We start with a poignant quote that hits closer home every time I talk about cancer
"Cancer does not have a face until it's yours or (of) someone you know," said Anthony Del Monte, founder of the patient support group I Had Cancer.
The challenges of cancer care in Kenya are multifold. First, patient education and poor health-seeking behaviors often contribute to late diagnosis. The cost of cancer care creates a severe financial burden, but the existing inequity in cancer care costs lives.
To put this issue into perspective, a cursory search of the official Kenyan medical practitioners database shows less than 100 oncologists are serving 54 million Kenyans in 2022, translating to an oncologist-to-patient ratio of 1:540 000.
In addition, there are 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.
Cancer care is prohibitively expensive in Kenya and many patients with cancer grapple with double anxiety of their disease and the cost of care. These cancer care gaps sometimes cut across many spectrums and go beyond individual characteristics, such as race, religion, gender, and economic status. They are compounded by a scarcity of cancer professionals, lack of community-based cancer centers, low uptake of health insurance, a complex health system, poverty and wealth index gaps, and climate change.
Health care is not publicly funded in Kenya. Most patients pay for health care through insurance schemes or via expensive out-of-pocket costs. According to the National Health Insurance Fund, the leading government-owned insurance company, only 25% of the Kenyan population is insured, not to mention the limited remittances of cancer treatment costs and bureaucratic pre-authorizations hoops.
Although tertiary public hospitals serve more than 80% of patients with cancer in the country, almost all of them in Nairobi, patient volumes and the scarcity of modern cancer machines cause treatment interruption and long waiting times, leading to distress as well as time and financial toxicity.
This issue has led to the ever-burgeoning and exorbitantly expensive local private hospitals as an option for the few financially stable patients with cancer and the mushrooming of medical tourism to other countries for cancer treatment, costing the patients and the Kenyan government millions of dollars annually.
However, in the spirit of Africa's quintessential, extensive, and close-knit family ties, a cancer diagnosis is a family affair. Cemented by the existing families and friends support system, an equivalent of the Jimmy Fund is usually put together for patients with cancer. This financial distress coping mechanism offsets the costs of cancer care and averts impending asset liquidation.
Although progress has been made, such as the Cancer Action Plan, launched in 2020, for most Kenyans, primary cancer care is not where it should be.
We need a feasible national action plan for cancer care in Kenya. One that wraps around primary prevention, robust community-based cancer services, employing and training more oncology professionals, establishing regional and national cancer task forces, and cushioning cancer costs by providing healthcare insurance and subsidizing cancer drugs for patients with the disease.
It is time to revolutionize cancer care in Kenya, build robust and well-equipped regional cancer centers at the grassroots level, train more oncologists and nurses, invigorate and motivate our cancer researchers, and be fair to our patients and our nation.
If you want to read more about the state of cancer care in Kenya, please read my Lancet Oncology article on the same right here : https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(22)00087-0/fulltext
About the Author
Dr. Omar Abdihamid is a Clinical Oncologist. He is passionate about Global Oncology and cancer care in low- and middle-income countries, particularly cancer awareness and patient education. His main areas of interest are Gastrointestinal cancers, Breast Cancer, Lung, Head and neck, and Genitourinary Cancers. Dr. Omar has a keen interest in cancer research and has published multiple SCI publications in peer-reviewed journals. He is also an editor and a reviewer for several cancer journals