# Global oncology and access in low- and middle-income countries

Source: https://onco.cc/technologies/global-oncology-access/  
OnCo record `global-oncology-access` (Technology). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Seventy percent of cancer deaths occur in low- and middle-income countries, where radiotherapy machines, pathologists, essential medicines and palliative care are scarce. Global oncology works on affordable, adapted care and the systems to deliver it.

## Summary

The Lancet Oncology Commissions (2010, 2015 radiotherapy GTFRCC, 2020 sustainable care) quantified the gaps: ~28 African countries have no radiotherapy, one pathologist per million people in parts of Africa, and cancer survival for children ~20% versus ~80% in high-income countries. Responses include the WHO Global Initiative for Childhood Cancer (2018, target 60% survival by 2030), the WHO Cervical Cancer Elimination Initiative (2020: 90-70-90 targets), the WHO Global Breast Cancer Initiative, the WHO Essential Medicines List for cancer (updated 2023-25 to include trastuzumab, PD-1 inhibitors), the Access to Oncology Medicines Coalition (ATOM, UICC/2022), pooled procurement (St Jude-WHO Global Platform for childhood cancer medicines, delivering to 50 countries from 2025), differential pricing and generic/biosimilar entry, treatment protocols adapted for resource levels (NCCN Harmonized Guidelines for Africa, SIOP PODC), twinning programmes, telepathology and AI-assisted screening, and workforce training (AORTIC, ASCO International). Rays of Hope (IAEA, 2022) targets radiotherapy expansion. Cancer is increasingly part of universal health coverage debates.

## Fields

- Kind: Technology
- Status: emerging
- Last checked: 2026-09-08
- Tags: gap-fill; equity; global
- Principle: Match the delivery system to the resource level without abandoning evidence: prioritise high-cure, low-cost interventions (cervical screening/vaccination, childhood cancer protocols, essential chemotherapy and surgery, palliative care) while building pathology, radiotherapy and workforce capacity.
- Strengths: Large, cheap gains available (HPV vaccination, childhood ALL, Wilms, Burkitt, cervical screening); Pooled procurement and biosimilars are lowering prices; International targets create accountability
- Limitations: Financing and workforce shortfalls dwarf aid flows; Cancer under-prioritised relative to infectious disease; Data systems (registries) weak; late presentation common

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Global_health
- WHO Global Initiative for Childhood Cancer: https://www.who.int/initiatives/the-global-initiative-for-childhood-cancer
- Lancet Oncology Commission: radiotherapy (2015): https://doi.org/10.1016/S1470-2045(15)00222-3
- UICC ATOM Coalition: https://www.uicc.org/what-we-do/thematic-areas/access-oncology-medicines-atom-coalition

