Ghana's Indo-African Oncology Institute: Building Cancer Care Sovereignty

A BOOT Partnership Transforming Oncology Access in West Africa

The Challenge: Cancer Burden Without Capacity

Ghana, like much of sub-Saharan Africa, faces a rapidly growing cancer crisis with virtually no local capacity to respond. Projections from GLOBOCAN indicate that cancer cases in Africa will double by 2040, yet the continent has fewer than 5% of the world’s radiotherapy machines and critically limited oncology expertise.

For Ghanaian cancer patients, the reality is stark:

  • Late-stage diagnosis: 70% of cancers detected at stage 3-4
  • Medical migration: 40% of patients with treatable cancers travel to South Africa, India, or Europe for care
  • Limited local treatment: Fewer than 3 oncologists per 10 million population
  • High costs: A single course of cancer treatment can cost $5,000-$50,000 USD, far exceeding household incomes
  • Preventable mortality: Cancers like cervical, breast, and colorectal—which are 80-90% preventable or treatable—claim thousands of lives annually

Ghana’s Ministry of Health recognized that incremental approaches would not suffice. The nation needed transformative infrastructure, integrated supply chains, and long-term capacity building—backed by sustainable financing and international expertise.

The CARE9 Solution: Build-Own-Operate-Transfer (BOOT)

In 2023, CARE9 Global and Ghana’s Directorate of Integrated Healthcare Operations (DIHOC) entered into a landmark partnership to establish a 250-bed Indo-African Oncology Institute (IAOI) in Accra. The project represents the first large-scale BOOT partnership for specialty healthcare infrastructure in West Africa.

Partnership Structure

Model: BOOT (Build-Own-Operate-Transfer)

  • Timeline: 24-30 month construction, 20-30 year operational concession, transfer to government thereafter
  • Investment: $80-120 million
  • Capital Stack:
    • DFI debt: 55% (IFC, AfDB, Proparco)
    • Export credit finance: 25% (EXIM Bank India)
    • Sponsor equity: 15% (CARE9 + local co-investors)
    • Donor support: 5% (viability gap funding from Gates Foundation, Global Fund)

Governance

CARE9 operates under:

  • Joint Steering Committee (Ghana MoH + CARE9 + DFI partners + donor representatives)
  • Performance-linked KPIs and quarterly reporting
  • Annual independent clinical and financial audits
  • Knowledge transfer roadmap ensuring Ghana’s ownership post-concession

Infrastructure & Clinical Architecture

The IAOI Accra facility will house:

Radiation Oncology (40% of operational capacity)

  • 2 Linear Accelerators (LINACs) with IMRT/VMAT capabilities for complex tumor treatment
  • Brachytherapy units for gynecological and urological cancers
  • Treatment planning systems with 3D imaging and dose optimization
  • Radiopharmacy for isotope handling and quality control
  • Shielded radiation protection zones meeting IAEA standards

Medical Oncology (35% of capacity)

  • 50+ chemotherapy day-care chairs with infusion protocols and patient monitoring
  • Oncology ICU for managing treatment complications
  • Bone marrow transplant unit for blood cancers
  • Palliative care ward providing symptom management and end-of-life care
  • Cytotoxic drug reconstitution suite with isolation and safety protocols

Surgical Oncology (15% of capacity)

  • Dedicated oncology operation theaters with intraoperative imaging
  • Minimally invasive and robotic-assisted surgery capabilities
  • Reconstructive surgery units (breast, head & neck)
  • 24/7 emergency oncology services

Diagnostic & Laboratory (20% of functions)

  • PET-CT and 3T MRI for precision staging and treatment planning
  • Molecular oncology labs with Next Generation Sequencing (NGS)
  • Liquid biopsy capabilities for monitoring treatment response
  • Immunohistochemistry and advanced pathology for tumor characterization
  • AI-enabled image analysis for radiomics and early detection

Digital Integration via CARE9 HIMS

  • Complete electronic medical records and e-prescriptions
  • Tele-oncology platform for rural consultations and international collaboration
  • National cancer registry for epidemiological research and policy planning
  • Mobile screening units for community-based early detection programs

Oncology Drug Supply Chain

A critical innovation is CARE9’s vertical integration of oncology pharmaceuticals, ensuring uninterrupted supply of cancer medicines—typically Ghana’s most significant procurement challenge.

