate cancer is the fourth most common cancer with over 1.4 million new cases in 2022. While incidence rates are higher in developed countries, often linked to widespread PSA testing, mortality rates are particularly high in regions like Africa and the Caribbean , underscoring the impact of limited access to care.

Key Risk Factors and Demographic Patterns: A notable characteristic of breast cancer in Ethiopia is its frequent presentation in premenopausal women , often in the 40-49 age group. This contrasts with patterns in high-income countries where breast cancer is more common in postmenopausal women. This demographic feature has significant implications for the types of screening and treatment modalities required, as well as for the socio-economic impact on families and national productivity. Identified risk factors in Ethiopia include dietary habits (consumption of solid oils, packed foods, meat), use of wood or animal dung as cooking fuel, physical inactivity, early menarche, and postmenopausal status.

For prostate cancer, well-established risk factors include advancing age, Black race, and a family history of the disease. Awareness of prostate cancer and its screening methods plays a crucial role in health-seeking behavior and early detection.

The Critical Challenge of Late-Stage Presentation: A defining and deeply concerning feature of both breast and prostate cancer in Ethiopia is the exceptionally high rate of diagnosis at advanced stages. Studies indicate that approximately 59% of female breast cancer cases , with ranges reported between 57% and 72.5% , and 66.9% in another cohort , are diagnosed at late stages (III or IV). Similarly, about 46.7% of prostate cancer cases in Ethiopian men are identified at an advanced stage. This contrasts sharply with high-income countries where late-stage presentation for breast cancer, for example, is around 15%. This phenomenon is strongly linked to delays in health-seeking behavior, low public awareness of cancer symptoms and screening, and formidable systemic barriers within the healthcare system that impede timely diagnosis and access to care.

Mortality-to-Incidence Ratio (MIR) Analysis: The Mortality-to-Incidence Ratio (MIR) serves as a crucial indicator of the effectiveness of cancer management within a health system. A high MIR suggests poor survival outcomes, often reflecting deficiencies in early detection and access to adequate treatment. For Africa as a whole, the MIR for all cancers combined was 0.64 in 2020, with a strong negative correlation between a country's Human Development Index (HDI) and its MIR. This implies that lower HDI countries, which likely include Ethiopia, experience worse cancer survival rates.

For breast cancer in Ethiopia, a pooled mortality rate of 36% and a 5-year survival rate of only 22% have been reported. This low survival rate, when compared to the 80-90% 5-year survival rates in high-income countries, underscores a critical failure in managing the disease effectively. For prostate cancer in Ethiopia, GLOBOCAN 2020 data (2,720 new cases, 1,600 deaths) yields a raw MIR of approximately 0.59. The reported median survival of 28 months and a 5-year survival rate of 22% for prostate cancer patients further highlight the grim outlook. Such high MIRs for cancers that are often treatable if detected early are a direct indictment of the inadequacies in diagnostic and therapeutic capacities, heavily influenced by the availability and functionality of medical devices.

Table 1: Comparative Epidemiology of Prostate and Breast Cancer in Ethiopia

Cancer Type

Metric

Ethiopia

Sub-Saharan Africa (Average/Proxy)

Northern America (High-HDI Region)

Breast Cancer

Incidence Rate (ASR/100k, Females, 2022)

~20.9-22.6% of all cancers (Specific ASR varies, lower than HIC but high burden)

Varies, e.g., Eastern Africa low ~27/100k

~100/100k (Australia/NZ, N. America)

Mortality Rate (ASR/100k, Females, 2022)

~17-17.5% of cancer deaths (High relative to incidence)

High in many regions, e.g., Africa 1 in 47 lifetime death risk

Lower, e.g., 1 in 77 lifetime death risk

5-Year Prevalence (Cases, 2022)

Data specific to Ethiopia not readily available in summary form; Africa: 507,659

507,659 (Africa)

1,332,343

Estimated 5-Year Survival

22%

Generally lower than HICs

~90%

Common Age at Diagnosis

Premenopausal, 40-49 years

Younger onset common in Africa

Predominantly postmenopausal

% Diagnosed at Advanced Stage

57-72.5%

High, ~80% in SSA

~15-20%

Prostate Cancer

Incidence Rate (ASR/100k, Males, 2022)

~40.6/100k (study specific ); Lower than HIC but significant burden

Varies, e.g., Middle Africa high

High, e.g., N. America ~70/100k

Mortality Rate (ASR/100k, Males, 2022)

~6.02/100k (study specific ); High relative to incidence

High in Africa

Lower

5-Year Prevalence (Cases, 2022)

3,775 (2020 data ); Africa: 193,684

193,684 (Africa)

1,116,730

Estimated 5-Year Survival

22% (median survival 28 months)

Generally lower than HICs

High

Common Age at Diagnosis

Advancing age

Advancing age

Advancing age

% Diagnosed at Advanced Stage

46.7%

High

Lower with screening

Note: Rates and percentages can vary based on data source and year. This table provides illustrative comparisons based on available snippets. ASR = Age-Standardized Rate. HIC = High-Income Country. SSA = Sub-Saharan Africa.

This epidemiological profile underscores an urgent need. The high proportion of cases diagnosed at advanced stages, particularly for breast cancer occurring in younger women, has profound implications for the types of medical devices required—not just for late-stage treatment but critically for early detection and diagnosis where interventions can be more effective and less costly.

B. Assessment of Medical Device Availability for Cancer Care in Ethiopia

The capacity to diagnose, treat, and manage cancer effectively is fundamentally dependent on the availability of appropriate medical devices. Ethiopia faces severe shortages across the spectrum of cancer care technology.

