Cancer Health Fund: Patients, survivors decry challenges

Cancer patients and survivors have lamented that they are facing some challenges with the implementation of the pilot phase of the Cancer Health Fund (CHF) initiative that are limiting their benefits from the fund four years after it was created.

Investigations revealed that the challenges range from delay in enrollment for the CHF, lack of access to some drugs, inadequate funding, slow response to request for additional funding, few centres for accessing and non coverage of all cancers, among others.

Some patients also lamented that they applied for the CHF for years and had neither been enrolled nor benefitting from the fund. Indigent cancer patients with other type of cancers also lamented their non inclusion in the fund.

They said there was an urgent need to address the challenges in order to fully benefit from the fund.

Findings also revealed that there was no operational framework for the implementation of the fund at its takeoff and the committee set up to oversee the fund virtually operated in a vacuum.

Cancer treatment is very expensive and many patients in the country can either not afford the out-of-pocket costs for care nor sustain it when they begin their medical treatment.

The Cancer Health Fund

The Nigerian Cancer Health Fund (CHF) was created by the Federal Ministry of Health in collaboration with a private sector-led coalition in 2020 to provide standard of care cancer treatment to underprivileged populations regardless of their ability to pay, and to also strengthen the national cancer care ecosystem.

The Federal Ministry of Health said the CHF commenced in 2021 with six pilot hospitals, one in each geo-political zone of the country for patients with breast, cervical and prostate cancers.

They are the Ahmadu Bello University Teaching hospital (ABUTH), National Hospital, Abuja (NHA), University of Benin Teaching Hospital, Benin (UBTH), Federal Teaching Hospital Gombe (FTH), University of Nigeria Teaching Hospital (UNTH), University College Hospital (UCH).

The federal government, through the ministry, partnered with many stakeholders, such as the American Cancer society, ROCHE, PFIZER, MYLAN, Clinton Health Access Initiative, WWCV, BICON and EMGE resources for the CHF.

Upon successful application, cancer patients access up to N2million in drugs, radiotherapy and chemotherapy in the pilot facilities.

According to the president of the Nigeria Cancer Society, Dr Adamu Alhassan Umar, the CHF was initially called the Catastrophic Cancer Fund, and “came about as a result of sustained efforts by players within the Nigerian cancer advocacy space, with particular reference to the private sector because the concept began around the year 2017 during a business case development and presentation that was made at a cancer conference in Abuja.”

He said, “It was at that meeting that the idea was conceived to get a fund that is dedicated towards addressing cancers in those that cannot afford to pay for care. This is considering the fact that over 80 per cent of Nigerians pay for health care out of their pockets.”

The Director of Hospital Services of the Federal Ministry of Health Dr. Jimoh Olawale Salaudeen, said the CHF was one of the the best things to happen to the country, and that the fund was not in the hands of anyone but domiciled in the Central Bank of Nigeria (CBN).

He said that following enrollment, the wallet created for each patient was credited with a minimum of N1million, which could be topped up when it was exhausted and the patients needed more care.

He said the fund covered medical tests, drugs and the various cancer treatments.

He said that so far 2,450 cancer patients registered and 750 of them were already enjoying the fund.

He said the wide gap between those who registered and those enrolled was because some of them were discovered not to have cancer after tests.

He said a total of N1.3billion had been allocated to the fund in the past four years.

He said, “However, in the last meeting we had with the National Assembly on the CHF, they also promised that another N1bn would go for adult cancer, and that focus would also be given to children. They said they wanted to ensure that half a billion naira would be put in the account for children in the 2024 budget.”

Patients’ experiences

Monica Ihom, 25, applied for the Cancer Health Fund (CHF) in 2021 but didn’t receive any response till 2023. She was earlier diagnosed of breast cancer at the age of 20 in 2019.

During the time Ihom applied till her CHF wallet was credited, she had to resort to soliciting for money from people to support her treatment.

She said, “The illness was getting worse, so I had to beg people to help me. If I kept on waiting for them, I would die.

“I was in school and also doing little business but had to drop out as a result of the illness. I don’t have money to support my treatment. My father is old, and cannot fund my treatment, and my bothers don’t have anything too.

