How to in­crease ac­cess to can­cer treat­ment in Kenya

2016 study found only three coun­ties had equip­ment to di­ag­nose and treat can­cer and lack of inances the ma­jor chal­lenge to treat­ment

Business Daily (Kenya) - - TOP NEWS - BY LOUISE MAKAU BARASA AND NI­CHOLAS A. ABINYA SOME SO­LU­TIONS

Can­cer is the third most com­mon cause of death in Kenya, af­ter in­fec­tious dis­eases and heart con­di­tions and ac­counts for seven per cent of all deaths in the coun­try. Due to the lack of a na­tional registry, it’s es­ti­mated that there are be­tween 22,000 and 41,000 new can­cer cases each year.

Pa­tients seek­ing treat­ment in both pri­vate and pub­lic hos­pi­tals in sub-sa­ha­ran Africa face sig­nif­i­cant bar­ri­ers that re­sult in ad­vanced dis­ease, mis­di­ag­no­sis, in­ter­rupted treat­ment, stigma and fear.

Our study — con­ducted among doc­tors and can­cer sup­port and ad­vo­cacy groups in Kenya — iden­ti­fied the big­gest bar­ri­ers that hin­der ac­cess to can­cer test­ing and treat­ment in Kenya.

Th­ese in­clude lack of af­ford­able can­cer treat­ment, lower drug costs, bet­ter equipped fa­cil­i­ties and spe­cial­ist doc­tors. The dis­tance to hos­pi­tals and favourable na­tional can­cer poli­cies are also ma­jor fac­tors.

BAR­RI­ERS TO TREAT­MENT

Kenya has lim­ited spe­cialised health work­ers and only 12 health fa­cil­i­ties di­ag­nose and treat can­cer coun­try­wide; seven pri­vate hos­pi­tals, two mis­sion hos­pi­tals and three pub­lic fa­cil­i­ties. The four ra­dio­ther­apy cen­tres are lo­cated in ur­ban ar­eas.

The study was con­ducted in Jan­uary 2016 and only three coun­ties had equip­ment to di­ag­nose and treat can­cer. Our study showed pro­hib­i­tive costs for tests such as mam­mo­grams that check for breast can­cer.

One of the re­spon­dents pointed out: “Money is the ma­jor con­cern. In our setup, you can’t even ac­cess med­i­cal ser­vices. The ma­jor chal­lenge [to treat­ment] is lack of fi­nances.”

Pa­tients with pri­vate in­sur­ance and the gov­ern­ment-spon­sored scheme, the Na­tional Hos­pi­tal In­sur­ance Fund (NHIF), are more likely to un­dergo treat­ment than those with­out in­sur­ance. Cap­ping cov­er­age and in­creas­ing pre­mi­ums fur­ther de­ters pa­tients from re­ceiv­ing and com­plet­ing treat­ment.

One of the pa­tients said: “If you get can­cer, most of the pri­vate in­sur­ance com­pa­nies don’t want to take it up be­cause it’s re­ally ex­pen­sive. If you’re still un­der the cover, they may pay for the first course of treat­ment, then af­ter that they give let­ters that they can’t pay.”

Most Kenyans don’t go for rou­tine screen­ing for var­i­ous types of can­cer. This is partly be­cause of lack of ac­cu­rate in­for­ma­tion about can­cer symp­toms which con­trib­utes to late pre­sen­ta­tion by pa­tients who seek med­i­cal care when can­cer symp­toms are present.

Peo­ple who are unin­sured are put off by the pro­hib­i­tive costs as­so­ci­ated with med­i­cal check­ups, screen­ing and di­ag­nos­tic tests. The treat­ment costs de­pend on the type of the hos­pi­tal and the ex­tent of the dis­ease.

It can range from $2,500 to $10,000 for doc­tors’ fees, surgery, drugs and ra­di­a­tion. Sub­sidised or free rou­tine or an­nual med­i­cal check­ups could re­duce the num­ber of peo­ple who are di­ag­nosed with can­cer at an ad­vanced stage.

Another de­ter­rent to can­cer screen­ing and treat­ment is the poor at­ti­tude of health work­ers. Th­ese at­ti­tudes are due to lack of knowl­edge, so­cial, cul­tural be­liefs and per­sonal bi­ases. Ad­di­tion­ally, poor doc­tor to pa­tient com­mu­ni­ca­tion de­ter­mines whether pa­tients seek treat­ment re­gard­less of the pa­tient’s lit­er­acy level. Kenya needs to de­velop ef­fec­tive can­cer test­ing and treat­ment op­tions by train­ing and equip­ping doc­tors in health fa­cil­i­ties.

