Abstract:
PURPOSE The eastern corridor of Africa is affected by a high burden of esophageal cancer (EC), with . 90% of
patients presenting with advanced disease. Self-expanding metal stents (SEMS) have been previously reported
as safe and effective for palliation of malignant dysphagia in resource-limited settings; however, access is limited
throughout Eastern Africa.
METHODS In response to demand for palliative interventions for patients with dysphagia because of EC, the
African Esophageal Cancer Consortium (AfrECC) partnered with the Clinton Health Access Initiative to improve
access to SEMS in Eastern Africa. We undertook a stepwise implementation approach to (1) identify barriers to
SEMS access, (2) conduct a market analysis, (3) select an industry partner, (4) establish regulatory and
procurement processes, (5) develop endoscopic training resources, (6) create a medical device registry, and (7)
establish principles of accountability.
RESULTS Following an evaluation of market demand and potential SEMS manufacturers, Boston Scientific
Corporation announced its commitment to launch an access program to provide esophageal SEMS to patients in
Tanzania, Kenya, Malawi, and Zambia at a subsidized price. Parallel regulatory and procurement processes
were established in each participating country. Endoscopy training courses were designed and conducted,
using the Training-of-Trainers model. A device registry was created to centralize data for quality control and to
monitor channels of SEMS distribution. Principles of accountability were developed to guide the sustainability of
this endeavor.
CONCLUSION The AfrECC Stent Access Initiative is an example of a multisector partnership formed to provide an
innovative solution to align regional needs with a supply chain for a high-priority medical device.