Diagnostic Capabilities:

• Imaging: Access to essential diagnostic imaging is severely limited. An older study of public hospitals in Addis Ababa found mammography available in only 9% of facilities, CT scans in 18%, and MRI in 0%. While St. Paul's Hospital in Addis Ababa does offer mammography services, broader awareness and uptake remain low. Basic ultrasound is more widely available (100% in the older study ), but its utility for comprehensive cancer diagnosis depends on advanced probes, skilled operators, and integration with other diagnostic modalities, which may not always be present. The scarcity of these imaging technologies means that initial detection is often delayed, and staging—crucial for treatment planning—is frequently inadequate.

• Pathology Services: Accurate pathological diagnosis, including immunohistochemistry for determining hormone receptor status in breast cancer (essential for guiding endocrine therapy), is a cornerstone of modern oncology. However, Ethiopia faces significant limitations in pathology laboratory infrastructure, equipment, reagents, and specialized testing capabilities. One study in rural Ethiopia found that only 39% of cancer cases were pathologically confirmed. While private initiatives like ONCO Pathology aim to improve services , systemic shortages of pathologists and resources persist, hindering precise diagnosis and tailored treatment.

• Endoscopy: Endoscopic procedures are vital for diagnosing and staging various cancers (e.g., colorectal, esophageal). The WHO includes endoscopy units in its list of priority medical devices for cancer management , but access in Ethiopia is likely constrained, particularly outside the capital.

Treatment Infrastructure:

• Radiotherapy: The lack of radiotherapy services is perhaps one of the most critical deficiencies. For its population of over 100 million, Ethiopia historically had only a single functioning radiotherapy machine. The IAEA recommends a minimum of four radiotherapy machines per million people, highlighting an immense gap. As of early 2025, services are available in three public hospitals, with plans to expand to a total of nine machines in the near term, and eventually more, including Linear Accelerators (Linacs), Cobalt-60 units, and brachytherapy capabilities. However, the journey to meet the population's needs is long and complex.

• Surgical Oncology: For many cancer patients in rural Ethiopia, surgery is often the only treatment modality accessible. However, surgical oncology capacity is also limited by the availability of trained surgeons, adequately equipped operating theatres, and post-operative care facilities. While there has been an expansion of breast cancer surgery services from just two hospitals to 24 hospitals nationwide , ensuring quality and comprehensiveness of these services remains a challenge.

• Systemic Therapy (Chemotherapy): The availability of chemotherapy is largely concentrated in Addis Ababa and a few peripheral university hospitals. Chronic shortages of chemotherapeutic agents are common , although the government is working to subsidize their procurement. Access to a consistent supply of appropriate drugs is essential for effective cancer treatment.

International Standards/Recommendations: When benchmarked against international guidelines, such as the WHO's lists of priority medical devices for cancer management and IAEA guidance for radiotherapy infrastructure, Ethiopia's current capacity falls drastically short. Guidelines from bodies like the European Society for Medical Oncology (ESMO) and the National Comprehensive Cancer Network (NCCN) for breast and prostate cancer further delineate the comprehensive array of technologies needed for standard-of-care management, from advanced imaging like PSMA-PET for prostate cancer to sophisticated laboratory assays and targeted therapy delivery systems, most of which are scarce or non-existent in much of Ethiopia.

Table 2: Availability of Key Medical Devices for Cancer Management in Ethiopia (Selected Examples)

Device Category

Specific Device Type

Estimated Availability in Public Sector (Illustrative)

WHO/IAEA Recommended (or proxy)

Key Challenges/Notes

Diagnostic Imaging

Mammography Unit

Very limited; 9% in Addis Ababa public hospitals (older study ); St. Paul's has unit

Essential for breast cancer screening/diagnosis

Primarily in Addis Ababa, low awareness/uptake, functionality issues.

Ultrasound (diagnostic)

Widely available for basic use

Basic essential device

Advanced probes/applications for oncology may be limited; operator skill dependent.

CT Scanner

Limited; 18% in Addis Ababa public hospitals (older study )

Important for staging and treatment planning

Concentrated in larger cities, frequent breakdowns, high patient load.

MRI Scanner

Extremely limited; 0% in Addis Ababa public hospitals (older study )

Important for specific cancer staging/evaluation

Virtually inaccessible in public sector for most.

Pathology

Basic Pathology Lab Setup

Available in larger hospitals, but often under-equipped

Essential for all cancer diagnosis

Reagent shortages, equipment malfunction, quality control issues. Only 39% rural cancer cases pathologically confirmed.

Immunohistochemistry Capability

Very limited, mainly in specialized centers

Crucial for breast cancer (ER/PR/HER2), prostate cancer diagnosis

Lack of reagents, expertise, and equipment limits personalized treatment.

Radiotherapy

Linear Accelerator (Linac)

Few; plans for 5 new Linacs at St. Paul's ; part of national expansion

Standard for modern radiotherapy

High cost, complex maintenance, requires specialized personnel and infrastructure (bunkers).

Cobalt-60 Unit

Historically 1-2 units, one often non-functional

Viable option in resource-limited settings

Aging technology, source decay, maintenance challenges, one out of service since 2015 due to repair costs.

Brachytherapy Unit

Very limited; first GyneSource afterloader installed at Tikur Anbessa

Essential for cervical, prostate, and other cancers

Requires specialized applicators, sources, and expertise.

Surgical Support

Endoscopy Tower (for diagnosis/biopsy)

Availability not well-documented but likely limited outside major centers

Priority device for GI, lung, other cancers

Requires trained endoscopists and maintenance.

Basic Surgical Oncology Instruments

Available, but quality and completeness may vary. Expansion of breast surgery to 24 hospitals.

Essential for surgical treatment

Sterilization issues, lack of specialized instruments for complex procedures. Surgery often only option in rural areas.

