Let us intensify the war against cancer

In 2017, Grace, a 45-year-old mother of five, discovered a painless mass in her right breast. She trekked 80km from home to the Kakamega County Hospital where doctors called for surgical removal of the mass – without explaining it could be cancerous. Not realising the full extent of her risk and lacking accurate information, Grace declined to have the procedure. 

A few months later, Grace experienced growing pain that became incapacitating. She turned to her family to cover living expenses. When she was finally diagnosed with Stage II breast cancer, the mama mboga could not afford the cost of treatment as she had no NHIF coverage. Fortunately, through support from a local NGO and late registration in the NHIF, Grace was able to access treatment.

Her plight is sadly familiar. A growing number of Kenyans are facing cancer diagnoses. For many, there are limited primary health services to help with prevention, detection and early treatment of cancer. Weak communication about diagnoses and options for treatment lead to devastating decisions while stigma, fear and myths impede patients from seeking care early.

Grace’s story is featured in a recent World Bank study titled, Economic and Social Consequences of Cancer in Kenya: Case Studies of Selected Households. The report illustrates the battles of several cancer patients with the disease. All are characterised by late health-seeking behaviour, difficulties navigating the healthcare system in search of an accurate diagnosis, and inadequate financial protection against catastrophic expenses.

Cancer is the second leading cause of death in Kenya among non-communicable diseases (NCDs). The illness affects Kenyans of all ages and socio-economic backgrounds but has a disproportionate impact on the most vulnerable groups. Cervical cancer leads, followed by breast cancer, Kaposi’s sarcoma, and oesophageal and prostate cancer. Only 11 per cent of Kenyan women have been screened for cervical cancer – though the government has accelerated efforts to vaccinate 800,000 girls over the past 18 months.

Most cancer cases in Kenya are diagnosed at an advanced stage when treatment options are limited. A 2018 Kenya Household Health Expenditure and Utilisation Survey found that 8 per cent of all households experienced catastrophic health expenditures, and out-of-pocket payments pushed 1.1 million Kenyans into poverty annually. Should they or their loved ones receive a cancer diagnosis, most Kenyans are highly vulnerable to such a fate because fewer than 20 per cent have health insurance coverage. Moreover, the NHIF coverage of inpatient and outpatient cancer services has been limited.

The good news is that the government has stepped up response to the mounting threat of cancer. In fact, its cancer-control efforts are setting an example of what is possible in resource-constrained, limited-capacity sub-Saharan African countries. The Health ministry has developed a National Cancer Control Strategy that stresses the importance of universal coverage of cancer services and NHIF has begun to expand coverage to more cancer services. Efforts are also underway to boost the capacity of health providers through in-service training on early cancer screening and pre-service training to increase availability of specialised personnel (only 22 oncologists are serving a population of 47 million people).

Likewise, various new programmes are expanding access to these services in primary health settings. For example, the World Bank and Access Accelerated are supporting a pilot project to strengthen primary care services aimed at helping people in Busia and Trans-Nzoia counties to prevent or manage several NCDs, including cervical and breast cancer.

But while these efforts are laudable, more needs to be done. The main priorities highlighted in the World Bank-funded report include:

- Improving health-seeking behaviour by raising awareness and knowledge of cancer, lowering barriers to care, strengthening quality of care, ensuring access to supportive counselling, and urging households to enroll early in the NHIF.

- Continue to promote financial protection by progressively expanding the benefit package to cover more interventions and more people over time.  

- Improving the capacity of the primary health system to prevent, detect and promptly treat cancer to save lives and minimise health care costs.

- Empowering cancer survivors and family members to play a critical role in the cancer journey,  advocating for patients, and establishing support groups to mitigate fears and foster solidarity.

On this 20th anniversary of World Cancer Day, we should renew our commitment to ensure cancer patients have access to quality, affordable care. “I Am and I Will”, the theme of this year’s celebration, is a reminder that individually and collectively, we must turn the tide on cancer.

-Mr Hansen is the World Bank’s Country Director for Kenya. Ms Schneidman is a Lead Health Specialist, World Bank