Date: 30th September 2024 | Issue #2
Like many other low- and middle-income countries (LMICs), Kenya has undergone a significant epidemiological transition over the past decade. Originally designed to combat communicable diseases, the country’s health system now faces an increasing burden of non-communicable diseases (NCDs). Globally, NCDs account for two-thirds of all premature deaths, with cancer as the second leading cause among NCDs after cardiovascular diseases. Presently, 54% of deaths in Kenya are due to communicable diseases, while deaths from NCDs have risen from 27% in 2014 to 39%. By 2030, deaths from NCDs are projected to increase by 55%.
According to GLOBOCAN 2022, Kenya reported an annual cancer incidence of 44,726 cases and 29,317 cancer-related deaths. The most prevalent cancers include breast, cervical, colorectal, prostate, and esophageal cancers, which collectively account for 51.7% of all new cancer cases and 48.2% of cancer-related deaths. Given the rising cancer burden and Kenya’s economic status, there is a pressing need for efficient and effective cancer management strategies. Primary health care (PHC), the cornerstone of Kenya’s healthcare system, is crucial in addressing the cancer burden and achieving universal health coverage.
Kenya’s healthcare system is organized into six levels with PHC services predominantly delivered at levels 1 to 3. PHC serves as the initial point of contact for individuals, families, and communities with the healthcare system, offering essential medical services directly where people live and work. It encompasses disease prevention, health promotion, and addressing social determinants of health, including health education, family health services, environmental health, first aid, community-based surveillance, psychosocial support, rehabilitation, and palliative care.
Kenya’s Ministry of Health recently conducted a health facility census to enumerate all health facilities, determine service availability, and identify system gaps. According to the census, 92% of assessed facilities were level 2 or 3, indicating that these are our primary access points to healthcare. However, significant challenges still need to be addressed, including an uneven distribution of healthcare facilities, with a national average of 2.4 facilities per 10,000 people, primarily concentrated in major towns within specific counties. Some counties have only one facility that serves 10,000 people. Furthermore, only 55% of primary health facilities were accredited by the public health insurer, the National Health Insurance Fund (NHIF). Additionally, many PHC facilities do not offer basic laboratory and imaging services.
Within Kenya’s economic and social context, primary health care is pivotal in addressing the cancer burden as these facilities are most accessible to the population. Despite their importance, several challenges hinder effective cancer care in these settings. Late detection remains a significant issue due to low screening rates and limited diagnostic capacity. Integrating screening into routine services can mitigate the barriers patients face, such as embarrassment, discomfort, or fear. It’s concerning that despite most Kenyans seeking initial healthcare from primary facilities, cancer diagnoses in these facilities are rare, prolonging the time between symptom development and treatment initiation. Lowering the threshold of suspicion among healthcare workers in these facilities is crucial to improving early detection and timely intervention.
Primary healthcare facilities often lack essential diagnostic tools and adequately trained personnel to detect and manage cancer effectively. Investing in advanced diagnostic technologies, providing comprehensive training for healthcare providers, and implementing evidence-based triage protocols can enhance early detection and facilitate timely referrals. Integrating cancer screening tools such as mammography, PSA tests for prostate cancer, CEA tests for colorectal cancer, pap smears, VIA/VILI for cervical cancer, and colposcopy with biopsy into primary health facilities, particularly at level three, is crucial. Increasing public awareness of the benefits of screening and ensuring that screenings are affordable and accessible can lead to better treatment outcomes and a reduction in the overall cancer burden. These can only be achieved with responsive funding mechanisms that account for screening costs for the target groups and the required frequency.
Subsequently, health education is crucial for addressing risk factors like tobacco use, alcohol consumption, and sedentary lifestyles. Community health promoters are vital in disseminating health information and raising awareness about cancer prevention and screening. Public awareness campaigns and education programs can demystify cancer, promote proactive health behaviors, and empower individuals to take ownership of their health.
Of significance is the vaccination against human papillomavirus (HPV). This is pivotal in preventing cervical cancer, particularly when administered to girls by age 15. Community health promoters are instrumental in promoting HPV vaccination, addressing safety concerns, and ensuring no missed opportunities for vaccination. Strong recommendations from healthcare providers significantly influence vaccination uptake, highlighting the importance of effective communication about HPV vaccination as a preventive measure against cancer.
Lastly, Integrated care, an organizational principle that aims to improve patient care and experience through coordinated service delivery, is critical in comprehensive cancer management. It ensures seamless coordination among healthcare providers and services, optimizing patient outcomes and care delivery. This approach relies heavily on effective referral systems and coordinated care across multiple levels. We need to rethink the primary healthcare system’s expanded role as the first line of defense in addressing the cancer burden, leveraging its accessibility and community-centered approach to ensure comprehensive cancer screening, early detection, and timely intervention become standard practice across all healthcare facilities. This proactive strategy, backed by strong diagnostic capabilities, ongoing healthcare provider training, and targeted public education campaigns, is critical to lowering mortality rates and improving the quality of life for all Kenyans affected by cancer.
James Kiilu is the Head of Outrach Division at the Integrated Cancer Research Foundation of Kenya.