The geographical concentration of available advanced medical devices, primarily in Addis Ababa, creates profound access barriers for the 84% of the population residing in rural areas. This not only delays care but also likely deepens urban-rural health inequities. Furthermore, the acquisition of new, sophisticated machines, such as Linacs, without concurrently developing robust systems for maintenance, quality assurance, and the training of skilled personnel for all technological tiers—including basic imaging and pathology—risks underutilization of these new assets or the persistence of critical bottlenecks elsewhere in the patient care continuum. The consistent reports of non-functional or under-utilized existing equipment due to maintenance, spare parts, or training deficits underscore this critical point.

IV. Systemic Failures: Root Causes of Medical Device Scarcity in Ethiopia

The scarcity of medical devices in Ethiopia is not a singular problem but a consequence of interconnected systemic failures that span the entire lifecycle of medical equipment, compounded by human resource limitations and overarching policy, governance, and economic challenges.

A. Challenges in Medical Equipment Lifecycle Management

Effective management of medical equipment, from planning and procurement to utilization and disposal, is fraught with difficulties in the Ethiopian context.

Procurement Processes and Policies: A fundamental issue lies in the procurement process itself. Public hospitals often lack robust medical equipment development plans, and plans for budgeting and spare parts procurement are reportedly implemented in less than 50% of these institutions. A significant portion of hospitals (40.3%) do not prepare adequate technical specifications when ordering medical devices, which can lead to the acquisition of inappropriate or suboptimal equipment. The Ethiopian Pharmaceutical Supply Service (EPSS), a key player in public sector procurement, faces its own challenges, including poor data quality from health facilities, staff capacity constraints, communication breakdowns, and policy ambiguities, all contributing to long lead times for acquiring essential items.

A critical flaw is the prevalent "push system" where hospitals often receive equipment from central bodies (EPSS, Regional Health Bureaus, Ministry of Health) or as donations, without a thorough needs assessment or direct involvement of the end-user facilities in the selection process. This misalignment between supply and actual requirements can result in the accumulation of unsuitable or unusable devices, thereby wasting scarce resources. Donated equipment, while often well-intentioned, frequently arrives without consideration for local operational capacity, necessary spare parts, or long-term maintenance needs, sometimes turning Ethiopia into a "disposal site" for outdated technology from donor institutions.

Installation, Maintenance, and Repair Infrastructure: Even when equipment is acquired, ensuring its functionality is a major hurdle. Studies reveal alarmingly low overall availability of functional medical equipment in Ethiopian hospitals. One assessment in the Amhara region indicated that while 55.93% of listed medical equipment was available in at least one surveyed hospital, the availability of at least one piece of each type of essential equipment across all surveyed hospitals was only 25.6%, with an overall functional status of 74.68%. Data from the Amhara Regional Health Bureau previously showed that over 10% of reported medical equipment was non-functional, with many other devices uninstalled.

The Ministry of Health has identified key reasons for this widespread non-functionality: poor equipment handling and utilization by staff, frequent power surges damaging sensitive electronics, the advanced age of much of the equipment, a lack of operator training, insufficient preventive maintenance, chronic unavailability of spare parts, inadequate local maintenance capacity, and limited technical knowledge regarding sophisticated devices. The lack of spare parts and accessories is a pervasive issue, with one study finding that only one out of eight surveyed comprehensive specialized hospitals had them readily available. This is compounded by the absence of well-equipped, standardized maintenance workshops at facility and regional levels. The stark reality of this maintenance crisis is exemplified by one of the country's few Cobalt-60 radiotherapy machines at Black Lion Hospital, which remained out of service for over four years (from 2015) due to a lack of funding for repairs.

Effective Utilization: Beyond availability and functionality, the effective utilization of existing medical equipment is also a concern. Studies report significant underutilization, with one estimating that over 40% of equipment in some public referral hospitals was underused. Another report suggested that more than 40% of medical equipment in Ethiopian healthcare institutions is constantly malfunctioning , and in Jimma Zone hospitals, over a third of devices were found to be non-functional. Factors contributing to this include the condition in which equipment is received (e.g., donated without manuals or accessories), inconsistent availability of trained operating staff, lack of preventive maintenance, absence of spare parts, power interruptions, inappropriate physical location of equipment, and lack of calibration. Furthermore, systems designed to support equipment management, such as the Medical Equipment Management Information System (MEMIS), are often underutilized, primarily serving basic inventory functions rather than comprehensive lifecycle management.

Table 3: Summary of Key Challenges in Medical Device Lifecycle Management in Ethiopia

Lifecycle Stage

Key Challenges Identified

Illustrative Source IDs

Planning & Needs Assessment

Lack of robust needs assessment; "push system" predominates over demand-driven approach; inadequate hospital involvement in planning; insufficient budgeting for full lifecycle costs.

Procurement & Sourcing

Flawed procurement policies and practices; lack of technical specifications; long lead times; challenges with EPSS; issues with donated equipment (suitability, lack of spares/manuals); foreign currency shortages impeding imports.

Installation

Delays in installation, especially for donated equipment; lack of preparedness at facility level (e.g., power, space).

Training & Utilization

Insufficient operator training on specific devices; poor equipment handling; underutilization of available equipment; MEMIS underutilized; power interruptions affecting use.

Maintenance & Repair

Lack of preventive maintenance schedules and implementation; absence of well-equipped maintenance workshops; critical shortage of spare parts and accessories; insufficient funding for repairs; lack of skilled biomedical technicians/engineers; long downtimes for critical equipment (e.g., radiotherapy).

S27,

Spare Parts & Consumables

Chronic unavailability of spare parts in local market; multiple brands for single equipment types complicate sourcing; forex shortages hinder importation of parts and consumables.

Decommissioning & Disposal

Absence of clear national or institutional guidelines for decommissioning and safe disposal of obsolete or irreparable medical equipment.

