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

Source: https://onco.cc/ideas/idea-fund-lmic-radiotherapy-finance/  
OnCo record `idea-fund-lmic-radiotherapy-finance` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

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.

## Summary

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.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- 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.
- Proposed test: 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
- Actor: philanthropy

## Sources

- IAEA Rays of Hope: https://www.iaea.org/services/rays-of-hope

## Connected records

- ideas: [A Global Fund for cancer care in low- and middle-income countries](https://onco.cc/ideas/idea-fund-global-cancer-fund/), [Burden-matched funding for trials led in low- and middle-income countries](https://onco.cc/ideas/idea-fund-lmic-burden-match/), [Validate and reimburse AI contouring and planning to expand radiotherapy capacity](https://onco.cc/ideas/idea-fund-rt-planning-ai-capacity/)
- cancers: [Cervical cancer](https://onco.cc/cancers/cervical/), [Head and neck squamous cell carcinoma](https://onco.cc/cancers/head-and-neck/), [HR-positive / HER2-negative breast cancer](https://onco.cc/cancers/breast-hr-positive/)
- technologies: [Brachytherapy](https://onco.cc/technologies/brachytherapy/), [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/)
- institutions: [International Agency for Research on Cancer (IARC / WHO)](https://onco.cc/institutions/iarc/), [Tata Memorial Centre](https://onco.cc/institutions/tata-memorial/)
- bottlenecks: [Most of the world has almost no cancer care](https://onco.cc/bottlenecks/b-global-access/), [Surgery and radiotherapy cure most, get least](https://onco.cc/bottlenecks/b-surgery-radiation-innovation/)

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