Poor cancer facility design costs govt millions

Government has hired new architects, STUP Consultants Indian, to redesign the National Cancer Centre (NCC) bunkers to house radiotherapy and brachytherapy treatment facilities at a cost of K465 million, Nation on Sunday has learnt.

In a written response to a questionnaire, Ministry of Health (MoH) head of health infrastructure development Sanderson Kuyeli confirmed the development, saying they signed a contract with a new consultant this year after the previous designs failed to meet the International Atomic Energy Agency (IAEA) requirements.

The cancer centre in Lilongwe, which started operating recently, has not been offering radiotherapy and brachytherapy services due to lack of facilities; hence, patients have been lining up for government support to access such treatment in India.

Kuyeli said the initial bunker designs were lacking some finer details and the construction plan was not properly done.

He said: “When the construction of the bunkers was halted due to the discovery of the technical faults, the contract for the consultant was coming to an end and it was difficult for the consultant to continue with the work since it had taken a substantial amount of time for the situation to be rectified.

“When the initial contract with the consultant ended, we still needed proper designs and a consultant to supervise the works as they are not done. This is when the ministry engaged another consultant to do the work. It is just unfortunate that the procurement of the current consultant took long to be completed.”

Kuyeli said the previous consultant was responsible for the designs of the whole cancer centre, but was not paid for the bunkers designs.

He painted a grave picture as regards to the implications of unavailability of radiotherapy services: “In terms of cancer incidence and deaths, Malawi currently ranks highly and is second highest in some types of cancers.

“It should be noted that the brachytherapy is most often used to treat cancers of the head and neck, breast, cervix, prostate and eye. In addition, the radiotherapy is most often used to treat certain types of thyroid cancer and advanced prostate cancer or gastroenteropancreatic neuroendocrine tumours.”

Kuyeli indicated that the bunker designs will be ready in six weeks while their construction will have been completed by mid-next year.

Explained Kuyeli: “The consultant produced the inception report which was accepted by the ministry. The ministry is working in close collaboration with all the relevant stakeholders and regulatory bodies such as the Malawi Atomic Energy Regulatory Authority and the IAEA. This stage will also include certification processes of the bunker designs.

“This is a crucial stage because bunkers are not any ordinary building. They house highly radioactive equipment and any micro crack in the structure means the whole structure is rendered useless.

“By June next year, the bunkers would have been completed and by end of that year, all the equipment installed and the facility will be functional. I should mention that the procurement of equipment is being coordinated by the IAEA and the funds were already made available both by government and Opec Fund for International Development.”

Terrastone Construction Limited, who were hired to construct the cancer centre and the bunkers, said they abandoned the project site three years ago.

In an interview on Thursday, the company’s managing director Jose Da Costa said the designs were made by South African architects.

He said: “We were hired to construct the cancer centre and in that were the two bunkers. We started construction of the bunkers with excavations and foundations. Thereafter we were asked to stop. But the designs were made by some architects from South Africa.”

Meanwhile, MoH director of clinical service George Chithope-Mwale said each foreign cancer referral costs taxpayers $10 000 (over K8 million).

He said in a response to a questionnaire yesterday: “Cancer management may involve surgery, chemotherapy and/or radiotherapy. The cancer cases that we send abroad require cycles of radiotherapy because we don’t have this service in Malawi. Government spends not less than $10 000 (about K8.2 million) on each case requiring radiotherapy.”

In a separate interview, health activist Maziko Matemba said failure by the previous consultant to draft proper designs is a major setback.

“This is a serious project that required thorough assessment of the consulted,” he said.

Matemba, who is the executive director of Health and Rights Education, has since asked government to ensure the project is finalised next year as planned.

“We are spending millions to have people access radiotherapy treatment in India when we can do it on our own,” he said.

While the Health Ministry was coy to provide information on foreign referrals’ expenditure, Matemba said his organisation has been tracking the budgetary allocation which falls between K500 million and K700 million annually.

Lack of bunkers has resulted in the delay to install a multi-million kwacha hi-tech cancer treatment machine, known as Bhabhatron-II, which India donated to Malawi four years ago and it lies idle in the Asian nation.

The machine, , is used for radiation therapy, a treatment that uses high doses of radiation to kill cancer cells and shrink tumors.

NCC head Richard Nyasosela in an earlier interview stated that government refers between 20 and 50 to India for radiotherapy annually “depending on Ministry of Health annual budget”.

He said the cancer centre is treating 6 000 patients, of which over 4 000 require radiotherapy.

The cancer centre, as outlined in the 10-year National Cancer Control Strategic Plan 2019-29, was supposed to be fully operational two years ago.