B. Human Resource Constraints

The effective deployment and operation of medical technology are critically dependent on a skilled workforce, an area where Ethiopia faces severe limitations.

Shortages of Specialized Personnel: There is an acute shortage of healthcare professionals specialized in oncology. Reports indicate as few as 13 oncologists for the entire nation. The number of pathologists is also critically low, with estimates ranging from 18 to around 110 , the latter still translating to roughly one pathologist per million people—far below international benchmarks. Similar shortages exist for medical physicists, radiologists, and specialized radiotherapy/radiology technicians, who are essential for operating and ensuring the quality of diagnostic and treatment equipment. This dearth of specialists means that even if devices were available, the expertise to use them effectively and interpret results accurately would be lacking.

Training and Capacity Building Needs: Compounding the shortage of specialists is the inadequate training for existing personnel. A lack of operator training on specific medical equipment is a recurrent theme, contributing to improper use and premature equipment failure. A study in the Amhara region found that 75% of biomedical engineers in surveyed facilities did not receive regular on-the-job training pertinent to the equipment they were expected to maintain. The need for robust local training curricula, for instance, for radiotherapy technicians, is critical, as sending large numbers of staff abroad for training is unsustainable. Furthermore, retaining trained specialists in rural and underserved areas presents an additional challenge, with a tendency for skilled professionals to migrate to urban centers or better-equipped facilities.

C. Policy, Governance, and Economic Factors

Overarching policy frameworks, governance structures, and economic conditions significantly influence the medical device landscape.

National Health Policies and Cancer Control Planning: Ethiopia's overarching National Health Policy and National Medicine Policy have reportedly remained largely unchanged for over three decades, potentially failing to keep pace with the evolving health needs of the population, including the rising NCD burden, and advancements in health technology. However, the National Health Policy was reported to be under revision as of July 2023 to address these shifts and align with goals like Universal Health Coverage (UHC).

The country launched its first National Cancer Control Plan (NCCP) for 2015-2020, which outlined strategies for prevention, screening, early diagnosis, treatment, and palliative care, including specific targets for cervical cancer control (e.g., the WHO 90-70-90 goals). Despite these plans, implementation has faced significant challenges, including inadequate comprehensive political support, persistent funding shortages, a scarcity of centers of excellence, insufficient in-service training for healthcare providers, and critical shortages in specialty care encompassing complex diagnostics, chemotherapy, oncology surgery, pathology, and radiotherapy. Deficiencies in Electronic Health Records (EHRs), cancer registries, and e-referral systems also hamper progress.

While the Ministry of Health's Ethiopian Hospital Services Transformation Guidelines (EHSTG) include a chapter on medical equipment management , the development and enforcement of specific, comprehensive medical device policies at the hospital level are often lacking. The importance of Health Technology Assessment (HTA) to guide the selection and adoption of health technologies has been acknowledged in various policy documents, but a systematic, institutionalized HTA process is yet to be effectively implemented. The absence of such a system means that decisions on technology acquisition may not always be grounded in evidence of cost-effectiveness, appropriateness for the Ethiopian context, or considerations of long-term sustainability, potentially perpetuating cycles of acquiring ill-suited or unmaintainable equipment.

Healthcare Financing and Budgetary Allocations: Overall government spending on health in Ethiopia has been described as low. Specifically for cancer control and NCDs, funding and policymaker attention have been inadequate, partly due to the historical and ongoing focus on infectious diseases and maternal and child health. Insufficient budgets allocated for equipment repairs and maintenance are a direct cause of non-functional devices. While international partners like the European Union have provided budget support for health facilities, particularly in response to crises like COVID-19 , sustainable domestic financing for comprehensive cancer care, including device procurement and upkeep, remains a critical gap.

Impact of Economic Constraints: Ethiopia has faced significant economic challenges, most notably a severe and chronic shortage of foreign currency. This has a direct and debilitating impact on the importation of essential medicines and medical equipment, as well as the spare parts needed for maintenance. Importers report delays of three to six months, or even longer, in obtaining foreign currency allocations, during which time currency fluctuations can further increase costs. This bottleneck affects both public sector procurement through agencies like EPSS and private sector importers.

Supply Chain Vulnerabilities: The public health supply chain in Ethiopia, like in many LMICs, is fragile and prone to disruptions. The EPSS, responsible for procuring and distributing pharmaceuticals and medical supplies, experiences challenges in ensuring a continuous supply of essential items due to forex issues, internal capacity limitations, and data quality problems. This results in frequent stockouts of vital medicines and supplies at health facilities. International organizations like the USAID Global Health Supply Chain Program-Procurement and Supply Management (GHSC-PSM) project are working to strengthen the supply chain for various health commodities , and entities like SGS offer specialized medical device supply chain services , but systemic vulnerabilities persist.

The interplay of these factors—from flawed procurement and maintenance systems to critical shortages of skilled personnel and hamstrung by outdated policies and severe economic constraints like forex shortages—creates a challenging environment for ensuring access to essential medical devices for cancer care in Ethiopia. The lack of a unified, effectively enforced national medical device policy, coupled with the absence of a robust HTA system, further complicates efforts to manage technology rationally and sustainably.

V. The Human Cost: Impact of Device Shortages on Cancer Patient Outcomes

The critical deficiencies in medical device availability and the associated systemic failures in Ethiopia translate directly into devastating consequences for individuals diagnosed with prostate and breast cancer. These impacts are felt across the entire patient journey, from initial symptom recognition to diagnosis, treatment, and ultimately, survival.

