Kenya: Cancer Experts Want Govt to Focus On Prevention

Residents of Eldoret mark World Cancer Day on February 4, 2016 (file photo).
4 February 2019

Experts are warning that the battle against cancer would not be won if the country continues focusing on treatment at the expense of prevention.

Despite cancers claiming many lives, Kenya's health system spends very little on preventive and more on curative measures.

Experts are now warning that many lives will continue to be lost if the trend is not reversed.

According to data from the death registry, deaths by cancer rise every year by at least five percent.

In 2013, cancer claimed 13,720 lives, a figure that shot to 14,175 in 2014 and 15,714 in 2015. The disease killed 15,762 and 16,953 in 2016 and 2017 respectively.

This is causing concern due to the fact that cancer progresses relatively slowly -- enough for it to be identified -- compared to the top two infectious diseases.

Cancer is Kenya's third killer after malaria and pneumonia, accounting for seven per cent of all deaths.

STRATEGY

The World Health Organisation's cancer registry (Globocan) indicates that Kenya reported 47,887 cancer cases in 2018, with breast (13 percent), cervical (11 percent) and oesophageal cancer (nine percent) taking the top spots.

In a tweet chat, Dr Edwin Barasa, a health systems expert at Kemri Wellcome Trust, wrote that while curative and preventive services need the government's attention, the better strategy and priority would be prevention.

"It's not an 'either or' question ... Both preventive and curative care are important parts of a health system, but from a quality of life, health outcomes, cost perspective, it makes more sense to prevent a disease rather than wait for it to occur and then treat it," he wrote.

Citing the example of oesophageal cancer, Dr Andrew Odhiambo, a medical oncologist at Nairobi Radiotherapy and Cancer Centre in Nairobi, said issues of treatment access and cost exacerbate the deaths in Kenya.

COST

Dr Odhiambo said the most preferred treatment for this cancer is surgery, after which a tube called a stent is inserted into the oesophagus to keep it open, but this is often unaffordable for most patients.

The stent, Dr Odhiambo says, costs between Sh10,000 and Sh100,000 depending on the material used.

The services are offered at Kenyatta National Hospital, MP Shah, Moi Teaching and Referral Hospital and Tenwek and Kijabe mission hospitals.

While the national health insurance funds surgery and therapies, costs such as diagnosis are not catered for yet.

The costs are higher in treating cancers because of the expertise needed.

The surgery associated with certain cancers, such as oesophageal cancer, is so specialised that only a thoracic surgeon can perform it.

SPECIALISTS

Information about the availability of cancer experts in 2014 shows there were only 25 oncology specialists, 14 physicians, four radiation oncologists, six medical oncologists and four paediatric oncologists. There are very few thoracic surgeons.

Dr Barasa, who has studied resource allocation in Kenya's health system, explained that "it is not smart to have expensive curative care and underfunded preventive and promotive care, but it is smart to invest in preventive and promotive care and curative care".

Dr Barasa said a health system should be structured in such a way that it tries to the extent possible to prevent disease, "but where this is not possible, it should also have the capacity to treat it".

The focus on curative care has also led to inequalities in access to care where only those with money can afford to pay for the services that accompany treatment.

QUALITY

Dr Odhiambo said: "The question is 'where are you seeking care?' and 'how much you can pay?' You can have one person in Kenya getting the same treatment as one would in New York ... it is so unfortunate but it's something we cannot run away from."

He also criticised the disjointed way in which Kenya's health system makes follow-ups on patients impossible, noting that by the time they see a specialist, it is too late.

"When Kenyans seek treatment for early signs of cancer and are not cured in one hospital, they move to another and begin the whole process again.

"Since medical records are not electronic, doctors seeing the patient wouldn't flag the recurring issue early enough," he said.

However, the Universal Health Coverage programme, if implemented well, offers hope in changing the focus to primary healthcare.

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