Sourcing & Manufacturing

  • Partnership with WHO-GMP, USFDA, EMA manufacturers in India, Europe, and ASEAN
  • Dedicated supply agreements for high-cost molecules: trastuzumab, paclitaxel, doxorubicin, oxaliplatin, bevacizumab, pemetrexed
  • In-house CDMO capabilities for critical generic oncology injectables
  • Access to donor-funded pipelines (Global Fund, GAVI, UNITAID)

Delivery & Traceability

  • CARE9 Verified® platform ensuring batch-level traceability from manufacturer to patient
  • Cold chain storage (2-8°C and -20°C) with remote temperature monitoring
  • AI-driven inventory planning linked to prescription loads and patient outcomes
  • 100% stock availability promise backed by performance-linked SLAs

Financial Model

  • Long-term procurement agreements (LTPAs) with Ghana’s National Health Insurance Authority (NHIA)
  • Blended payment model: NHIA covers 70% of costs, patient co-pays 15%, institutional support 15%
  • Outcomes-linked pricing for new molecular therapies
  • Donor support for uninsured patients requiring life-saving drugs

Workforce Development & Knowledge Transfer

CARE9 recognizes that infrastructure without expertise will fail. The partnership includes comprehensive capacity building:

Oncology Fellowship Programs

  • 2-year Indo-African fellowship for 15-20 Ghanaian physicians in Medical, Radiation, and Surgical Oncology
  • Rotations through leading centers in India and internationally recognized programs
  • Return-of-service agreements ensuring Fellows work at IAOI Accra for minimum 5 years

Specialist Training

  • Nursing specialization in cancer care and chemotherapy administration
  • Radiotherapy technician certification with hands-on LINAC training
  • Pathology and molecular diagnostics training for lab staff
  • Hospital management and administrative leadership programs

Research Capacity

  • Introduction to clinical trial design and real-world evidence generation
  • Molecular oncology and translational research methods
  • Health economics and outcomes research to support local policy

Training Impact (Target by 2028)

  • 20+ Oncologists trained in Ghana
  • 200+ Nursing and technical staff certified in oncology care
  • 500+ Healthcare workers across regional hospitals trained in supportive care
  • 10+ Indigenous clinical trials launched at IAOI Accra

Patient Impact & Clinical Outcomes

Projected Annual Services (at full operation, Year 3-5)

  • 100,000+ cancer patients screened via mobile units and community programs
  • 10,000+ new cancer cases treated per year
  • 250+ oncology beds operational with ~90% average occupancy
  • 1000+ direct jobs created (physicians, nurses, technicians, support staff)
  • 1500+ indirect jobs in supply chain, logistics, security, and facilities

Medical Outcomes Targets

  • 80%+ of cases diagnosed at stage 1-2 (vs. 30% baseline in Ghana)
  • 30-40% reduction in outbound medical travel
  • 5-year survival rates approaching international standards (70%+ for treatable cancers)
  • Zero out-of-pocket catastrophic costs for NHIA-covered patients

Regional Expansion

IAOI Accra serves as the flagship for West African expansion:

Phase 2 (2025-2026)

  • IAOI Lagos, Nigeria: 300-bed comprehensive oncology center
  • Oncology hubs in Côte d’Ivoire and Senegal
  • Regional diagnostic networks supporting primary and secondary care

Phase 3 (2026-2028)

  • IAOI expansion to East Africa (Kenya, Tanzania)
  • Southern Africa presence (Zimbabwe, Zambia)
  • Target: 1000+ oncology beds operational across 6+ countries by 2028

