ABS-United Bulawyo Hospitals Partnership

Overview

The ABS–United Bulawayo Hospitals (UBH) Partnership is a long-term health partnership working to improve the early diagnosis and management of breast cancer in Bulawayo and Matabeleland South, Zimbabwe. Established in 2019 and building on collaboration dating from 2018, it brings together UK and Zimbabwean clinicians, nurses, educators and health-system partners to strengthen breast services through workforce development, diagnostic capacity, clinical education, data systems and locally led service improvement.

A brief history of the UBH-ABS Partnership’s Breast Cancer Project in Zimbabwe 

Project Leads, Dick Rainsbury and Munyaradzi Magara, outline the history of the project:

"The seeds of our longstanding Partnership in Zimbabwe were sown more than 8 years ago when the United Bulawayo Hospitals (UBH) agreed to work with the ABS to investigate the terrible breast cancer outcomes in Zimbabwe, focusing particularly on Matabeleland South (MS) and Bulawayo Metropolitan (BM). We were awarded a small  ‘Start-up’ grant from Johnson & Johnson (Tropical Health and Education Trust, THET) in 2019, and the project was launched with a 2-day brainstorming session involving a wide range of healthcare stakeholders which provided vital background information for a questionnaire-based Needs Analysis (NA).  

The NA involved interviewing nearly 1,500 people- women, their families and frontline staff living and working in MS and BM- during the first year of the pandemic. Shocking delays were disclosed at every stage of a patient’s pathway. This was due to the widespread lack of understanding about the nature, investigation and treatment of breast cancer- which in turn reflected the absence of any formal education or training at all levels, combined with little if any public awareness of the 
disease..."

Read more

Needs analysis

The ABS/United Bulawayo Hospitals partnership began with a needs analysis to understand why women in Matabeleland South and Bulawayo Metropolitan Provinces often experience late breast cancer diagnosis and poorer outcomes. The work brought together local clinicians, nurses, health professionals, community representatives, patient advocates and other stakeholders to identify the barriers affecting women at every stage of the breast cancer pathway.

The findings highlighted complex and interlinked challenges. Many women and families had limited awareness of breast cancer symptoms and curability, while fear, cost, travel distances and reliance on traditional or faith-based care could delay presentation. Health professionals also identified gaps in training, access to diagnostic equipment and referral support, particularly in rural and district settings.

The needs analysis also showed that delays continue after women enter the healthcare system. Long referral pathways, limited specialist services, pressures on histopathology and imaging, and inconsistent patient information systems all contribute to slower diagnosis and treatment. At the same time, the study found strong support among health professionals for targeted training, decentralised diagnostic services and better communication across the pathway.

These insights have shaped the partnership’s priorities: improving breast cancer awareness, strengthening the skills of frontline health workers, supporting earlier assessment and referral, and developing more sustainable local diagnostic pathways. By grounding the project in evidence from patients, families, healthcare providers and community leaders, ABS and UBH are working together to build practical, locally led solutions that can improve outcomes for women with breast cancer in the region.

Key Activities

• Delivery of recurring breast clinical skills courses, including locally led training by Zimbabwean Master Trainers
• Hands-on breast ultrasound workshops covering assessment of breast masses, basic scanning and biopsy techniques
• Establishment and support of diagnostic breast clinics at UBH, Gwanda and Beitbridge
• Installation of Starlink connectivity to support data use, remote image review and digital education
• Development of the UBH breast database with NUST and computer-skills training for clinic staff
• Delivery of an intensive Surgical Masterclass covering assessment, multidisciplinary planning and oncological breast surgery
• Six-week UK fellowships for Zimbabwean breast care nurses, alongside UK faculty visits to Zimbabwe
• Development and piloting of a Diploma in Breast Disease Management and a training-the-trainer programme
• Work on context-specific referral pathways, guidelines, patient information and multilingual awareness materials

Outcomes and Impact

The partnership has established the core elements of a more responsive breast cancer service across Bulawayo and Matabeleland South. Diagnostic clinics now provide breast assessment alongside existing women’s health services, local trainers are delivering clinical skills education, and frontline staff have greater access to breast ultrasound training and specialist advice. The programme has also created pathways for advanced nursing and surgical development, strengthened collaboration between district clinics and UBH, and embedded prospective data collection and audit.

Progress has been shaped by infrastructure and system constraints, particularly unreliable internet access, limited theatre capacity, variable clinic activity and the need for national approval of new pathways and qualifications. Recent investment in connectivity, local training capacity and Ministry engagement is intended to support sustainable delivery. Priorities now include completing the nursing diploma, strengthening referral and patient-tracking systems, expanding awareness activity, continuing surgical training and securing diversified long-term funding.

Nurse Training

The past, present and future of the education of Zimbabwean nurses in breast care nursing

Read more on nurse training in this report by Lis Grimsey and Janet Hicks:

"The International Forum was formed in 2018 and in preparation for the 1st Breast Bulawayo Symposium in July 2019, there was much work to do. The educational programme for the nurses consisted of three days of teaching. This was combined with some shared lectures with the doctors.

Following this successful visit, the feedback from the nurse’s programme highlighted how dedicated the staff were and how enthusiastic they were to develop greater levels of knowledge in breast care nursing. Consideration was given to how this could be 
achieved, and it was decided to write a course which could be undertaken by the nurses in Zimbabwe.

Two modules were written. Introduction to Breast Care and Introduction to Breast Care Management. Initially this was to be in the form a workbook but with the help of UEA (Blended Learning UK) an online course was established. This went live in 2022. Throughout the modules learning tools are used in a variety of ways to reinforce knowledge and the nurses are mentored throughout the course. Whilst under development it became clear that the content would be suitable for Band 5 nurses in the UK without any breast care experience. The course was then badged by the ABS. It is sold to nurses in the UK but there are free places offered to nurses in low and middle-income countries.

The Matabeleland South Province and Bulawayo Metropolitan Project was launched in 2023 with a focus on education and training of health professionals to facilitate earlier breast cancer detection and treatment with the aim of improving patient outcomes. Nurses are a key to the success of this project as they will be examining patients when the attend for cervical screening in the VIAC (Visual Inspection with Acetic Acid and Camera) clinics and will be a vital link between communities and specialist care.

Read more in the ABS Yearbook 2026

Developing a nursing diploma

UK Obervership in Breast Diagnosis, Breast Ultrasound and Multidisciplinary care at Milton Keynes University Hospital

"Breast Cancer is one of the most common malignancies affecting women worldwide and remains a significant public health concern. Although breast cancer primarily affects women, it can also occur in men though at a much lower incidence. The causes of breast cancer are multi factorial and include genetic predisposition, hormonal influence and lifestyle factors .Most women in developing countries
including Zimbabwe present with advanced breast cancer mostly due to limited access to screening, financial barriers to care, cultural beliefs associated with breast cancer and to some communities, lack of knowledge regarding management of breast diseases. The knowledge and skills that I have gained from observing will be disseminated to my colleagues and the communities at large in Gwanda and Zimbabwe as a whole and hence improve the livelihood of the citizens..."

Sitshengiso Mlotshwa

RGN/Midwife

Gwanda Provincial Hospital, Zimbabwe

Read more

Database Development