## Connected records

- technologies: [After treatment in low and middle income countries: mostly nothing](https://onco.cc/technologies/rejuv-access-survivorship-care-lmic/), [Biosimilar manufacturing and comparability](https://onco.cc/technologies/biosimilar-manufacturing/), [Cobalt-60 teletherapy](https://onco.cc/technologies/cobalt-60-teletherapy/), [Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood)](https://onco.cc/technologies/colorectal-screening/), [Early integrated palliative care](https://onco.cc/technologies/palliative-care/), [Hand-held and point-of-care ultrasound](https://onco.cc/technologies/hand-held-ultrasound/), [HPV & HBV vaccination](https://onco.cc/technologies/hpv-vaccine/), [Oncology nursing and nurse-led care](https://onco.cc/technologies/oncology-nursing/), [Radiotherapy access and the global machine gap](https://onco.cc/technologies/radiotherapy-access-gap/), [Telehealth and hospital-at-home in oncology](https://onco.cc/technologies/telehealth-oncology/), [Visual inspection with acetic acid (VIA) for cervical screening](https://onco.cc/technologies/via-cervical-screening/), [What recovery costs in the rest of the world](https://onco.cc/technologies/rejuv-access-what-it-costs-elsewhere/), [Where rehabilitation is commissioned, and who misses out](https://onco.cc/technologies/rejuv-rehab-commissioning-inequity/)
- cancers: [Acute lymphoblastic leukaemia](https://onco.cc/cancers/all-leukemia/), [Burkitt lymphoma](https://onco.cc/cancers/burkitt-lymphoma/), [Cervical cancer](https://onco.cc/cancers/cervical/), [Hepatocellular carcinoma](https://onco.cc/cancers/hcc/), [HIV-associated (AIDS-related) lymphomas](https://onco.cc/cancers/hiv-associated-lymphoma/), [Kaposi sarcoma](https://onco.cc/cancers/kaposi-sarcoma/), [Oesophageal cancer](https://onco.cc/cancers/esophageal/), [Retinoblastoma](https://onco.cc/cancers/retinoblastoma/), [Wilms tumour (nephroblastoma)](https://onco.cc/cancers/wilms-tumor/)
- fronts: [Prevention & Risk](https://onco.cc/fronts/prevention/), [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- institutions: [Advanced Centre for Treatment, Research and Education in Cancer](https://onco.cc/institutions/actrec/), [All India Institute of Medical Sciences, New Delhi](https://onco.cc/institutions/aiims-delhi/), [Butaro Cancer Center of Excellence](https://onco.cc/institutions/butaro-cancer-center/), [Cancer Institute (WIA), Adyar](https://onco.cc/institutions/cancer-institute-adyar/), [Cancer Institute of Iran, Imam Khomeini Hospital Complex](https://onco.cc/institutions/tehran-cancer-institute/), [Charlotte Maxeke Johannesburg Academic Hospital / University of the Witwatersrand](https://onco.cc/institutions/wits-charlotte-maxeke/), [Children's Cancer Hospital Egypt 57357](https://onco.cc/institutions/cche-57357/), [Christian Medical College, Vellore](https://onco.cc/institutions/cmc-vellore/), [Dharmais National Cancer Center](https://onco.cc/institutions/dharmais-cancer-hospital/), [Groote Schuur Hospital / University of Cape Town](https://onco.cc/institutions/groote-schuur-uct/), [Ho Chi Minh City Oncology Hospital](https://onco.cc/institutions/hcmc-oncology-hospital/), [Homi Bhabha Cancer Hospital and Mahamana Pandit Madan Mohan Malaviya Cancer Centre, Varanasi](https://onco.cc/institutions/homi-bhabha-cancer-hospital-varanasi/), [Hospital de Amor (Barretos Cancer Hospital)](https://onco.cc/institutions/hospital-de-amor-barretos/), [Institut National d'Oncologie, Rabat](https://onco.cc/institutions/institut-national-oncologie-rabat/), [Institut Salah Azaïez](https://onco.cc/institutions/institut-salah-azaiez/), [Instituto Nacional de Câncer (INCA)](https://onco.cc/institutions/inca-brazil/), [Instituto Nacional de Cancerología (Colombia)](https://onco.cc/institutions/inc-colombia/), [Instituto Nacional de Cancerología (Mexico)](https://onco.cc/institutions/incan-mexico/), [Instituto Nacional de Enfermedades Neoplásicas](https://onco.cc/institutions/inen-peru/), [International Agency for Research on Cancer (IARC / WHO)](https://onco.cc/institutions/iarc/), [Kenyatta National Hospital](https://onco.cc/institutions/kenyatta-national-hospital/), [Kidwai Memorial Institute of Oncology](https://onco.cc/institutions/kidwai-memorial-institute-of-oncology/), [King Hussein Cancer Center](https://onco.cc/institutions/khcc/), [Korle Bu Teaching Hospital](https://onco.cc/institutions/korle-bu-teaching-hospital/), [Lagos University Teaching Hospital](https://onco.cc/institutions/luth-lagos/), [National Cancer Grid of India](https://onco.cc/institutions/national-cancer-grid/), [National Cancer Institute, Cairo University](https://onco.cc/institutions/nci-cairo/), [National Health Authority (Ayushman Bharat PM-JAY)](https://onco.cc/institutions/nha-pmjay/), [Ocean Road Cancer Institute](https://onco.cc/institutions/ocean-road-cancer-institute/), [Philippine General Hospital](https://onco.cc/institutions/philippine-general-hospital/), [Tata Medical Center, Kolkata](https://onco.cc/institutions/tata-medical-center-kolkata/), [Tata Memorial Centre](https://onco.cc/institutions/tata-memorial/), [The new AIIMS network (PMSSY)](https://onco.cc/institutions/aiims-network/), [Uganda Cancer Institute](https://onco.cc/institutions/uganda-cancer-institute/), [Vietnam National Cancer Hospital (K Hospital)](https://onco.cc/institutions/k-hospital-hanoi/)
- terms: [Cancer health disparities and equity](https://onco.cc/terms/cancer-health-disparities/), [China National Reimbursement Drug List negotiation and volume-based procurement](https://onco.cc/terms/china-vbp-nrdl/), [India New Drugs and Clinical Trials Rules 2019](https://onco.cc/terms/india-new-drugs-rules-2019/), [Nexavar compulsory licence (India, 2012)](https://onco.cc/terms/nexavar-compulsory-licence/), [Novartis v. Union of India (Glivec, 2013)](https://onco.cc/terms/novartis-glivec-ruling/), [Oncology drug pricing and price transparency](https://onco.cc/terms/drug-price-transparency/), [Oncology workforce](https://onco.cc/terms/oncology-workforce/), [TRIPS Agreement and the Doha Declaration](https://onco.cc/terms/trips-doha/), [WHO Essential Medicines List for cancer](https://onco.cc/terms/who-essential-medicines/)
- key papers: [A National Cancer Grid pooled procurement initiative, India](https://onco.cc/key-papers/paper-pramesh-ncg-pooled-procurement-2023/), [Expanding global access to radiotherapy](https://onco.cc/key-papers/paper-atun-lancet-oncol/)
- people: [C. S. Pramesh](https://onco.cc/people/pramesh-c-s/), [Devi Shetty](https://onco.cc/people/shetty-devi/), [V. Shanta](https://onco.cc/people/shanta-v/)
- trials: [Kerala oral cancer visual screening trial (Trivandrum)](https://onco.cc/trials/kerala-oral-screening/)
- roadmaps: [Global access and affordability roadmap: essential medicines and generics → biosimilars and frugal trials → reliance, pooling and homegrown innovation](https://onco.cc/roadmaps/global-access-roadmap/)
- companies: [Butterfly Network](https://onco.cc/companies/butterfly-network/)

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