Following her initial treatment, Monica was placed on three drugs for the management of her condition. They are zoladex (10.8 mg), herceptin, and tamoxifen.

However, despite her enrollment in the CHF since last year, she has only been able to access herceptin out of the N1m approved for her from the CHF. She has so far not been able to access zoladex through the fund, and still pays for tests from her pocket.

“When we were filling the CHF form, they told us zoladex was covered along with herceptin, but whenever I go to the pharmacy in the National Hospital Abuja, where I am receiving treatment, they will either tell me that zoladex is not covered or it is not available and that I should buy outside the hospital,” she narrated.

Doris Sokpo , 27, applied for the CHF in June 2022 and was enrolled in December the same year. She said her major challenge with the CHF was that she had not been able to access a crucial injection for her treatment through the fund.

She said there was the need to make the CHF application process faster to benefit patients. “I know of a lot of people who applied years ago and they have not been able to access the fund till date. There are lots of people out there who are really struggling and don’t have help from anywhere to be able to pay for medication for the illness. If the application process could be made better, it would help,” she added.

Peace Samuel applied for the CHF in 2020 and was lucky to be enrolled soon after. She said the little challenge she faced was that she kept receiving debit alerts from her wallet, which she didn’t utlise, but it was later refunded.

She said she currently takes a particular injection every three weeks that cost over N1m. “You have to take 18 of the injection every three weeks. So if CHF is giving N1m, it can only cover such patients for just one treatment. I think they should look at the kind of treatment the patient is taking to ascertain how much to give to him or her.”

Another patient who wishes to be identified by her first name, Maryam, said she travelled from Bauchi to the teaching hospital in Zaria to access care but was shocked when she was asked to pay for her tests and drugs. She barely could afford transport fare to go back after the treatment, she said.

The president and founder of *Nest Of Hope Advocacy and Support Community, Dozie Akwarandu, an engineer, said the implementation of CHF so far was abysmal, adding that “within this period of the fund conception, the global theme has been to ‘close the care gap.’ And one of the ways is to access affordable, quality treatments, yet cancer patients in Nigeria cannot access care.”

He said, “Within the last four years of its takeoff, we are still piloting. This shows that there’s no framework for its success.”

Akwarandu, who is also a colorectal cancer survivor, said the CHF should also be made to accommodate all cancers, all ages, irrespective of where you are. “Someone is dying of colorectal cancer and the fund wants to treat prostate. That’s not ideal,” he said.

Experts’ view

Experts said the CHF was a good initiative that could help to ensure affordability of treatment for indigent cancer patients and the attainment of Universal Health Coverage (CHF), if properly implemented.

Dr Adamu of the Nigeria Cancer Society said, “When you look at the size of the population of Nigeria you will see a very insignificant percentage of those that have benefited.”

The coordinator of the Africa Health Budget Network (AHBN), Dr Aminu Magashi Garba, said the issue of equity for cancer services when there are only six facilities in Nigeria providing the support was grossly inadequate.

He said it was also problematic for cancer patients to be going to designated teaching hospitals all the time and officially register to access care.

“Cancer services should be such that any patient can walk in and access it, irrespective of whether there is a wallet or account for that person or not. We need to devise a means of expanding the scope of those who are benefiting from the services,” Dr Magashi advised.

He said there was the need for more funding in implementing the CHF, adding that it should not only be funding from the federal government but also a basket fund, where the 36 states and the Federal Capital Territory (FCT) can contribute.

He said it should also be managed by a dedicated, honest and credible board of trustees that would track the allocation, disbursement and utilisation.

Dr Magashi, who is also one of the advocates that have been calling for the movement of the CHF to the National Institute for Cancer Research and Treatment (NICRAT), said it would help “reduce bureaucracy. Also the ministry is a policy environment and is supposed to provide an oversight function for the CHF, not to be implementing it.”

He said that having NICRAT managing the CHF would allow better coordination and effective implementation.

He added that with the relocation, the NICRAT could make a case to the National Assembly to get more allocation beyond the initial proposed N1bn for the 2024 budget.