Cancer not a priority in Kenya’s devolved health system

By Gatonye Gathura

Not a single of the 47 counties in Kenya has cancer among top priority diseases for prevention, treatment or investment.

Even in Nairobi County, indicated to have the highest cancer cases in Kenya, the disease is not among the top five priority illnesses.

Data released in December by the Texas Cancer Centre which has hospital in the city and Eldoret, showed Nairobi to have highest cases of cancer in the country.

Nearly half of the patients who visited the two hospitals in 2016 – 47 per cent – were from Nairobi. “Only one out of every two patients lived outside Nairobi,” said center director Dr Catherine Nyongesa.

In 2014, the center treated 718 patients, 2,154 in 2015 and 3,558 in 2016 and the number the director said is rising especially in Nairobi.

However The Nairobi City County Health Sector Strategic and Investment Plan 2013 to 2019 does not indicate cancer as a significant cause of illness or death in the county.

Cancer, the document reflects is not among top 10 causes of illness in children in Nairobi while it is listed as sixth in importance among adults.

Consequently throughout the plan cancer in Nairobi does not attract significant attention or resources, compared to pneumonia, tuberculosis and maternal health.

In 22 counties with published health development plans cancer was mentioned in passing and nowhere is it among priorities diseases.

While for example Bomet County is indicated in several reports to have the highest throat cancer incidence in Kenya, the disease is not among top five illnesses of importance in the county plans.

“The five common diseases in order of prevalence are malaria, upper respiratory tract infection, skin infections, pneumonia and intestinal worms,” says the county’s integrated plan.

Kiambu County, in a region indicated for high rates of lifestyle disease, none of these illnesses, including cancer are a priority in its Integrated Development Plan 2013 – 2017.

“The most prevalent diseases in the county as captured from hospital visits are flu, malaria, respiratory tract infections and Ear Nose and Throat infections in that order,” shows the plan.

The strategic plan for Siaya County has prioritized malaria being responsible for 54 per cent of illness in the area, respiratory tract infections, 15 per cent of illness and diarrheal diseases causing four per cent of sickness.

Plans from other counties such as Kericho, Nyamiara and Marsabit have similar disease prioritization patterns with none having cancer as a priority disease in planning.

At the Coast, The  Kilifi County Integrated Development Plan 2013-2017 says the most common causes of illness are malaria, lower respiratory infections, stomach ache, diarrhea and flu.

But even the Ministry of Health in its crucial Kenya Health Policy 2012-2030 cancer does not appear among the top ten leading causes of death or illness in the country.

The head of the National Cancer Institute of the Ministry of Health Dr Alfred Maina Karagu, says the disconnect between cancer prioritization in counties and public perception is lack reliable data for planning.

Dr Karagu says the country does not have a national cancer registry with only two regional centers in Nairobi and Eldoret.

“The Nairobi and Eldoret registries largely services the regions of location which may not give the true picture of the disease across the country,” says Dr Karagu.

But demand for cancer treatment at Kenyatta hospital, Moi referral and at private hospitals as well as requests for support at the National Hospital Insurance Fund (NHIF), Dr Karagu says reflects a hugely unattended disease out there.

He explains that cancer by its nature and treatment cost is among the most disruptive diseases once detected in a family. “It is very expensive and in many cases a cause of family impoverishment especially if the patient is the bread winner.”

Put together the data shows neither the national nor county governments have a cancer dedicated budget line compared to the donor driven malaria or HIV.

The closest such a plan has been contemplated is in the National Cancer Control Strategy 2017- 2022 published in October.

In the strategy, the Ministry of Health proposes county governments to allocate specific budget lines for cancer research, prevention, screening and early diagnosis by 2022.

‘Give us the money and we will be glad to oblige,’ the governors have told the ministry. At an extra ordinary meeting of the Council of Governors in Nairobi in December, Chairman Josphat Nanok asked the national government to urgently provide counties with cancer control funds.

“What county governments need is adequate funding for equipment and comprehensive training for specialists,” the governor had said.

But cancer expert David Makumi of Aga Khan University Hospital says counties must first be cured from this quest for high-end technology as the ultimate solution to the cancer problem.

Counties he says should first identify priority areas of cancer control that require low financial, materials and human resources but with the greatest impact.

“Smoking cessation services, lifestyle modifications programs, HPV vaccinations, cervical cancer screening using table vinegar are low cost interventions that would not need ‘machines,” says Makumi.

An analysis of the 2016/17 health budget in the counties shows about 80 per cent went mainly to salaries leaving too little to invest in peoples’ health.

The analysis by the Ministry of Health warns seven counties: Machakos, Bomet, Tana River, Kwale, Wajir, Turkana, and Laikipia which apart from salaries had no money invested in people’s health.

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