Background and Context
Colorectal cancer is a growing public health concern in Nigeria. It now accounts for around 6.4% of all cancers in the country, with nearly 5,900 deaths annually attributed to the disease. Despite this, access to modern cancer care remains limited. Innovations like immunotherapy, molecular diagnostics, and precision oncology are often concentrated in high-income countries, while low- and middle-income nations (LMICs) face major infrastructure and affordability challenges.
In recent years, however, Nigeria has made notable progress. The government has launched the National Institute for Cancer Research and Treatment (NICRAT) and the National Strategic Cancer Control Plan (2023–2027). These initiatives signal growing political will to strengthen cancer services nationwide.
Against this backdrop, a new Global Initiative for Operational Excellence seeks to bridge the gap between innovation and access. The goal is simple yet ambitious — to deliver world-class immunotherapy for metastatic colorectal cancer (mCRC) in Nigeria and demonstrate that such care is feasible, sustainable, and effective in lower-resource settings.
About the Initiative
The program, known as the Immunotherapy Care Model (ICM) Initiative, is a collaboration among the Clinton Health Access Initiative (CHAI), the Parker Institute for Cancer Immunotherapy (PICI), and pharmaceutical and diagnostic partners such as Bristol Myers Squibb (BMS) and Roche.
Implemented at the National Hospital Abuja, the project was officially launched in October 2025, with the first patient enrolled shortly after. Unlike a drug trial, this effort focuses on operational excellence — proving that approved immunotherapy drugs, such as nivolumab, can be safely and effectively introduced in Nigeria.
Over two years, the project aims to build infrastructure, train medical teams, strengthen diagnostics, and deliver comprehensive patient care — from screening and diagnosis to therapy and follow-up.
Core Objectives
- Operational Excellence: Show that modern immunotherapy and diagnostics can be delivered in Nigeria with high quality and safety.
- Health Systems Strengthening: Build the capacity of National Hospital Abuja to manage complex oncology cases, including diagnostic testing and adverse-event management.
- Equity of Access: Ensure that such advanced therapies are not limited to the wealthy; every patient should have equal access regardless of income or location.
- Evidence Generation: Collect real-world data on cost, logistics, and outcomes to guide future national expansion.
- Model for Scale: Create a framework that can be replicated across Africa and other LMICs.
Why Metastatic Colorectal Cancer?
Metastatic colorectal cancer (mCRC) presents a severe health burden in Nigeria. Many patients are diagnosed late, leaving few treatment options and poor survival outcomes. Globally, immunotherapy has revolutionized care for patients with microsatellite instability-high (MSI-H) tumours, yet such treatment remains largely unavailable in Africa.
By focusing on mCRC, the initiative addresses both an equity gap and an outcomes gap. It also serves as a test case for Nigeria’s broader readiness to deliver precision medicine. Colorectal cancer management involves surgery, pathology, oncology, and radiology — making it a valuable model for strengthening entire health systems.
Implementation Design
1. Diagnostics and Patient Selection:
Eligible patients are screened for MSI status using Roche’s Ventana diagnostic platform at National Hospital Abuja. This testing determines suitability for nivolumab therapy.
2. Treatment and Care Delivery:
Patients with MSI-H tumours receive nivolumab at no cost, along with full follow-up, toxicity management, and supportive care.
3. Health Systems Capacity Building:
Training covers oncology nursing, pathology, pharmacovigilance, and logistics. The initiative strengthens supply chains, patient navigation, and data management systems.
4. Monitoring and Evaluation:
Over 24 months, outcomes such as treatment response, side effects, turnaround times, and cost-drivers will be tracked to evaluate feasibility and cost-effectiveness.
Challenges Ahead
While the initiative is promising, it faces significant challenges:
- Late Diagnosis: Most Nigerian patients present with advanced disease, limiting the effectiveness of any therapy.
- Infrastructure Gaps: Many facilities still lack molecular diagnostics and specialized staff.
- Sustainability: The project currently covers costs, but long-term financing will depend on government and insurance support.
- Supply Chain Reliability: Maintaining a steady flow of immunotherapy drugs and diagnostic reagents requires strong logistics and regulatory efficiency.
- Public Awareness: Limited awareness and stigma surrounding cancer reduce early detection and participation in treatment programs.
Impact for Nigeria
If successful, the initiative could transform cancer care in Nigeria. It would prove that high-standard oncology services can be delivered locally rather than abroad, reducing medical tourism and costs. The strengthened capacity at National Hospital Abuja could serve as a national training and research hub, spurring expansion to regional centres.
Moreover, the project could attract further investment and policy attention. By showing that immunotherapy works in Nigeria, the program may convince policymakers to increase cancer funding and integrate advanced care into public health systems.
Broader Global Significance
For global health, the initiative demonstrates how public-private partnerships can close the cancer-care divide. If it succeeds, it will serve as a model for other LMICs seeking to introduce immunotherapy and precision medicine.
Beyond patient treatment, the data collected will enrich global oncology research, offering insights into cancer biology, treatment tolerability, and cost structures in African populations.
The project may also inspire new financing approaches—for instance, pooled procurement or outcome-based reimbursement—to sustain access to high-cost therapies in low-resource settings.
Stakeholder Perspectives
- Dr. Abubakar Bello, Principal Investigator at National Hospital Abuja, stated:
“This project will prove that with the right investment, Nigeria can deliver innovative cancer care to world standards.” - Dr. Adekunle Iziaq Salako, Minister of State for Health, emphasized:
“This milestone demonstrates our institutions’ readiness to deliver advanced cancer treatment and strengthen local expertise.” - Dr. Olufunke Fasawe, Vice President of CHAI Nigeria, added:
“Operational excellence is possible anywhere when health systems are properly supported.” - Jasmine Greenamyer of Bristol Myers Squibb reinforced equity, saying that geography should never determine access to life-saving medicine.
Measuring Success
Success will depend on several tangible outcomes:
- Completion of patient enrolment and adherence to treatment protocols.
- Reliable diagnostics with quick turnaround.
- Safe and effective administration of nivolumab with positive response rates.
- Strong data collection and transparent reporting.
- Institutional strengthening at National Hospital Abuja.
- Policy uptake to expand access across Nigeria and possibly West Africa.
Risks and Mitigation
To prevent drop-outs, patient navigation teams will ensure follow-up and provide transport or counseling support.
Supply chain risks will be mitigated by buffer stocks and partnerships with global logistics providers.
Financial sustainability will rely on early cost analysis and engagement with Nigeria’s National Health Insurance Authority.
Training, mentorship, and telemedicine support will address workforce shortages.
Public awareness campaigns will promote early detection and community engagement.
Looking Forward
If the project meets its goals, Nigeria could emerge as a regional hub for cancer innovation in West Africa. The model could then extend to other cancers such as lung or melanoma, or to other LMICs.
By embedding research, training, and system improvement into care delivery, the initiative will leave a lasting impact beyond oncology — strengthening Nigeria’s overall health infrastructure.
Conclusion
The Global Initiative for Operational Excellence in Nigeria for Metastatic Colorectal Cancer Patients represents more than a pilot program. It is a proof of concept that innovation, equity, and sustainability can coexist in healthcare.
With effective collaboration between government, NGOs, and the private sector, Nigeria is taking a bold step toward reducing cancer mortality and reshaping how advanced medical care is delivered in developing regions.
If it succeeds, this initiative could become a blueprint for equitable cancer treatment across Africa — and a testament that world-class care is achievable everywhere.
