On a hot Friday afternoon, Mary Chebet stands patiently in a queue of about 50 women waiting to undergo Pap smear tests for cervical cancer screening at a local health centre.
"I don't want to take the risk. My mum was diagnosed with the disease when it was at stage four and she died six months later."
"The doctor said that her chances of survival would have increased if the cancer had been caught early. That experience made me to begin taking cancer screening tests seriously."
Mary is among the many Kenyans who have experienced the devastating effect of cancer, either directly or indirectly.
As nations reflect on the disease, following the World Cancer Day, which is marked annually on February 4, health experts are calling for concerted efforts — both individual and collective responsibility — to accelerate the fight against cancer that is still a major killer.
In Kenya, cancer cases have been increasing over the years, putting a strain on the country's health sector and economy.
According to the 2018 GLOBOCAN report by the World Health Organisation’s International Agency for Research on Cancer, approximately 47,887 people get the disease annually in Kenya while 32,987 die from it yearly.
This is an increase from the 41,000 cases and 28,000 deaths recorded six years ago.
"Unhealthy diets and sedentary lifestyles that cause obesity are contributors to these rising cancer cases. We also have excessive alcohol consumption and smoking that increase people's chances of getting the disease," notes Dr Andrew Odhiambo, a medical oncologist and secretary of the Kenya Society of Haematology and Oncology (Kesho).
According to him, a major contributor to cancer related deaths is the late diagnosis of the disease.
"Most people come to the hospital when their cancer is already at an advanced stage. This makes treatment expensive and reduces survival chances. That’s why we encourage frequent cancer screening."
However, for these early check-ups to be enhanced, health experts note that the National Hospital Insurance Fund (NHIF) cover should be able to meet the costs instead of focusing solely on tests for already sick people.
Treatment options for major cancers in Kenya include surgery (for removing tumours or growths), chemotherapy (use of drugs to kill cancerous cells) and radiotherapy (use of radiation to destroy affected cells).
Depending on the type and stage of the disease, cancer treatment in the country — often involving the three procedures — costs between Sh250,000 and Sh2,000,000.
These prices used to be way out of reach for a majority of Kenyans until the launch of the NHIF cancer cover in 2016.
However, glitches with the funds allocation system are still making it hard for all Kenyans to access those services.
For instance, the NHIF notes on paper that it can cover chemotherapy drugs at an approved rate of up to Sh150,000. “But not all sick people will get the full amount. And the criteria used to determine what each patient should be given is still highly subjective,” says David Makumi, the chairman of the Kenya Network of Cancer Organisations (Kenco).
“So if a poor patient gets half the amount and is not able to raise the balance, he or she will be forced to stop treatment midway. And this will on make the disease worse.”
According to Mr Makumi, sometimes patients may be diagnosed with cancers whose treatment surpasses the NHIF cover limit.
For instance, women with a rare form of early stage breast cancer (HER2+) are required to use a drug known as Herceptin, which cost Sh250,000 per dose.
As such, affected patients will need to have at least Sh4.5 million to acquire the recommended 18 doses.
“These women should not be segregated and left to bear the treatment cost on their own. No one chooses to be diagnosed with an expensive cancer. So we need to do away with this unjust treatment,” Mr Makumi states.
According to Dr Odhiambo, drug supply chain systems need to be strengthened — especially in public facilities — so as to prevent stock-outs, which deny patients the life-saving drugs they need.
“The NHIF card will be of no use to patients if they go to a hospital and fail to find prescribed drugs. This delays treatment and may force the patients to meet the costs on their own.”
Access to cancer care services, notes Mr Makumi, is also hampered by the skewed distribution of medical oncologist and cancer treatment infrastructure in this country.
In total, Kenya boasts of 12 radiotherapy machines. Kenyatta National Hospital has three while the rest are in the private sector — two each at Nairobi Hospital, Aga Khan University Hospital, Texas Cancer Centre and HCG-CCK Cancer Centre.
Outside Nairobi, there is only one radiotherapy machine at Eldoret Hospital in western Kenya.
"Cancer treatment equipment has increased. But you can see that almost all of them are concentrated in Nairobi within a five-kilometre radius of each other yet they are supposed to serve all Kenyans. This unequal distribution is worrying and needs to change," says Mr Makumi.
He notes that people living in other parts of the country usually have to travel long distances to access radiotherapy treatment hence incurring additional transport and accommodation costs. "Even if the NHIF cover pays for the treatment, patients who cannot meet the travel expenses will just remain home and die."
Irrespective of the challenges, the numerous machines have reduced the radiotherapy treatment queues at KNH that previously subjected patients to waiting periods of up to two years.
"The queues drastically reduced to below three months. And in cases of emergency, we are able to offer the treatment promptly to those in need," states Dr Odhiambo who treats cancer patients at KNH.