Across sub-Saharan Africa, cancer mortality remains disproportionately high, driven in part by delayed diagnosis and limited access to timely treatment. With cancer deaths projected to increase significantly by 2040, health systems across the region face growing pressure to strengthen early detection and continuity of care.
In Botswana, breast cancer is now among the leading cancers affecting women, with many patients still presenting at advanced stages of disease. The trend mirrors a broader regional rise in non-communicable diseases, placing increasing pressure on oncology services and health systems across sub-Saharan Africa.
Data indicating the prominent distribution of top cancer types, highlighting the critical burden of breast and cervical malignancies.
In response, Botswana is implementing a new model of coordinated patient navigation designed to improve how patients move through the cancer care system. With support from International Cancer Foundation (ICF) and the Merck Foundation, the Botswana–Rutgers Partnership for Health (BRPH) is leading the Upscaling of Patient Navigator Services in Botswana project. Led by Dr. Refeletswe Lebelonyane and implemented under the national stewardship of the Ministry of Health, with additional in-kind support from Roche, the initiative is establishing an integrated patient navigation pathway designed to ensure no patient is lost between suspicion, diagnosis, and treatment.
A Bi-Directional Training Model
The initiative utilizes a bi-directional training model to strengthen two essential layers of the health system simultaneously. Together, these investments shorten the critical window between a patient’s first concern and a definitive diagnosis.
Frontline Nurse Navigators
On the frontline, nurse navigators are being empowered to manage the full continuum of care. Their role is both clinical and patient-centered—identifying systemic barriers, coordinating referrals, and providing the psychosocial support necessary to keep patients engaged from their first presentation through to treatment.
A key component of their training is mastering the ability to distinguish between benign, potentially malignant, and urgent breast conditions, allowing them to activate the correct referral pathways without delay.
Decentralized Diagnostics
Medical officers are being equipped to perform essential diagnostic procedures, such as fine-needle aspiration (FNA) and core needle biopsy procedures. Traditionally limited to surgeons, these competencies are being decentralized to primary and district-level facilities, bringing diagnostic capacity closer to the point of first presentation.
To ensure clinical confidence, training is highly practical. Medical officers progress from hands-on instruction using moulage, fruit-based simulations, and gelatin breast models to supervised procedures with consenting patients.
Early Signs of a More Responsive Care Pathway
Early operational impact is already emerging from Bontleng Clinic, which has been designated as a dedicated Breast Health Clinic within the Gaborone District Health Management Team catchment area. The clinic now serves as a referral center for women presenting with abnormal breast examinations at the primary care level, making it a key site for implementing the project’s decentralized diagnostic model.
The impact of specialized training for medical officers is already becoming evident. Within a single month, 15 patients referred to the clinic for abnormal breast findings were assessed by two trained medical officers, leading to the identification of eight breast cancer cases. All identified patients were promptly referred to Princess Marina Hospital for specialist management.
While still early, these outcomes provide a strong proof-of-concept for how decentralized diagnostic capacity can strengthen early detection and help reduce delays within overstretched referral systems.
A Workforce Development Strategy That Expands Capacity Across the Health System
Expanding coordinated cancer care requires sustained investment in frontline health workers and facility leadership. Over the past several months, the initiative has focused intensively on building the human infrastructure required for phased national implementation. The training model has also evolved in response to local implementation needs.
90
Nurse Navigators
were trained across the South-East and North-East catchments, including general nurses, midwives, and family nurse practitioners.
85
Medical Officers
were trained in advanced breast cancer diagnostic procedures, significantly expanding decentralized diagnostic capacity.
14
Facility Matrons
completed leadership training to improve oversight, multidisciplinary coordination, and the integration of patient navigation into routine services.
In Francistown, delivering sessions in Setswana significantly increased participation and ownership among nurses, leading to immediate curriculum improvements, including the deeper integration of palliative care.
While still early, these results offer a strong proof-of-concept for how decentralized diagnostic capacity can strengthen early detection and reduce delays within overstretched referral systems.
A Multidisciplinary Approach That Strengthens Coordination Across Facilities
Sustainability is more than training; it requires the health system to speak the same language. At Nyangabgwe Referral Hospital, this is taking shape through the establishment of a Multidisciplinary Team (MDT). By bringing together pathology, radiology, surgery, oncology, and frontline staff, complex cases are now reviewed collectively.
By shifting case management from isolated decision-making to collective clinical review, the MDT model strengthens communication across departments, reduces delays in care planning, and improves continuity between primary facilities and referral centers. Lessons from global oncology platforms, including the ESMO 2026 Conference, continue to inform these multidisciplinary efforts.
Supporting these implementation efforts is a growing coordination team working across training delivery, stakeholder engagement, and operational integration. Among them is Kabo Mazunga, Patient Navigation Coordinator and Clinical Research Consultant, whose work has contributed to workforce capacity-building and the integration of patient-centered navigation approaches across participating facilities.
A Phased Expansion Strategy Designed for Sustainable National Scale
A defining feature of the initiative is its deliberate approach to scale. Rather than expanding uniformly, implementation is being phased across catchment areas to allow operational lessons from early sites to inform subsequent rollout.
Implementation is currently active in the Gaborone and Francistown catchments, which are serving as operational learning environments as the model expands nationally.
Gaborone & Francistown Catchments
Serving as primary operational learning environments to refine the navigation model.
Expanded Network Rollout
Expansion to Letsholathebe Memorial Hospital Catchment, Sekgoma Memorial, alongside remaining Princess Marina and Nyangabgwe catchments.
Phased implementation of the Patient Navigation Program across Botswana catchment areas, linking primary and district hospitals to referral and oncology centers through coordinated care pathways.
Conclusion
What is being built in Botswana is a re-engineered model of care delivery. By integrating early detection, patient-centered navigation, and multidisciplinary coordination, the project is creating a more resilient and equitable health system.
As the Upscaling of Patient Navigator Services in Botswana continues to expand, it offers a compelling blueprint for other health systems in the region and beyond, proving that with the right partnership, timely and high-quality cancer care is possible for every patient.