Ngoma, T., Ngilangwa, R., Mujinja, P.G.M., Mackintosh, M. and Cross, C. (2023) 'Against the grain: reflections on decades of Tanzanian efforts to build better cancer care - and ways forward'. Presentation at Decolonizing Medicine in Africa and its Diaspora, Towson University, Towson, Maryland, USA. 21 - 24th September 2023.
This paper describes and reflects on some of the experiences of Professor Twalib Ngoma, a leading Tanzanian clinical oncologist and long-standing contributor to international debate on cancer care in low-resource countries. Professor Ngoma has worked with Tanzanian colleagues and international collaborators since 1990 to establish and improve cancer care services in Tanzania, including palliative care. He is a leading advocate for African countries to set their own cancer control agendas, with international agencies in a supporting role. These efforts have generally been “against the grain” of international priorities, given the strong international focus on transmissible diseases. While there is now increasing international recognition of the huge burden of non-communicable illness including cancer, international funding priorities have not yet shown a major shift. Prof. Ngoma is at the moment involved in International Global Health Catalyst initiatives and has also recently worked with Tanzanian and UK social science colleagues including co-authors of this paper on a project researching cancer care experiences of patients, health professionals and other stakeholders in Tanzania. The paper also summarises some findings of that project. The paper shows how local expertise and knowledge can drive transformative change within an African health care system. It discusses the challenge of decolonisation in terms of embedding contextually appropriate locally led strategies within internationally supported continuing efforts to improve cancer care in Tanzania and in Africa more broadly.