The World Health Organization has determined that geographic locale, ethnicity, education, environmental stress, and access to a health care system are social determinants of health and health inequities. The disparity influences these factors in the distribution of resources, wealth, and power.
In 2020, an estimated 19.3 million people worldwide were newly diagnosed with cancer, of which 9.9 million died. Closer home, in Sub-Saharan Africa, a number north of 52000 cases was diagnosed, with projections showing about 1 million deaths per year by 2030. Therefore, urgent action is needed to curb the growing cancer incidence and mortality crisis. (1)
In Kenya, cancer is the second leading cause of non-communicable disease deaths, and the trend of cancer deaths is projected to increase as per the 2018 GLOBOCAN report showing 47,887 new cases annually with mortality of 32,987. Common cancers in men in Kenya are esophageal cancers (cancer of the food pipe), prostate, colon, and rectum cancers. In contrast, in women, breast, cervical, and esophageal cancers are the leading cancers. (2)
Challenges in cancer care in Kenya are multifold; patient education and poor health-seeking behavior often contribute to late diagnosis, lack of awareness, poor uptake in cancer screening, diagnosis-related stigma, taboos, cultural barriers to seeking treatments, exorbitant cancer treatment costs, few oncology professionals, and cancer care inequities remain main drivers of poor patient outcomes. The cost of cancer care creates a severe financial burden, catastrophic spending, and assets liquidation, but the existing inequity in cancer care costs lives. (3)
Dr. Martin Luther King Jr said, "of all the forms of inequality, injustice in healthcare is the most shocking and inhumane."
Lack of enough oncology workforce (less than 100) in Kenya (4) and less than five tertiary or comprehensive cancer centers in the country, with nearly all of them in the capital (Nairobi), meaning that there are insufficient resources for cancer screening and prevention in the rest of the country. (3)
To bridge these gaping cancer care gaps, the Kenyan government has launched a feasible cancer action plan 2019-2030(2), and through partnerships with county governments of Kenya, four community-based cancer centers, including Garissa cancer center, were also launched, and supported by the ministry of health. This was a tour de force of the ministry of health and timely intervention for the historically neglected cancer patients in the region.
Garissa Cancer Center is northern Kenya's first regional and referral cancer center since its independence (1964). Homogenous minority communities inhabit this region, and the center is poised to greatly benefit from devolved healthcare services, including cancer care services.
Residents of Garissa and the northern Kenya region have historically suffered from such healthcare injustices due to a lack of specialized care access or facilities. Compounded by environmental injustices and unforgiving climate change, these communities, mainly nomads and pastoralists, continue to bear the brunt of perennial droughts responded to with short-term food trucks and aid, with no long-term climate change policies or food security strategies despite huge opportunities for such interventions.
The new cancer center is equipped with expensive machines, including the much-needed radiotherapy LINAC machine that is worth millions of Kenyan shillings but is equally worth the much-needed patients' needs that is invaluable in terms of shillings.
Radiotherapy is one of the modalities of cancer treatment, the other two being surgery and chemotherapy. With the availability of radiotherapy services and surgeons in the center, improvement in cancer drug supply is needed to avoid detrimental treatment interruptions and out-of-pocket costs. Other complimentary services needed include improvement in ease and access to health insurance, fast-tracked pathology services to aid timely diagnosis, which currently has a turnaround time of 3 weeks, blood banks for timely supportive treatments, counseling, oncology nutrition personnel, and funding of cancer research to address the cause of worrying trends of head and neck cancers among patients of ethnic Somali who are the main inhabitants of the region.
The first patient (patient zero) was successfully treated at the center on 25th Sept 2022, thanks to the concerted efforts of the oncology workforce consisting of oncologists, nurses, medical physicists, radiation therapists, and technical support from the national cancer control program at the ministry of health and the local county health executives.
I urge the county government to invest in culturally based cancer sensitization programs that translate to an increase in the uptake of cancer services now available at the cancer center, including cancer screening, preventative services, and active treatment close to home that will avert time and financial toxicity.
Health insurance uptake in this community is very low; therefore, a similar sensitization on registering for the available National Health Insurance fund is paramount.
High cost is the single determinant of health-seeking behaviors in these communities. Therefore, health insurance will cushion cancer patients and their families from treatment-related financial burdens and catastrophic spending.
I am honored to have witnessed the historic success of the able pioneer oncology team at the new Garissa Cancer Center. It is encouraging to see the previously unmet needs of cancer patients in the region gradually addressed. However, the center requires continuous capacity building in the thematic areas of pathology, laboratory services, palliative care, research and development, and employment of more core oncology workforce to improve service delivery.
About the Author
Dr. Omar Abdihamid is Clinical Oncologist. He is passionate about Global Oncology and cancer care equity in low- and middle-income countries. His main areas of interest are culturally based cancer care, patient education, and cancer care advocacy. Dr. Omar is a scientific writer, a published cancer researcher, and a reviewer for cancer journals. He is the recipient of the 2021 Journal of Global Oncology editorial fellow program and a winner of ASCO Voices 2022.
- Ngwa W, Addai BW, Adewole I, Ainsworth V, Alaro J, Alatise OI, et al. Cancer in sub-Saharan Africa: a Lancet Oncology Commission. Lancet Oncol. 2022;23(6):e251-e312.
- Kenya MoH. Health Mo. Kenya-Cancer-Policy-2019-2030. Republic of Kenya. 2019. 2019.
- Abdihamid O. Closing the gap in cancer care in Kenya in 2022. Lancet Oncol. 2022;23(6):715-6.
- Kenya Medical Practitioner PaDC. Licenced Local Specialist Practitioners for the year 2022 As At 27/08/2022. 2022.
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