Uganda needs regional histopathology services to accelerate cancer diagnosis

Uganda recorded an estimated 35,968 new cancer cases and 24,629 cancer deaths in 2022, according to the International Agency for Research on Cancer’s GLOBOCAN estimates. Yet histopathology services, which are essential for confirming cancer diagnoses and guiding treatment decisions, remain concentrated in a few national and urban-based facilities, as well as a handful of university-affiliated facilities. With this growing burden, Uganda needs properly equipped and staffed regional histopathology centres so that patients can get cancer diagnoses closer to home and begin treatment sooner.

Histopathology is the examination of a small piece of body tissue, usually taken during a biopsy or operation, under a microscope to find out whether cancer is present, what type it is, and which treatment may work best. While imaging (tests that take pictures of the inside of the body) and clinical examinations may show that a patient has a suspicious growth, examining the tissue is often necessary to confirm whether it is cancer and determine its type.

Currently, Mulago National Referral Hospital hosts the National Pathology Reference Laboratory and serves as a major referral centre for histopathology services, receiving specimens from health facilities across Uganda through the national sample transportation system. This has allowed patients outside Kampala to access testing, but it also means large numbers of samples must be processed at the laboratory. As demand grows, patients may wait longer for results. This growing workload underscores the need to strengthen cancer services closer to where patients seek care, particularly at regional referral hospitals.

Although some regional hospitals and university-affiliated hospitals like Gulu and Mbarara have made progress in establishing pathology units, capacity remains uneven across the country. Some regional hospitals lack essential laboratory equipment, reliable supplies and sufficient numbers of trained pathologists and laboratory professionals to provide consistent histopathology services. These constraints continue to limit their ability to provide reliable and timely histopathology services.

We urge the Ministry of Health and development partners to assess regional demand and capacity, identify ready regional referral hubs, and invest in the equipment, reliable supply chains, specimen transport and referral systems needed to bring histopathology closer to patients. This must be matched with training and retention of pathologists (specialist doctors who examine tissues to identify diseases), stronger laboratory histotechnology skills (skills for preparing body tissue samples for examination under a microscope to identify diseases), mentorship between national and regional teams, and telepathology (using digital technology to examine and share tissue images from a distance to help identify diseases) where feasible to provide specialist support. All services should follow common national quality standards, including competency assessment, internal quality control and external quality assessment.

Decentralising histopathology must mean more than sending equipment to regional hospitals. Uganda needs a connected network of skilled professionals, reliable laboratories and strong quality systems that can bring accurate cancer diagnosis closer to patients.

The writer is a Laboratory Leadership Fellow with the Uganda Public Health Fellowship Program, Ministry of Health and a laboratory manager for the national histopathology laboratory, Mulago. The views expressed are those of the author.