Delayed Diagnosis and Treatment Initiation: One of the most immediate and damaging effects of medical device scarcity is the profound delay patients experience in obtaining a diagnosis and starting treatment. For radiotherapy, a cornerstone of treatment for many cancers, waiting times in Ethiopia have been reported to be as long as a year or more. By the time patients access this treatment, an estimated 70% are already in the final, often incurable, stages of their disease. This delay is not solely due to radiotherapy machine shortages; it begins much earlier in the pathway. Patients with breast cancer in Ethiopia, for instance, have reported an average time of 1.5 years from initial symptom recognition to presenting at a health facility. Such delays in seeking care, compounded by diagnostic delays within the health system due to lack of imaging or pathology capacity, are major contributors to the country's high cancer mortality rates. Misdiagnoses and protracted, uncoordinated referrals between multiple healthcare facilities further exacerbate these delays, with patients often undergoing repeated investigations at unnecessary expense.

Compromised Quality of Care and Treatment Efficacy: When essential medical devices are unavailable or non-functional, the quality and efficacy of cancer care are severely compromised. In many rural areas, surgery remains the only accessible treatment option for cancer patients, often performed without the benefit of precise pathological diagnosis or staging that would guide the extent and type of surgery needed. The limited availability of pathology services, particularly specialized tests like immunohistochemistry for breast cancer hormone receptor status, means that treatment decisions cannot always be tailored to the individual patient's cancer subtype, precluding the use of effective targeted therapies like endocrine therapy. Even when treatment like radiotherapy is initiated, frequent equipment outages due to poor maintenance can interrupt treatment courses, reducing their effectiveness and potentially allowing for tumor regrowth or resistance.

Increased Morbidity, Mortality, and Reduced Survival Rates: The culmination of delayed diagnosis, limited access to appropriate diagnostic tools, and inadequate treatment options is predictably poor patient outcomes, including increased morbidity, higher mortality rates, and drastically reduced survival. The 5-year survival rate for breast cancer in Ethiopia is estimated at a mere 22% , a stark contrast to the 80-90% rates seen in high-income countries where early detection and comprehensive treatment are the norm. Similarly, for prostate cancer, the 5-year survival in Ethiopia is also around 22%, with a median survival of only 28 months. These figures are a direct reflection of a system where most cancers are found late and treated inadequately. The high cancer mortality rates observed across Africa are strongly linked to late-stage presentation, insufficient public awareness, and the profound lack of oncologic infrastructure, including medical devices. In Ethiopia, breast cancer is reportedly three times more deadly for women than in the United States , a statistic that powerfully illustrates the human cost of these systemic deficiencies.

Patient Pathways and Referral System Challenges: The journey for a cancer patient through the Ethiopian healthcare system is often long, fragmented, and fraught with obstacles. Patients typically visit an average of three healthcare institutions from their first encounter with a provider until their final treatment initiation, if treatment is received at all. Complicated and uncoordinated referral processes, coupled with long diagnostic intervals, contribute significantly to delays in initiating curative treatment. One study in rural Ethiopia found that while referrals for diagnostic tests had a higher chance of successful completion, a distressing 21% of all diagnosed cancer patients remained without any form of therapy.

Numerous barriers impede effective referral, including the absence of clear communication protocols and formal linkages between different levels of the healthcare system, inadequate and costly transportation (especially for rural patients), lack of affordable accommodation near specialized treatment centers, difficulties navigating unfamiliar hospital systems (often compounded by language barriers or illiteracy), and shortages of essential medications even at referral hospitals. Financial difficulties and rural residence are strong predictors of presenting with advanced-stage cancer.

The visible and repeated failures of the healthcare system to provide timely and effective cancer care due to these device shortages and systemic weaknesses can lead to a profound erosion of public trust. This may drive patients, particularly those in rural areas or facing significant access barriers, towards unproven traditional remedies as a first or last resort. Such choices, born out of desperation or lack of viable alternatives, invariably lead to further delays in accessing evidence-based medical care, tragically worsening outcomes.

Moreover, the immense psychological burden on patients and their families—stemming from diagnostic uncertainty, prolonged suffering due to treatment delays, the fear of a "death sentence" perception of cancer , and crippling financial distress —is a largely unaddressed consequence that further diminishes quality of life and can negatively impact treatment adherence even when services are eventually accessed. The system, forced by diagnostic delays to focus on managing late-stage disease, diverts already scarce human and material resources towards complex and often palliative interventions. This reactive approach consumes resources that could potentially yield greater population-level impact if invested in strengthening early detection capabilities and primary prevention efforts, where available basic diagnostic devices could play a more cost-effective role.

VI. Current Efforts and Interventions

Despite the formidable challenges, various initiatives by the Ethiopian government, international organizations, and NGOs are underway to improve cancer care and access to medical devices in the country.

Ethiopian Government Initiatives and the National Cancer Control Plan (NCCP): The Ethiopian government launched its first National Cancer Control Plan (NCCP) for 2015-2020, a framework aimed at reducing cancer incidence and mortality through strategies focusing on prevention, early diagnosis, treatment, palliative care, research, and surveillance. The plan included specific targets, particularly for cervical cancer (aligning with WHO's 90-70-90 goals) and promoting breast cancer screening.

A significant component of the government's strategy involves infrastructural expansion. This includes the construction of six new regional oncology centers in locations such as Addis Ababa (St. Paul's Hospital Millennium Medical College), Gondar, Hawassa, Harar, and Mekele. These centers are intended to decentralize cancer care and are being equipped with new technology, including radiotherapy machines (Linacs, brachytherapy units) and cryotherapy machines for treating pre-cancerous cervical lesions. The St. Paul's Hospital oncology center, for instance, is a major project set to house multiple Linacs and a cyclotron facility.

Access to treatment is also being addressed by expanding chemotherapy and breast surgery services from an initial two hospitals to 24 hospitals across the country. To improve affordability, the government is subsidizing the procurement of essential chemotherapy drugs for public facilities, with provisions for free access for the lowest-income patients. Recognizing the human resource gap, long-term plans are in place to train more oncology specialists, nurses, and pharmacists.

