Skewed distribution of medical oncologists has slowed down the uptake of cancer screening services in Kenya despite billions of in investment in the sector, putting the country’s cancer management systems on the spot.
Data from the Kenya Demographic Health Survey (KDHS) 2014 shows that breast and cervical types of cancer in women recorded a screening rate of 14 percent, falling below the World Health Organization’s (WHO) recommended screening threshold, while only three percent of men underwent screening for prostate cancer.
The WHO recommends at least 70 percent of women are screened for cervical cancer by the age of 35 and 45 years, a strategy aimed at accelerating the elimination of cervical cancer as a public health problem.
The low screening rate is attributed to the unique challenges facing the country’s health system including limitations in infrastructure as well as human resources to effectively provide cancer management services.
Dr Andrew Odhiambo, a medical oncologist who treats cancer patients at Kenyatta National Hospital attributes the low screening rate to the less number of oncologists in the country and also the lack of awareness about cancer among Kenyans.
“The high cost of cancer treatment adds to distress, hardships, and burdens to patients and their families. Skewed distribution of medical oncologists and urban concentration of cancer care services is also hampering the access to screening and treatment services,” adds Dr Odhiambo.
Despite the high burden of the disease in the country, the latest KDHS report released by the Kenya National Bureau of Statistics has not captured any data about cancer, further putting Kenyans in the dark about its actual prevalence.
Payment for screening services and the high cost of treatment is the biggest contributor to the low uptake of screening.
Apparently, a greater percentage of cancer screening services in Kenya are financed through out-of-pocket payments.
The National Health Insurance Fund (NHIF) is the major insurance coverage for the majority of the population, but not all Kenyans can afford to make the monthly contribution as required, attributed to joblessness.
“The cost of cancer therapy varies with the type of diagnosis and hospital. It costs up to Sh150,000 for complete cycle chemotherapy for breast cancer in a private hospital and Sh50,000 in a public hospital. Cancer patients seeking cervical cancer chemotherapy will part with up to 120,000 in a private hospital as compared to Sh40,000 charged in a public facility. For colon cancer, the charges in a private hospital in Sh200,000 and between Sh80,000 to Sh100,000 in a public hospital,’ says Dr Odhiambo.
Treatment of cancer by radiotherapy in Kenya is also inadequate and centralized in terms of facilities
The country needs at least 54 external beam radiotherapy machines to treat the approximately 42,000 patients diagnosed with cancer annually, but there are only 19 such machines currently operational, with six domiciled in public facilities, according to KDHS 2014 data.
Kenya’s annual budget 2022/2023 for health was 4.4 percent, which is too small to cover the health sector according to the recommendation by the “Abuja declaration” which proposed governments designate 15 percent for healthcare to facilitate easy access to cancer treatment facilities.
“If implemented, this would facilitate increases in the annual budgets allocated to the 47 counties for infrastructure, staff training, and other logistics necessary for at least one complete cancer centre in each county” read part of the declaration.
In 2019, the Ministry of Health revealed that Kenya had only 16 radiation oncologists, 10 medical physicists, 35 oncology nurses, 27 therapy radiographers, and 3 nuclear medicine physicians.
The WHO recommends the ratio of clinical oncologists to cancer patients to be 1:1000.
The challenges are derailing further the National Cancer Control Strategy's goal to reduce cancer incidence, morbidity, and mortality in Kenya, which can be achieved through screening and early detection.
Kenya is currently relying on just nine well-established facilities providing comprehensive cancer management services with only three of them classified under public facilities, but it is estimated that only 23 percent of cancer patients access comprehensive services.
The public facilities are expected to serve nearly 9 million people from poor backgrounds that live below $1.90 a day.
They include Kenyatta National Hospital, Kenyatta University Teaching Referral, and Research Hospital, and, Moi Teaching and Referral Hospital.
Due to the high number of patients seeking different cancer services, the situation gets worse due to the long wait to just see an oncologist, also limited in numbers.
Screening of cervical and breast cancer can be done in the majority of the County and Sub-county hospitals where the costs of cancer care and treatment are affordable compared to the private hospitals, but the major workload as a result of inadequate trained manpower remains an obstacle to the turnout.
The six private facilities include The Nairobi Hospital, HCG Cancer Care Kenya, Equra Health Kenya, The Nairobi West Hospital, Texas Cancer Centre, and Aga Khan University Hospital which are equally charging high prices for the cancer screening and treatment services.
In Kenya, cancer is the third leading cause of death after infectious and cardiovascular diseases. It kills an estimated 30,000 people while 47,000 are diagnosed with the disease every year.
According to GLOBOCAN data, 15 Kenyans are diagnosed with cancer daily, and 75 deaths are reported in the same period.
Cervical cancer contributes 12.9 percent translating to 5,250 new cancer cases annually and 11.84 percent translating to 3,286 of all cancer deaths annually.
It is the leading cause of cancer-related deaths in Kenya and the second most common cancer among females.