Akazi

Akazi (meaning ‘women’ in Chichewa), is a project designed to promote a systematic approach to breast cancer control in Malawi and to facilitate efficient utilisation of available resources in the country.

The project succeeded to identify gaps in breast cancer care, deliver Malawi’s first breast health training for frontline health workers, and raise awareness to reduce stigma and encourage earlier presentation, establishing an important foundation for improving breast cancer care.

Akazi 2 builds on this foundation by extending the focus from early detection and awareness to the entire breast cancer care pathway. The project aims to strengthen the continuum of care for breast cancer patients by working with national and local stakeholders to identify gaps and bottlenecks in the care pathway, develop practical recommendations and interventions, and reduce inequalities in access to breast health services in Malawi.

In sub-Saharan Africa, three women for every hundred die annually due to breast cancer. In Malawi, breast cancer is the third most-common cancer in women, with very low survival rates from the time of diagnosis (average of 5.6 months). Only 9.5% of patients survive beyond 18 months. Breast cancer remains one of the cancers with the greatest potential for avoidable mortality if women can access timely diagnosis and treatment.

Objectives

Akazi 2 has three aims:

Care pathway analysis

Akazi 2 will examine the full breast cancer care pathway in southern Malawi, identifying bottlenecks and gaps from initial presentation to diagnosis, referral, treatment and follow-up. This work will support the development of evidence-based recommendations for improving the organisation and delivery of services.

National breast cancer guidelines

The absence of a clear breast cancer pathway can contribute to delays, variation in practice and gaps in care for breast cancer patients. Akazi 2 will facilitate and support the drafting of national guidelines and protocols to strengthen the continuum of care for breast cancer patients. The aim is to support the delivery of effective, people-centred and equitable services through clearer and more consistent approaches to diagnosis, referral, treatment and follow-up.

Supportive interventions

Addressing gaps in breast cancer care requires practical solutions that are feasible, locally relevant and responsive to the needs of patients and health services. Akazi 2 will work collaboratively with local stakeholders to develop and test interventions for women at critical points in the care journey. Guided by local priorities and available resources, these interventions will aim to improve breast cancer care at community and health service levels, strengthen the continuum of care, and build stakeholder support for sustainable scale-up nationwide.

In addition, the Akazi 2 continues to support training of the primary healthcare workers in community-based environments and the delivery of breast health awareness activities in the communities expanding the project’s scope across the Blantyre region.

The project is a collaboration between RCSI, the Agency for Scientific Research and Training (ASRT) and Kamuzu University of Health Sciences, funded by the Irish Research Council COALESCE programme.

The RCSI team