How NHIF cover has spurred growth in cancer care investment

Before the National Hospital Insurance Fund (NHIF) cover, radiotherapy machines in private hospitals were unable to operate at full capacity — about 50 to 70 per cent of the time — because only few Kenyans could afford treatment.

However, the rising number of patients covered by the NHIF as well as private insurers has expanded the market for cancer services, giving hope to investors planning to purchase hi-tech machines with less side effects and improved treatment outcomes.

Dr Catherine Nyongesa, a consultant oncologist who founded Texas Cancer Centre in Nairobi, says the number of patients seeking radiotherapy treatment has increased by more than 50 per cent with the advent of the NHIF comprehensive cover.

“And this keeps on rising as more and more Kenyans take up the cover. It is encouraging, since in the past, many cancer patients would die as they could not afford treatment,” she said.

At Cancer Care Kenya, which was recently bought by India-based Healthcare Global Enterprises (HCG), the number of Kenyans seeking treatment has also risen to about 70 per cent.

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Sensitive organs

Dr Najmudin Adamali, the director of Cancer Care Kenya, says bringing more advanced machines to Kenya is not a problem.

‘‘But you need to be able to get a return on the investment. So you can only bring something when the demand is there and many people can afford it. When more people are insured, a large pool of Kenyans will be able to afford cancer treatment,” says Dr Adamali.

The hospital is the first to bring in the Intensity Modulated Radiation Therapy (IMRT) machine which treats cancers located near sensitive organs that can easily be damaged.

“The machine is already here and we used it to treat a few patients this week. But we plan to formally launch it next week,” said Dr Navnit Arora, the country head at Cancer Care.

The equipment costs between Sh300 million and Sh500 million. The hospital, in partnership with MP Shah and HCG also plans to invest in a positron emission tomography (PET) scan.

“Patients have been travelling to India to use this technology. But come April 2018, we will have it here in the country,” says Dr Adamali.

Government statistics show that Kenya loses about Sh10 billion ($120 million) yearly due to the mass movement of patients seeking care abroad in search of low-cost treatment and special technologies such as PET scans.

More local health facilities are partnering with international hospitals to bring in better machines that treat tumours that can change location or move.

An example is a cancerous lump lodged in the lungs which can move when patients inhale or exhale while on the radiotherapy table.

Tumours in the prostate gland can also change position depending on whether a patient’s bladder is full or not.

Dr Nyongesa said national and county hospitals could also begin acquiring advanced technologies that will benefit many people.

The most basic cancer radiotherapy technology is the Cobalt 60 machine which is currently being used at the KNH. It costs about Sh100 million and it has been phased out in developed nations.

The Cobalt 60 machine is not reliant on electricity since it uses gamma rays released by the radioactive cobalt to kill cancer cells, but such old technologies are harsh on the skin and less effective in treating shallow and deep-seated tumours.

“They also slow down with time, so you need to keep replacing the radioactive cobalt every five years hence incurring additional costs,” says Dr Nyongesa. Due to these challenges, private hospitals have shifted to the Linear Accelerator (Linac) machine.

The Linac uses electricity to produce X-ray and electron beams which kill cancerous cells. Due to their high energy levels, X-rays produced by Linac machines have the ability to penetrate dense body tissue and reach deep-seated tumours.

“These machines also have a skin sparing effect, meaning less adverse reactions to the skin after radiation,” says Dr Nyongesa. The KNH has both Linac and Cobalt 60 machines.

The IMRT machine at Cancer Care Kenya will treat irregularly shaped tumours because its radiation beams can be reduced to small volumes that conform to bumpy edges of such tumours in a precise manner whilst shielding adjacent body tissues from damage.

It also makes it possible for doctors to adjust the intensity of radiation doses during treatment.

“They can go high in areas with high concentration of cancer cells and go low in less affected areas which can be damaged by intense radiation doses,” said Dr P.Sridhar, a consultant radiation oncologist at HCG.

Permanent blindness

The IMRT is mostly used to treat head and neck cancers so as to prevent high doses from affecting the spinal cord — leading to permanent disability — or salivary glands— leading to dry mouth problems.

To treat cancers located next to delicate body organs or tissues, Kenya would also need a more advanced type of radiation machine known as a cyber-knife. It produces highly focused radiation beams that converge on tumours and destroy them with very high radiation doses whilst cushioning delicate adjacent organs from damage.

For instance, if a brain tumour is lying next to the optic nerve, a cyber-knife machine directs the radiation to the affected area without ‘touching’ the nerve so as to avoid causing permanent blindness.

“It’s like walking on egg shells when dealing with such sensitive cancers. That’s why sophisticated technologies are required,” said Dr Sridhar.

Aside from brain tumours, he noted that the cyber knife would treat liver and pancreatic cancers.

A cyber-knife machine costs about Sh1 billion. In countries such as India where the technology exists, patients pay with about Sh1 million ($10,000) for one treatment session.