Doc­tors need to be trained to check for can­cer more closely in pa­tients. Their key role would be to screen pa­tients at high risk such as those with a fam­ily his­tory of can­cer or those with pre­dis­pos­ing con­di­tions such as HIV/ Aids. This greatly re­duces the num­ber of pa­tients who seek treat­ment with ad­vanced dis­ease.

Doc­tors also need to be trained on pa­tient-cen­tred care and com­mu­ni­ca­tion. This would im­prove the pa­tient’s un­der­stand­ing of the dis­ease, com­pli­ance with treat­ment and po­ten­tially the out­come.

Coun­tries like Uganda, Tan­za­nia, Le­sotho and Zimbabwe have set up ef­fec­tive and in­ex­pen­sive cer­vi­cal can­cer screen­ing in­ter­ven­tions for cer­vi­cal can­cer in health fa­cil­i­ties from the pri­mary to na­tional level.

A na­tional pub­lic health ed­u­ca­tion cam­paign about the types of can­cer and their symp­toms would en­cour­age peo­ple to seek med­i­cal care in time for bet­ter out­comes.

Train­ing spe­cial­ist doc­tors and equip­ping health fa­cil­i­ties to screen and di­ag­nose can­cer can lead to timely treat­ment for the pa­tients and im­prove their health out­comes.

Kenya needs to im­ple­ment its ex­ist­ing can­cer poli­cies. It has been slow due to lim­ited fi­nances and re­liant on the coun­ties’ readi­ness to roll­out plans. Coun­ties such as Kisii have taken the ini­tia­tive to pro­ceed with es­tab­lish­ing a can­cer cen­ter that will be op­er­a­tional within the com­ing weeks. The coun­try’s first can­cer treat­ment, con­trol and pre­ven­tion pol­icy was cre­ated in 2011, fol­lowed by the 2012 Can­cer Act, which was amended in 2015.

Th­ese poli­cies have cre­ated a frame­work for ad­dress­ing Kenya’s grow­ing can­cer bur­den based on the doc­tors’ clin­i­cal data of see­ing more pa­tients ev­ery year. Our study makes four pol­icy rec­om­men­da­tions to im­prove ac­cess to treat­ment:

Im­prove health in­sur­ance for pa­tients with can­cer. In Oc­to­ber 2016, the NHIF added can­cer to the dis­eases it will pay for, but this cover is still very re­stricted. Pri­vate in­sur­ance caps need to be re­viewed to en­able pa­tients to com­plete treat­ments.

Es­tab­lish test­ing and treat­ment fa­cil­i­ties in all coun­ties through the na­tional can­cer con­trol plan. This is tak­ing more time than planned due to the need for fi­nan­cial and tech­ni­cal re­sources at the county level.

In­crease pub­lic health aware­ness and ed­u­ca­tion about can­cer to im­prove di­ag­noses and treat­ment. A na­tional pub­lic health aware­ness cam­paign sim­i­lar to the cam­paigns to raise aware­ness about HIV/AIDS and re­move stigma should be rolled out. This has worked in the US.

In Africa, this has be­gun through the African Or­gan­i­sa­tion for Re­search and Train­ing in Can­cer that pro­vides rel­e­vant and ac­cu­rate in­for­ma­tion on the pre­ven­tion, early di­ag­no­sis and treat­ment of can­cer in var­i­ous African coun­tries.

And fi­nally, doc­tors should openly dis­cuss treat­ment op­tions to en­cour­age more pa­tients to live pos­i­tively with can­cer.

Pa­tients with pri­vate in­sur­ance and the NHIF are more likely to un­dergo treat­ment than those with­out in­sur­ance ...Peo­ple who are unin­sured are put off by the pro­hib­i­tive costs as­so­ci­ated with med­i­cal check­ups, screen­ing and di­ag­nos­tic tests

Barasa is Ad­junct Pro­fes­sor, East­ern Univer­sity. Abinya is Pro­fes­sor of Medicine, sec­tion of Haematology and On­col­ogy, the Univer­sity of Nairobi. San­dra Greene, Stephanie Wheeler, Ashe­ley Skin­ner and An­to­nia V. Bennett contributed to this ar­ti­cle. The Con­ver­sa­tion

--FILE

AWARE­NESS Women re­ceive can­cer ed­u­ca­tion cam­paign ma­te­ri­als from staff of Outspan Hos­pi­tal in Ny­eri last year. THE WAY FOR­WARD

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