Financial Sustainability

The IAOI model is designed for long-term financial health:

Revenue Streams

  • Government long-term agreements with Ghana’s NHIA (~50% of revenue)
  • National health insurance reimbursements from beneficiaries
  • Corporate partnerships and employer-sponsored programs
  • International patient services (medical tourism) for non-emergency procedures
  • Training and certification programs for healthcare professionals regionally
  • Research collaborations and clinical trials with pharmaceutical companies

Cost Structure

  • Operations by Year 3: Break-even on operating costs
  • Debt service manageable through bundled, outcome-linked pricing
  • Path to full government ownership: Transfer to Ghana’s MoH after 25-year concession with fully trained, sustainable operations

Knowledge Transfer & Local Ownership

A defining feature of the CARE9-Ghana partnership is its commitment to building permanent, locally-owned capacity:

Governance Transition

  • Years 1-5: Joint operational governance with CARE9 in lead role
  • Years 5-10: Gradual transition of clinical leadership to Ghanaian physicians
  • Years 10-25: Ghanaian leadership across all functions with CARE9 in advisory role
  • Year 25+: Full transfer to Ghana’s government with sustainable, independent operations

Documentation & Protocols

  • All clinical protocols, SOPs, and systems documented in digital formats
  • Regular audit and update of protocols based on international guidelines
  • Continuous training of Ghanaian staff in system management and improvement
  • Access to CARE9’s global network of oncology experts for ongoing consultation

The Broader Impact: Building African Oncology Sovereignty

Ghana’s IAOI partnership exemplifies a new model for emerging market healthcare:

It is not about delivering charity or short-term aid. It is about building sovereign, sustainable capacity that serves populations equitably, generates local employment, attracts investment, and strengthens national health systems.

The partnership demonstrates that with the right model—integrating infrastructure, finance, expertise, supply chain, and governance—emerging markets can leapfrog the century-long journey developed nations took to build cancer care capacity.

By 2028, Ghana will have:

  • Local expertise in all oncology specialties
  • World-class infrastructure competing with international centers
  • Affordable access through insurance and subsidy integration
  • Research capacity generating African-focused evidence
  • Export potential training specialists for the broader African continent

Lessons for Other Emerging Markets

For other African nations, Latin American countries, and emerging markets considering similar partnerships:

  1. Infrastructure requires integrated financing: Mix of DFI debt, export credit, equity, and donor support
  2. Supply chain is non-negotiable: Integrated pharmaceutical sourcing eliminates the #1 failure point
  3. Workforce development from day one: Infrastructure without experts fails; expertise requires long-term commitment
  4. Data and governance matter: Joint committees, performance KPIs, and transparency build trust
  5. Design for transfer: Build local capacity and systems for eventual government ownership

What’s Next?

CARE9 and Ghana are currently:

  • Site finalization and regulatory approvals (Q4 2024 - Q1 2025)
  • Global consortium mobilization for DFI and export credit finance
  • Selection of international clinical partners for knowledge transfer
  • Recruitment of Ghanaian clinical leadership for fellowship training
  • Community engagement and awareness campaigns for screening and early detection

Construction is slated to begin in Q2 2025, with operational launch in Q4 2026.

Conclusion

Ghana’s Indo-African Oncology Institute represents more than a new hospital. It represents a fundamental shift in how emerging markets can achieve healthcare sovereignty—through strategic partnerships grounded in finance, expertise, technology, and sustained commitment to local ownership.

For Ghana, it means that within 5 years, a patient diagnosed with cancer will receive world-class treatment without having to leave the country. For Africa, it means that the burden of the continent’s cancer crisis is no longer a question of “if” local capacity will exist—but “when” and “where” it will be built.

CARE9 is proud to be the partner in this transformation.

Contact: For partnerships, procurement, or program inquiries: Email: ghana@care9global.com | Phone: +233 (0) 302 760 000