OnCo
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Blended finance and a low-cost linac to close the global radiotherapy gap

Dozens of countries have no radiotherapy machine at all. Combine long-term finance with a machine designed to be cheap, robust and maintainable where power and engineers are scarce.

Two linked efforts: a blended-finance facility (development banks, IAEA Rays of Hope, philanthropy) that finances radiotherapy centres including training and maintenance contracts over ten years rather than one-off machine donations; and an open engineering programme (following the CERN and STFC initiative for a linac for challenging environments) for a linear accelerator designed for unstable power, high ambient temperature, remote diagnostics and modular repair, manufactured at a fraction of current cost. The two must go together: machines without finance for staff and service become the idle equipment already common in low-income settings.

Hypothesis
The combined programme raises the number of functioning megavoltage machines per million population in participating countries by at least 50% within six years, with machine uptime above 90%, and reduces cost per course of curative radiotherapy below a defined target.
Rationale
Half of cancer patients in low-income countries who need radiotherapy have no access; the Lancet Oncology Commission on global radiotherapy showed investment is highly cost-effective. Donated machines fail for lack of service; finance models that bundle training and maintenance succeed, as in some IAEA and private-partnership examples.
What would test it
Finance ten centres under the bundled model and deploy two prototype low-cost linacs, tracking uptime, patients treated and cost per course against conventional installations.
Maturity
early clinical
Who has to act
philanthropy
Cost to try
Large (over $50M)
Years to first evidence
6
Bottlenecks it attacks

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