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Cancer patients seek affordable healthcare

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By DOROTHY KWEYU
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Will the much-heralded Universal Health Coverage (UHC), a major plank of President Uhuru Kenyatta’s Big Four Agenda, extend its benefits to cancer patients?

That is the question on the lips of patients, survivors, lobby groups and the leaders of organisations involved in the treatment and care of one of the most dreaded non-communicable diseases (NCDs), thanks to its costly nature.

Cancer survivor and founder of community organisation Breast Cancer Kenya Josephine Sitawa is categorical: “Cancer should be declared a national disaster.”

In a 30-minute telephone interview on Friday, Ms Sitawa, 35, discussed the economic cost of a disease that tends to be limited to its debilitating physical impact and the pain it causes patients.

Xeloda — the brand name for an anti-cancer-chemotherapy drug Capecitabine — has to be administered every two to three weeks at a cost of between Sh30,000 and 40,000, Ms Sitawa says.

“Remember, this is a woman with no money. She has been relieved of her duties and most likely parted with her husband and her family because of the stigma associated with disease. Patients would rather stay hungry in the house, where they are perceived to be doomed to die, than seek help to buy food,” she says of a disease with great psychological and physical impacts.

Another chemo drug, Herceptin (Trastuzumab) costs between Sh150,000 and Sh250,000 per cycle of three to four weeks, “depending on the supplier and the economic situation in the country”. Most patients, Ms Sitawa says, “give up and wait to die”.

Breast Cancer Kenya is seeking a memorandum of understanding with the National Hospital Insurance Fund (NHIF), irrespective of whether or not the President’s UHC will cover cancer.

And not just for breast cancer. Cervical cancer, which causes continuous bleeding, requires two packets of sanitary pads daily, which is way beyond the means of an already vulnerable lot.

The prohibitive cost of cancer has heightened the clamour to declare it a national disaster, as Laikipia Woman Representative Catherine Waruguru did when she filed a Motion in Parliament to that effect on March 21.

She also called for the establishment of a cancer fund to cater for patients’ treatment and care, noting that cancer causes more deaths than HIV, TB and malaria combined.

Dr Alfred Karagu, acting CEO at the National Cancer Institute (NCI), disclosed that an estimated Sh10 billion is spent annually by people seeking medical attention abroad, 50 to 60 percent are for cancer-related services. He described it as “a huge drain on the economy”.

He is for declaring cancer a national disaster because, “Whenever something is declared a national disaster, it makes everyone invest in it”.

He, too, referred this writer to the office of the Cabinet secretary, which is responsible for appointing boards to statutory organisations, for a comment on why the NCI has operated for a whole year without a board.

During a telephone interview with the Executive Director of the Kenya Hospices and Palliative Care Association (Kehpca), Dr Zipporah Ali, she backed the call to declare cancer a national disaster.

Kehpca, a grouping of 70 hospices, also has 17 palliative outlets in 35 counties, catering for cancer patients and those afflicted by NCDs.

Cancer is harder to treat, and more expensive, yet there is a shortage of treatment centres, she says.

“Patients and their families want cancer declared a national disaster and accorded the same importance HIV/Aids was given,” Dr Ali said, adding that HIV/Aids received more attention after it was declared a national disaster.

She challenged donors to also support NCDs, as “cancer does not come alone; a cancer patient can also have HIV or other NCDs”.

The doctor was concerned that the UHC programme does not seem to address palliative care, which, she says, should be part of the package.

Palliative care is important in addressing non-curable diseases that are often accompanied by distressing symptoms, which can be physical, psychological, emotional and spiritual.

It is holistic and extends to the entire family. Coughs, diarrhoea, and pain, “which can be very frustrating”, are among the afflictions terminally-ill patients face.

The Kenya Network of Cancer Organisations (Kenco) also noted frequent shortages and drug stock-outs, which were particularly bad this year in public facilities, including Kenyatta National Hospital. When the drugs were available, they were quite costly.

Its 2018 scorecard dated November 27, which the chairperson, Mr David Makumi, made available to this writer, shows that some patients cannot afford even Sh200 for a monthly dose of Tamoxifen.

The 25-member group blames shortages and the high cost of drugs on procurement hitches, which put patients at risk of disease progression.

“The cost of chemotherapy and supportive drugs is prohibitively high,” it says, urging the Ministry of Health to ensure that Kemsa [Kenya Medical Supplies Authority] stocks all chemotherapy drugs and avoid parallel procurement mechanisms in public hospitals.

“It is unacceptable that 55 years after independence, Kenyatta National Hospital is the only public hospital with radiotherapy facilities,” Kenco says in its scorecard.



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