Kenya: Why Cancer Remains a Major Burden Globally
Kenya joined other countries globally in observing the World Cancer day Thursday, with the unveiling of statistics of on how the disease has affected people and strained their livelihood in seeking treatment.
The burden of Non-Communicable Diseases (NCDs) is rising rapidly in the country and now accounts for over 50 percent of all hospital admissions, and nearly 30 percent of total deaths.
Cancer is the third leading cause of NCD mortality in Kenya after infectious and cardiovascular diseases with the most recent estimates pointing to an annual incidence of over 42,000 cases and 27,000 fatalities.
The top five cancers diagnosed annually in Kenya are breast cancer with approximately 6,800, cervical cancer 5,200, prostrates 3,400, esophagus 2,900, and colorectal 2,724 new cases. Cumulatively this accounts for 50% of all new cancers annually.
As much as there are initiatives in place to ensure accessible and affordable cancer care by the Ministry of Health like the National Hospital Insurance Fund (NHIF) which introduced cancer care as part of the outpatient benefit package, only 20% of the Kenyan population had health insurance coverage in 2018, with the NHIF covering a limited package of inpatient and outpatient cancer services.
While the cost of screening for cancer is relatively inexpensive, the cost of diagnostic procedures is substantially higher.
For instance, NHIF coverage in 2019 included reimbursement of Sh 25,000 per chemotherapy session for up to 6 sessions per financial year; Sh18,000 per week for radiotherapy sessions for up to 20 sessions in total; and up to Sh500,000 for surgery.
Households not covered by health insurance are among the most vulnerable to health shocks. Households are often forced to adopt coping strategies like borrowing or selling assets, with potentially long-term negative impacts on livelihoods.
Although screening for cervical and prostate cancer is covered under the NHIF, lack of awareness of the benefits of 12 early screening coupled with limited availability result in low uptake among members.
In a survey conducted by the Economic and Social Consequences of Cancer in Kenya, NHIF does not cover palliative care, psychosocial counseling, and the newest cancer therapies (i.e., monoclonal antibodies, biologics, and personalized medicines), which are expensive and unaffordable for most Kenyans.
“A fixed maximum coverage for cancer services with no provision for the variations in cancer types and treatments has left households with substantial out-of-pocket spending. Given that individuals do not always enroll in the NHIF when healthy, the 60-day waiting period becomes problematic for patients who enroll when they are in need of urgent care.
In addition to gaps in the benefits package, patients and families struggle with the substantial financial burden of non-medical costs including transport, accommodation, and special food.
The Ministry of Health recently noted that the government will be integrating the cancer screening services in the Universal Health Coverage package to ensure the availability of screening services in public facilities from level two upwards.
The ministry has also decentralized treatment services and ten chemotherapy units which are operational in Meru, Embu, Nyeri, Makuru, Garissa,Mombasa, Kisumu, Kakamega and Bomet counties.
“The ministry is expanding the radiotherapy capacity n the country with the ongoing equipping of three recently constructed radio therapy units in Mombasa, Nakuru and Garissa counties which will be operational by the end of this financial year,” it said.
It has also issued a directive to the Kenya Medical Supplies Authority (KEMSA) to have strategic pricing discussions with relevant drug manufacturers, to drive the cost of cancer medicines down.
“We call on Kenyans to enroll with NHIF to ensure a healthy pool for sustainability of the social insurance fund further noting that it is working closely with NHIF to improve the different care of cancer.”
The MoH also announced that the Kenyatta National Hospital will soon launch its state of the art cancer center and plans are underway to equip the facility with a CT simulator, with the first phase expected to be completed in month’s time.
Meanwhile medical experts also stated that the COVID-19 pandemic has posed challenges to those seeking treatment from the contagion.
In an interview with Capital Health, the Director of Medical services at the RFH hospital Dr Victor Ngani said Cancer remains a huge burden in the country, with at least 28,000 people diagnosed with the disease every year out of which 22,000 (78%) succumb to the disease.
“COVID-19 has been a major challenge to the country and in particular cancer patients. As a result many patients have been cautious and avoid coming to the clinics and to some degree we are seeing late presentations now of various sub sets of cancer due to late diagnosis and treatment,” Dr Ngani noted.
Dr Ngani also emphasized that with advancement in technology, statistics can be reduced significantly.
“For instance HPV vaccination has been introduced for Human Papilloma Virus (HPV), a virus that is associated with Cancer of the Cervix, wellness checks which when carried out regularly, one can reduce their risk of contracting diseases and detecting an illness early,” he said.
“Non communicable diseases kill 41 million people each year, equivalent to 71 percent of all deaths globally. NCDs are projected to represent the leading cause of death in all countries irrespective of income level,” said Dr Ngani.
According to the World Health Organization (WHO) globally, there were an estimated 20 million new cases of cancer and 10 million deaths from cancer. The cancer burden is set to increase by approximately 60% over the next two decades, further straining health systems, people and communities.
The predicted global burden will increase to about 30 million new cancer cases by 2040, with the greatest increases occurring in low- and middle-income countries.
WHO notes highlighted that one third to one half of cancer cases could be prevented by reducing the prevalence of known risk factors.
Examples of actionable interventions are tobacco control and HPV vaccination. The most effective primary prevention of cancer is based on whole-of-government approaches, with legislation, regulation and fiscal policies combined with activities to change community and individual behavior. Public health messages and health promotion should present evidence on specific risk factors.