Sustainable Development of Pathology in Sub-Saharan Africa An Example From Ghana Helge Stalsberg, MD, PhD; Ernest Kwasi Adjei, MD, FRCP; Osei Owusu-Afriyie, MD; Vidar Isaksen, MD  Context.—Pathology services are poorly developed in Sub-Saharan Africa. Komfo Anokye Teaching Hospital in Kumasi, Ghana, asked for help from the pathology department of the University Hospital of North Norway, Tromsø. Objective.—To reestablish surgical pathology and cytol- ogy in an African pathology department in which these functions had ceased completely, and to develop the department into a self-supporting unit of good interna- tional standard and with the capacity to train new pathologists. Design.—Medical technologists from Kumasi were trained in histotechnology in Norway, they were returned to Kumasi, and they produced histologic slides that were temporarily sent to Norway for diagnosis. Two Ghanaian doctors received pathology training for 4 years in Norway. Mutual visits by pathologists and technologists from the 2 hospitals were arranged for the introduction of immuno- histochemistry and cytology. Pathologists from Norway visited Kumasi for 1 month each year during 2007–2010. Microscopes and immunohistochemistry equipment were provided from Norway. Other laboratory equipment and a new building were provided by the Ghanaian hospital. Results.—The Ghanaian hospital had a surgical pathol- ogy service from the first project year. At 11 years after the start of the project, the services included autopsy, surgical pathology, cytopathology, frozen sections, and limited use of immunohistochemistry, and the department had 10 residents at different levels of training. Conclusions.—A Ghanaian pathology department that performed autopsies only was developed into a self- supported department with surgical pathology, cytology, immunohistochemistry, and frozen section service, with an active residency program and the capacity for further development that is independent from assistance abroad. (Arch Pathol Lab Med. 2017;141:1533–1539; doi: 10.5858/arpa.2016-0498-OA) P athology services are poorly developed in Sub-Saharan Africa. Most countries have less than 1 pathologist per 1 million inhabitants. 1–3 This is a particular problem for the treatment of cancer, which is a rapidly increasing health problem in developing countries. 4,5 To select the appropriate treatment for the individual cancer patient, a precise and complete pathologic diagnosis is required. A pathologic tissue diagnosis is also required to distinguish between cancer and benign lesions. A well-developed pathology service is therefore a key element in a comprehensive cancer program, to ensure a precise basis for the choice of treatment and to avoid the useless, harmful, and costly use of scarce resources. 6 A variety of initiatives have been taken to improve the African situation by assistance from developed countries. They include comprehensive plans and recommendations for the development of cancer care, including pathology, 5,7–9 general strategies for advancing African pathology, 2,10–13 rotation of volunteer pathologists from developed coun- tries, 14,15 telepathology with transmission of images to diagnosing pathologists in developed countries, 16–22 projects concentrating on fine-needle aspiration cytology, 23–25 and quality control on the performance of African laboratories. 26 Many of the articles report on projects after only a few weeks or months of experience. Cancer control plans recommended by the World Health Organization (WHO) have been taken up by some African countries, but funding and implementation have been slow and often have had to give way to other health priorities, such as tuberculosis, acquired immune deficiency syndrome (AIDS), and malar- ia. 9 We report here on an 11-year comprehensive plan and partnership between the pathology departments at Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana, and the University Hospital of North Norway (UNN) in Tromsø, Norway. The project has been successful and sustainable and could serve as a model for others. Accepted for publication February 3, 2017. From the Department of Pathology, University of Tromsø (Dr Stalsberg), and the Department of Pathology, University Hospital of North Norway (Drs Stalsberg and Isaksen), Tromsø, Norway; and the Department of Pathology, Komfo Anokye Teaching Hospital, Kumasi, Ghana (Drs Adjei and Owusu-Afriyie). The authors have no relevant financial interest in the products or companies described in this article. This project was financially supported by the governmental Norwegian Agency for Development Cooperation (NORAD), the Komfo Anokye Teaching Hospital (Kumasi, Ghana), and the University Hospital of North Norway (Tromsø, Norway). Reprints: Helge Stalsberg, MD, PhD, Department of Pathology, University Hospital of North Norway, 9038 Tromsø, Norway (email: hstalsb@online.no). Arch Pathol Lab Med—Vol 141, November 2017 Pathology in Sub-Saharan Africa—Stalsberg et al 1533