Colorectal cancer care in Uganda: a narrative review and case-based health needs assessment from Mbarara Regional Referral Hospital

Abstract

Colorectal cancer (CRC) is an important cause of cancer-related morbidity and mortality in both Sub-Saharan Africa (SSA) and Uganda. Despite national progress in cancer awareness and policy development, CRC care remains limited by resource constraints. CRC serves as an ideal lens for assessing health system resiliency, as it spans the care continuum. This review searched PubMed from inception through December 2025 for Uganda specific articles on CRC and analyzed 13 peer-reviewed articles to describe the current state of CRC care in Uganda, with insights from a health needs assessment (HNA) conducted at Mbarara Regional Referral Hospital (MRRH). Across Uganda, CRC diagnosis and treatment are hindered by insufficient endoscopic and pathology capacity, medication stockouts, and inconsistent access to immunohistochemistry and molecular testing. Screening programs remain underdeveloped due to inadequate resources for follow-up diagnostics. At MRRH, chemotherapy and surgery are available but constrained by equipment shortages, long wait times, and limited workforce despite rising patient volumes. Palliative care remains a strength, supported by national morphine availability and the efforts of Hospice Africa Uganda, though integration within oncology clinics remains incomplete. Improvement to CRC care will require expanding diagnostic infrastructure, digitizing health records, workforce development, and strengthening supply-chain management. Addressing chemotherapy and medication stockouts represents a tangible, near-term step toward improving quality of care. Experience from MRRH demonstrates both the challenges and opportunities to scaling cancer care in resource-limited settings and provides an illustrative example, albeit limited as a single-institution review, for addressing CRC systems across Uganda.