A recent milestone is the development of Ethiopia's first National Breast Cancer Guideline (2024-2028), created in alignment with the WHO Global Breast Cancer Initiative (GBCI), providing a structured framework for advancing breast cancer care. Furthermore, the National Health Policy is reportedly undergoing revision to better address current health challenges, including the NCD burden.

Contributions of International Organizations and NGOs: A multitude of international partners and NGOs are supporting Ethiopia's cancer control efforts:

• World Health Organization (WHO): Provides technical guidance on cancer control, supports the NCCP, and promotes initiatives like the GBCI. Ethiopia is also designated as a WHO CureAll Priority focus country for childhood cancer.

• International Atomic Energy Agency (IAEA): Through its "Rays of Hope" initiative, the IAEA is significantly involved in expanding access to radiotherapy services. This includes providing training for oncologists and medical physicists, facilitating the procurement and upgrading of radiotherapy equipment, offering technical cooperation, and supporting the Ethiopian Radiation Protection Authority in licensing new equipment. The IAEA has also donated equipment like CT simulators.

• Clinton Health Access Initiative (CHAI): CHAI collaborates extensively with the Ministry of Health to expand breast cancer services, focusing on clinician training, improving diagnostic capacity (including pathology), and strengthening the supply chain for cancer medicines. With support from the Global Fund, CHAI is also involved in procuring medical device maintenance, testing, and calibration tools, as well as power backup solutions (inverters) for critical diagnostic equipment like GeneXpert machines.

• Project C.U.R.E.: This organization has a long history of delivering containers of donated medical equipment and supplies to Ethiopia. A major ongoing initiative targets the Oromia region, aiming to deliver 40 containers of medical relief valued at approximately $16 million by 2025, in partnership with diaspora communities and local organizations like Haramaya University. Their C.U.R.E. Clinics program also provides medical training.

• The Global Fund to Fight AIDS, Tuberculosis and Malaria: While not primarily a cancer-focused agency, its funding mechanisms (e.g., C19RM) are being utilized to support broader health system strengthening, including the procurement of tools for medical device maintenance relevant to cancer care infrastructure.

• United States Agency for International Development (USAID): USAID has provided donations of general medical equipment to regions like Afar to restore basic health services. Its GHSC-PSM project works on improving the overall health commodity supply chain in Ethiopia. (It is noted that USAID funding globally has faced periods of uncertainty ).

• Other Key NGOs and Collaborations:

• Mathiwos Wondu Ethiopian Cancer Society (MWECS): A prominent local NGO providing patient support, distributing significant amounts of donated medical equipment (over $5 million worth), raising awareness, and working on health system strengthening for cancer and NCDs.

• American Cancer Society (ACS) and Norwegian Cancer Society (NCS): Have partnered with the Ethiopian government and CHAI on breast cancer care expansion programs.

• International Gynecologic Cancer Society (IGCS): Implements its Global Curriculum and Mentorship Program for gynecologic oncology fellows at Black Lion Hospital and St. Paul's Hospital in Addis Ababa.

• BEBIG Medical (formerly Eckert & Ziegler BEBIG): Installed a brachytherapy system (GyneSource afterloader) at Tikur Anbessa Hospital, as part of a UN aid program.

• Project HOPE: Works on broader health system strengthening, maternal and child health, and HIV care, which contributes to overall healthcare capacity.

These diverse initiatives reflect a growing recognition of the cancer burden and the need for concerted action. However, the success of these efforts, particularly the government's ambitious infrastructure projects, hinges on simultaneously addressing the deep-seated systemic issues of human resources, sustainable maintenance systems, and resilient supply chains. While international partnerships are crucial, their impact will be maximized if they are strategically coordinated with Ethiopia's national health priorities and contribute to building long-term, self-sufficient national capacity rather than creating isolated or temporary solutions. The "Rays of Hope" initiative and similar aid, for example, are vital for immediate relief and capacity building but must be leveraged to catalyze sustained domestic investment and comprehensive policy reforms to ensure the long-term viability of cancer control programs in Ethiopia.

Table 4: Overview of Major National and International Initiatives Supporting Cancer Care and Medical Device Access in Ethiopia

Initiative/Program Name

Lead Organization(s)

Key Objectives/Activities Related to Cancer Care & Medical Devices in Ethiopia

Reported Outcomes/Status (Illustrative)

Relevant Source IDs

Ethiopian Government Initiatives

National Cancer Control Plan (NCCP)

Ministry of Health (MoH), Ethiopia

Reduce cancer mortality; strategies for prevention, screening, early diagnosis, treatment, palliative care, research, surveillance. Targets for cervical/breast cancer.

Launched 2015; implementation challenges noted (funding, specialty care, EHRs). Under renewal/review.

New Regional Oncology Centers Construction

MoH, Ethiopia

Construct 6 new regional oncology centers (Addis Ababa, Gondar, Hawassa, Harar, Mekele); procure radiotherapy (Linacs, brachytherapy) & cryotherapy machines.

Ongoing construction; St. Paul's oncology center a major project. Aim to decentralize care.

Expansion of Chemotherapy & Surgery Services

MoH, Ethiopia

Expand chemo and breast surgery services from 2 to 24 hospitals nationwide. Subsidize chemotherapy procurement.

Significant increase in patient access reported.

National Breast Cancer Guideline (2024-2028)

MoH, Ethiopia

Provide structured framework for breast cancer care, aligned with WHO GBCI.

Launched July 2024.

International Organizations & NGOs

WHO Initiatives

World Health Organization (WHO)

Technical guidance, support for NCCP, Global Breast Cancer Initiative (GBCI), CureAll Priority focus country (childhood cancer).

