" /> THE EPIDEMIC OF CANCER IN KENYA – Svast

Current Cancer Rates

Cancer is a global problem that causes more death than malaria, TB, and HIV combined. According to the Kenya Network of Cancer Organizations, about 70% of the global cancer is in low- and middle-income countries like Kenya.                

Among the causes of death in Kenya, cancer is ranked third, with 7% of deaths reported every year (IAEA report, 2010), after infectious diseases and cardiovascular diseases in the first and second positions respectively. However, it is difficult to obtain accurate national data on cancer patients since most of the data originate from urbanized settings such as Nairobi.        

An estimate of 39,000 new cancer cases and 27,000 deaths is reported every year (IAEA report, 2010). Statistics indicate that approximately 50 Kenyans die from different forms of cancer daily. Accordingly, the statistics in the Ministry of Health indicate that at least 40,000 Kenyans are diagnosed with cancer disease throughout the country.            

According to the Cancer Statistics Report of 2018, there were 1,998 cases of cancer reported in 2017. This represents about 5% of the Kenyan annual incidence. The leading cancers in women according to the report are esophagus (15.1/100,000), breast cancer (38.3/100,000), and cervix uteri (40.1/100,000). In men, the leading cancers include prostate cancer (31.6/100,000), esophagus (20.5/100,000), and Kaposi sarcoma (16/100,000).              

Cancer causes a unique challenge to the health infrastructure in Kenya. This is because it affects a much younger population than anywhere else. Moreover, there are limited facilities for cancer screening with only four radiation centers, all of which are in Nairobi. These include Aga Khan, Nairobi Hospital, MP Shah, and Kenyatta National Hospital (KNH). There is also limited human capacity for cancer treatment in the public sector, with only: –   

·       Two medical physicists

·       Three oncology nurses

·       Five radiation therapy technologists

·       Four pediatric oncologists

·       Six medical oncologists

·       Four radiation oncologists

Cancer Patients Covered by Insurance in Kenya

National Hospital Insurance Fund (NHIF) for cancer patients was introduced in 2015. This is according to the NHIF Chief Executive Officer, Geoffrey Mwangi. Under this scheme, patients are entitled to monthly clinic check-up, MRI and CT scans, radiotherapy and chemotherapy. According to the World Health Organization’s report of 2018, the NHIF package makes cancer treatment almost free for 18% of Kenyans currently covered by the scheme.    

In 2015, NHIF initiated coverage of up to $50,000 for cancer patients who needed cancer treatment abroad. However, in 2016, this was revised to include cancer patients treated within the country. Indeed, official reports indicate that NHIF spent approximately $ 0.0136 billion in the 2017/2018 financial year as a payment for cancer treatment (both locally and abroad).

Currently, the NHIF package involves up to 10 chemotrerapy sessions, injectable or oral anti-cancer medicines, outpatient and in-patient oncological services, up to two sessions of brachytherapy for advanced cancer, as well as 20 sessions of radio therapy per year.    

Cancer Patients Who Have To Pay

Cancer treatment is expensive and often run into millions of Kenya shillings. Therefore, many patients must depend on the Kenyan concept “harambee” (community self-help or crowd funding) concept of raising funds.


Sarah lacks NHIF cover hence circulated this flier for crowd-funding
Source: www.tuko.co.ke


Fuasa Aboud (pictured below) from Mombasa started her HER2 – positive treatment privately but had to stop since funding from NHIF cover ran out. Friends and family did crowd-funding to help her proceed with medication. However, this was not enough to cater for her treatment. Her sister introduced her to an Innovative Public-Private Partnership initiative at KNH in Nairobi. Through this program, Fauzia was able to complete the remaining session of her treatment and was declared free from breast cancer.  


After being diagnosed with breast cancer, Fauzia (middle) moved close to the family for support
Source: www.roche.com


Another beneficiary of the Innovative Public-Private Partnership initiative at KNH is Rosa (pictured below). She was referred by her oncologist to pursue hormone therapy for HER2-positive treatment. This was after the exercise became too expensive for her to afford. However, she was overjoyed on realizing that she could only wait for one week to begin her treatment at KNH.


Rose was overjoyed when she was referred to a special program that KNH had set up to offer women free HER2-positive treatment.
Source: www.roche.com


The program at KNH was meant to improve the accessibility to precise and timely diagnostic services in order to make cancer treatment more effective. As part of the initiative, the Kenyan government and Roche Kenya have a memorandum of understanding to jointly help in covering the high cost of HER2-positive treatment within public institutions. According to the program director, the initiative was meant to develop a holistic approach in order to improve the treatment and care of cancer in Kenya. It is this initiative that helped Fuasa Aboud and Rosa to access HER2-positive treatment despite the high costs involved.       


Most Kenyans live on just a few US dollars a day, and paying for treatment for a life-threatening disease is a huge stretch. Special programs like the HER2-positive treatment from KNH offer a solution.
Source: www.roche.com

According to the government reports, Kenya loses approximately Ksh.11 ($0.11) billions per year in revenue to facilitate Kenyans going abroad for specialized cancer treatment. The data in the Ministry of Health indicates that at least 116 patients had travelled to India for cancer treatment between January and March 2017. The ministry’s reports reveal that India is globally rated and it is affordable compared to the similar services in America and Europe. This is because most Kenyans prefer going for cancer treatment in India than accessing similar services in Kenya.    

Geoffrey Moenga is one of the patients who have sought specialized treatment India. He was first diagnosed in a hospital in Nairobi with stomach ulcers and later umbilical hernia. In 2012, he underwent successful operation at a local hospital where he was informed that there was a head mass (tumor) in the pancreas and got discharged.    

He then thought of seeking specialized treatment in India despite his low financial status. He had spent all the money he had, and nothing was left to cater for his treatment in India. He talked to friends and family and agreed to do harambee. Meanwhile, he contacted the Agile Global Health to find the best health facility in India and required amount. The harambee which was conducted in Nairobi raised 25% of the required amount. He then took a loan from Kentours Sacco Board which catered for the remaining balance. While in India, a major surgery was carried out and he was declared free of pancreatic cancer.    

Jane Muthoni, a tutor, is another cancer patient who has sought treatment in India. She was diagnosed with thyroid cancer in 2002. She underwent surgery at a local Kenyan hospital, but the doctors were unable to remove the tumor which was stuck in her windpipe. As a result, cancer cells started spreading and affecting her food pipe and voice box, spreading into her lungs and chest.       

It was apparent that Jane’s survival was at stake. Back then, there was no insurance scheme for cancer patients prompting her to turn to friends and family for crowd-funding to facilitate her travel to Bangalore, India for treatment. Accompanied by her husband, they arrived in India for specialized treatment. The doctors took this case as a challenge and initiated a multi-disciplinary approach involving a neck and head surgeon, a thoracic surgeon, and gastrointestinal surgical team to perform the operation.  

The surgery took 15 hours, during which doctors succeeded to remove the tumor and sanitized her chest region by getting rid of her food pipe and voice box. The food pipe was later reconstructed by use of a tube from her stomach. She was pronounced free from thyroid cancer.
“This is like a new life. I never thought I’d be able to get back to see my children. I’ve been through a lot of pain and sorrow over the past 10 years with repeated surgeries, radiation and tests. We decided to face the risk of surgery and go ahead with a strong will,” said Jane.

Sources:

https://www.who.int/bulletin/volumes/96/4/18-020418/en/
https://timesofindia.indiatimes.com/city/bengaluru/Kenyan-thyroid-cancer-patient-gets-a-new-life/articleshow/30188279.cms