Coordinating advocacy efforts is key to achieving UHC in cancer care

Three years ago, many cancer patients in the Kenyan grassroots areas would travel over 200km to access critical cancer treatment services such as chemotherapy. These long and repeated journeys escalate their physical, emotional and economic burden of cancer, not just on them but also their caregivers and families.

In efforts to close the care gap in accessing cancer services, the Kenyan Network of Cancer Organizations (KENCO) in collaboration with eminent partners across the cancer control continuum in Kenya, deliberated on advocacy strategies for the implementation of critical milestones that will form the basis of a full realisation of the three dimensions of universal health care (UHC): People coverage, package of services provided and level of financial protection.

Here are some of the initiatives that KENCO has pushed for in addressing each of the above dimensions:

1.    People coverage 

(a)    KENCO carried out an advocacy project in 2022 funded by UICC whose objective was to raise the index of suspicion (the likelihood that cancer is the underlying cause of a patient's symptoms or findings) among health workers on geriatric cancers, as well as to build the capacity of health workers on important areas in order to improve their responsiveness to the needs of old people. This was done through a series of virtual training of oncology and palliative care health workers on cancer amongst older populations.

(b)    In conjunction with esteemed partners KENCO also pushed for the decentralisation of access to cancer services and treatment. Through these efforts the Kenyan government has currently established ten (10) regional cancer centres. Comprehensive services were only available in one (1) national referral hospital. Today, we have three major referral hospitals providing comprehensive cancer services and an additional three (3) comprehensive cancer centres in the county, with plans to set up more. Patients also have access to free Glivec clinics, which provide access to the drug Glivec for the treatment of chronic myeloid leukaemia, at no cost to patients. These have been decentralised to so far three (3) counties in the country.

2.    Package of services & level of financial protection

It is possible for civil society to play the watchdog role of monitoring the governments’ policies and actions and holding them accountable. Civil society can also work closely with governments to oversee maximum implementation of UHC in cancer care. 

KENCO sits in all technical working groups in the Ministry of Health (MOH) – National cancer Control programme (NCCP), partnering under various cancer control initiatives. This has significantly contributed to improving the oncology package under the National Health Insurance Fund (NHIF) and reducing the high cost of cancer treatment in the country. There are also more advocacy initiatives in the pipeline to ensure that even health insurance companies in the private sector offer similar arrangements.

Recently, the MOH, NHIF and Roche East Africa signed a memorandum of understanding (MoU) where breast cancer patients can now receive Herceptin free of charge for all 18 sessions in all public health facilities. 

To realise UHC fully, no stone must be left unturned as far as cancer control is concerned. It requires a holistic approach that touches on all cancer control aspects from prevention, early detection, diagnosis, treatment, psychosocial support, palliative care and survivorship.

It is fundamental that civil society drives the agenda to ensure that oncology packages cover all these services ,including diagnostics, palliative care and rehabilitative commodities such as stoma bags, breast prostheses and mastectomy bras, among others.

There is also a need for civil societies and community-based organisations to develop initiatives for training primary healthcare workers on identifying the signs and symptoms of cancer. Increasing the index of suspicion of cancer is key to improving survival rates in cancer care. The World Health Organization indicates that improving early diagnosis capacity is an important strategy to cancer control in all settings, which strengthens health systems and contributes to universal health coverage.

Many patients in Sub-Saharan Africa, Kenya included, will on average see between three to four healthcare providers before receiving a definitive cancer diagnosis. In most cases, the cancer is at an early stage when the patients first presents themselves into a facility for check-ups. However, due to limited knowledge of the early signs and symptoms of cancer among primary healthcare workers, these patients are treated for other conditions for long periods before finally cancer is diagnosed. By this time, the disease has progressed to an advanced stage, making treatment expensive and reducing the chances of survival.

KENCO has raised funds through the 2023 KENCO Annual Fundraising Dinner (3rd March 2023) that will facilitate the training of primary healthcare workers in cancer care with the aim of enabling them to detect cancer early enough and recommend the start of treatment and other related processes right away for patients.