Ongoing support and collaboration.

IAEA "Rays of Hope" & Technical Cooperation

International Atomic Energy Agency (IAEA)

Expand radiotherapy access (training, equipment procurement/upgrading), fellowships, equipment donation (CT simulator), support for licensing.

Ethiopia is a "Rays of Hope" recipient; ongoing training and equipment support. Aim for 9 functioning radiotherapy machines soon.

S27, S28,

CHAI Breast Cancer Program & Health System Strengthening

Clinton Health Access Initiative (CHAI), MoH, Global Fund, other partners

Expand breast cancer services (training, diagnostics, supply chain); procure medical device maintenance tools, inverters for diagnostics.

Breast cancer services expanded; procurement of maintenance tools underway.

Project C.U.R.E. Medical Relief

Project C.U.R.E., Diaspora groups, Haramaya University, Islamic Relief Canada/Ethiopia

Deliver containers of donated medical equipment and supplies (Oromia initiative: 40 containers, ~$16M); C.U.R.E. Clinics for training.

Oromia initiative ongoing (2024-2025); long history of deliveries.

Mathiwos Wondu Ethiopian Cancer Society (MWECS) Initiatives

MWECS

Patient support, equipment distribution (>$5M), health system strengthening, awareness for cancer & NCDs.

Ongoing projects in childhood cancer, breast cancer, etc.

IGCS Gynecologic Oncology Training

International Gynecologic Cancer Society (IGCS), Addis Ababa University

Global Curriculum and Mentorship Program for gynecologic oncology fellows at Black Lion & St. Paul's Hospitals.

Ongoing fellowship training.

VII. Strategic Recommendations for Enhancing Medical Device Access and Cancer Control in Ethiopia

Addressing the dual crisis of rising cancer incidence and critical medical device shortages in Ethiopia requires a comprehensive, multi-pronged strategy that targets systemic weaknesses and builds sustainable capacity. The following recommendations are proposed:

A. Strengthening Health System Governance and Policy for Medical Technology:

1. Policy Modernization and Integration: Prioritize the finalization and robust implementation of the revised National Health Policy. Concurrently, the National Medicine Policy must be comprehensively updated to include specific, actionable sections on Health Technology Management (HTM) that cover the entire lifecycle of medical devices. These policies should explicitly incorporate principles of Health Technology Assessment (HTA) to guide rational selection and investment.

2. Comprehensive National Medical Device Policy: Develop, legislate, and rigorously enforce a dedicated National Medical Device Policy. This policy must address all stages: needs assessment, evidence-based procurement, quality assurance, appropriate installation, user training, planned preventive maintenance, efficient utilization, calibration, repair, inventory management, and safe decommissioning/disposal, aligning with WHO guidelines and best practices.

3. Strengthened NCCP Implementation: Revitalize and adequately fund the National Cancer Control Plan, with clear, time-bound, and budgeted action plans specifically for medical device acquisition, equitable distribution based on epidemiological needs, and sustainable maintenance systems, particularly for newly established oncology centers.

4. Institutionalize Health Technology Assessment (HTA): Establish a functional, independent, and adequately resourced national HTA body. This entity should be mandated to provide evidence-based recommendations on the selection, procurement, and utilization of all health technologies, including cancer-related medical devices, ensuring cost-effectiveness, appropriateness for the Ethiopian context, and long-term sustainability.

B. Improving Medical Equipment Procurement, Maintenance, and Management Systems:

1. Demand-Driven Procurement: Transition from the current "push system" to a "pull" (needs-based) system for medical equipment procurement. This requires active involvement of health facilities (including biomedical and clinical end-users) in defining needs, developing technical specifications, and evaluating bids to ensure acquired technology aligns with actual service delivery requirements and capacity.

2. Robust Maintenance Infrastructure: Invest in establishing and equipping centralized and regional medical equipment maintenance workshops staffed by skilled biomedical engineers and technicians. Ensure consistent availability of genuine spare parts, consumables, and service contracts, especially for high-cost, complex equipment such as radiotherapy machines and advanced imaging systems.

3. Standardize Donated Equipment Protocols: Implement and enforce stringent national standards for all donated medical equipment. These standards must mandate that donations include comprehensive documentation (manuals in appropriate languages), a minimum period of spare parts supply, provision for operator and maintenance training, and demonstrable suitability and adaptability to the local infrastructure and technical capacity.

4. Optimize MEMIS Utilization: Mandate and support the full implementation and utilization of the Medical Equipment Management Information System (MEMIS) beyond basic inventory. MEMIS should be used for comprehensive lifecycle tracking, scheduling preventive maintenance, managing spare parts, analyzing utilization rates, and informing data-driven decision-making for future procurement and resource allocation.

5. Strengthen Supply Chain Resilience: Develop and implement strategies to improve the resilience of the supply chain for medical devices, spare parts, and essential consumables (e.g., pathology reagents, chemotherapy drugs). This includes advocating for strategic government prioritization in allocating foreign currency for essential health commodities and exploring pooled procurement mechanisms to enhance purchasing power and reduce costs.

C. Investing in Human Resource Development and Specialized Training:

1. National Oncology Workforce Strategy: Develop, fund, and implement a long-term national strategy to significantly increase the number of trained and retained oncologists (medical, radiation, surgical), pathologists, radiologists, medical physicists, radiotherapy technicians, biomedical engineers/technicians, and oncology nurses, with clear targets and timelines.

2. Strengthen Local Training Capacity: Invest in establishing and strengthening local training programs and curricula (e.g., for radiotherapy technicians, biomedical engineers specialized in oncology equipment) to ensure a sustainable pipeline of qualified professionals. Support international fellowships and advanced training selectively where local capacity does not yet exist.

