Cancer pain management in Tanzania: using scenarios to explore critical interrelationships and potential interventions

This working paper provides a work-in-progress overview of research on the application of scenario-building techniques to the problem of the undertreatment of cancer pain in Tanzania. The paper draws on field and documentary research in Tanzania and the UK; on an earlier research dissemination workshop; and on scenarios development exercises within the international Innovation for Cancer Care in Africa (ICCA) project. This research is part of the wider ICCA project, that brings together researchers from Tanzania, Kenya, India and the UK to address the opportunities and challenges of linking industry and health systems in order to widen access to cancer care, including innovative use of scenariobuilding techniques. Research in 2019 with cancer patients and health professionals, and workshop dissemination of early results to stakeholders in Tanzania, identified undertreatment of pain as a major concern within cancer care. Interviews identified opiate medication as a key resource for treatment of severe pain, and a lack of local production capability for opiate medication leading to a reliance on imports. The research also made visible the complexity of interacting health system and industrial supply factors that contribute to undertreatment of severe pain, including pricing, accessibility challenges, supply chains difficulties, perceptions of opiate medication, and skills and training challenges facing health professionals and policymakers. In this paper we frame pain management as a policy topic specifically in need of evidencebased contributions that can identify key innovations that can be considered by policy makers and their potential outcome. We show that scenario-building can map critical interactions: both those generating undertreatment and those arising from innovations. The paper also specifically identifies areas where further information is required to complete the scenarios in a form that can be used by policy makers. This project aims to demonstrate the usefulness and accessibility of scenario building techniques for effective policy innovations in complex interlocking industrial and health systems.