3. Equipment-Specific Operator Training: Mandate and provide regular, certified, equipment-specific operational and basic maintenance training for all clinical and technical users of medical devices to ensure correct usage, minimize breakdowns, and enhance safety.

4. Rural Service Incentives: Develop and implement attractive incentive packages (financial and non-financial) to encourage the deployment and retention of specialized healthcare professionals, including those skilled in operating and maintaining cancer-related equipment, in rural and underserved areas.

D. Enhancing Financial Resource Mobilization and Allocation:

1. Increased Domestic Health Budget: Advocate for and secure a significant increase in the domestic budget allocation for NCDs, with a specific and protected line item for cancer control. This must include dedicated funding for medical device procurement, comprehensive maintenance contracts, operational costs, and essential consumables.

2. Innovative Financing Mechanisms: Actively explore and implement innovative financing mechanisms, including well-structured Public-Private Partnerships (PPPs), for the acquisition, management, and maintenance of high-cost cancer treatment equipment (e.g., radiotherapy units, advanced imaging systems), drawing lessons from existing models like the St. Paul's Hospital oncology center PPP.

3. Strategic Donor Engagement: Strengthen advocacy for sustained and predictable international donor support, ensuring that such aid is closely aligned with national cancer control priorities, contributes to health system strengthening, and includes provisions for long-term sustainability (e.g., maintenance, training, spare parts) beyond initial equipment provision.

4. Expansion of Health Insurance Coverage: Accelerate the expansion and strengthening of national and community-based health insurance schemes to comprehensively cover essential cancer diagnostics (including pathology and imaging) and treatments (including radiotherapy and chemotherapy), thereby reducing catastrophic out-of-pocket expenditures for patients and improving access to care.

E. Fostering Multi-Sectoral Collaboration and International Partnerships:

1. Enhanced National Coordination: Strengthen coordination mechanisms between the Ministry of Health, Ethiopian Pharmaceutical Supply Service, regional health bureaus, academic institutions, professional associations (e.g., pathology, oncology, radiology societies), and regulatory bodies to ensure a unified and coherent approach to medical device provision and cancer care delivery.

2. Leverage International Partnerships: Strategically leverage existing and new international partnerships (e.g., with WHO, IAEA, CHAI, Project C.U.R.E., academic institutions) for technical expertise, capacity building in HTM and clinical oncology, technology transfer, development of quality assurance programs, and collaborative research. Ensure these partnerships support national ownership and sustainability.

F. Prioritizing Early Detection, Awareness, and Patient Pathways:

1. Strengthen Primary Healthcare for Early Detection: Invest in equipping and training primary healthcare workers for cancer awareness promotion, identification of early signs and symptoms of common cancers like breast and prostate cancer, clinical breast examination, and facilitating timely and appropriate referral to diagnostic centers.

2. Decentralize Basic Diagnostics: Ensure the availability and functionality of essential basic diagnostic tools (e.g., ultrasound with appropriate probes, biopsy capabilities, basic laboratory tests) at district and regional hospital levels, with clear, efficient, and supported referral pathways for confirmatory diagnosis (e.g., pathology, advanced imaging) and subsequent treatment.

3. Targeted Public Awareness Campaigns: Design and implement culturally appropriate and sustained public awareness campaigns focusing on the early signs and symptoms of breast and prostate cancer, dispelling myths and misconceptions, highlighting the importance of early diagnosis, and informing the public about available screening and diagnostic services.

4. Improve Patient Navigation and Support: Establish and scale up patient navigation programs and psychosocial support services to guide patients through the complex referral pathway, reduce delays, minimize loss to follow-up, and address financial and logistical barriers to accessing care.

The successful implementation of these strategic recommendations necessitates a phased approach, prioritizing foundational elements such as policy reform, basic diagnostic and maintenance infrastructure development, and primary healthcare strengthening, either before or in parallel with large-scale procurement of highly advanced technology. Crucially, strong political will, sustained leadership from the Ministry of Health, and a transparent accountability framework—with defined metrics for tracking progress in medical device availability, functionality, and its impact on cancer patient outcomes—will be indispensable for translating these recommendations into tangible improvements in cancer care for the people of Ethiopia.

VIII. Conclusion

The growing burden of prostate and breast cancer in Ethiopia presents a formidable public health challenge, one that is critically amplified by a severe and pervasive lack of essential medical devices. This deficiency is not merely an absence of technology but is symptomatic of deep-rooted systemic failures in policy, procurement, maintenance, human resource capacity, and economic resilience. The consequences are stark: delayed diagnoses, compromised treatment efficacy, and unacceptably poor survival rates that place an immense burden on patients, families, and the nation's healthcare system.

The analysis presented in this report underscores the intricate web of factors contributing to this crisis. From outdated national health policies and fragmented equipment management guidelines to chronic shortages of specialized personnel and the crippling impact of foreign currency constraints, the challenges are multifaceted and interconnected. While the Ethiopian government and its international partners have initiated commendable efforts to expand oncology infrastructure and services, the scale of the problem demands a more profound and sustained strategic response.

However, the situation, though dire, is not immutable. The potential for transformative change exists if a concerted, holistic, and strategically implemented approach is adopted. The recommendations outlined offer a pathway towards strengthening Ethiopia's capacity to provide equitable and effective cancer care. This requires unwavering political will, robust leadership, and a commitment to long-term investment in health systems that can effectively select, procure, manage, maintain, and utilize medical technology.

Ultimately, addressing the medical device gap and improving cancer control in Ethiopia is an urgent imperative. It is an investment in human capital, a step towards health equity, and a critical component of achieving broader national development goals, including Universal Health Coverage and the Sustainable Development Goals. The time for decisive and coordinated action is now, to alleviate suffering, save lives, and offer hope to the thousands of Ethiopians affected by cancer each year.

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