8% of all Kenyan households experienced catastrophic health expenditures, with out-of-pocket payments pushing more than 1 million Kenyans into poverty annually. Photo Sarah Farhat/World Bank

In 2017, Grace, a 45-year-old single mother of five children in Kenya, discovered a painless mass in her right breast. So she trekked 80 kilometers from her home to the nearest hospital, where doctors called for surgical removal of the mass – without explaining it could be cancerous. Not realizing the full extent of her risk and lacking accurate information, Grace declined to have the procedure. 

A few months later, Grace experienced growing pain that became incapacitating. When finally diagnosed with stage II breast cancer, the cost of treatment was financially beyond the reach of the family. Fortunately, through support from a local NGO and late registration with the national insurance fund, Grace was able to access treatment.

A growing burden

Grace’s plight is sadly familiar.

Cancer is the second leading cause of deaths due to non-communicable diseases (or NCDs) in Kenya, and the number of cases is rising rapidly. The illness affects Kenyans of all ages and socio-economic backgrounds but has a disproportionate impact on the most vulnerable groups. Cervical cancer makes up the largest portion of cancer cases (nearly 12%) followed by breast cancer, Kaposi’s sarcoma, and oesophageal and prostate cancer.  

In 2020, according to the World Health Organization’s International Agency for Research on Cancer (IARC), new cases of all types of cancers increased to nearly 20 million worldwide, and there were 10 million cancer deaths (up from about 17 million and 9.5 million, respectively, in 2018). Current IARC projections suggest that one in 5 people worldwide will develop cancer during their lifetime and that the global cancer burden is projected to rise by about 50% over the next 20 years. The growing cancer burden is driven by aging populations, as well as several risk factors, such as sedentary lifestyles, obesity and smoking.

As in many low- and middle-income countries, most cancer cases in Kenya are diagnosed at an advanced stage, when treatment options are limited and families make huge sacrifices, often with poor results. Households not covered by health insurance frequently grasp for dire financial fixes – borrowing, selling assets – that can plunge them further into insolvency.

According to a 2018 household survey, 8% of all Kenyan households experienced catastrophic health expenditures, with out-of-pocket payments pushing more than 1 million Kenyans into poverty annually.  With less than 20% of the population enrolled in the national health insurance scheme, financial barriers to accessing care remains problematic as many Kenyans only enroll once they become ill.

The Kenyan government has stepped up its response to the mounting threat of cancer , but much more needs to be done. Efforts are underway to boost the capacity of health providers through in-service training on early cancer screening and expand pre-service training to increase the availability of specialized personnel.

The World Bank is partnering with Access Accelerated, a private sector collaboration, to provide technical and financial support to countries to tackle NCDs, including cancer.  This partnership funds  innovative pilot projects, analytical work and knowledge sharing that will help developing countries deepen and expand access to NCD services.

In the case of Kenya, the partnership is supporting the non-profit AMPATH’s Primary Integrated Care For 4 Chronic Diseases (PIC4C) initiative, an innovative model of care that involves raising awareness, promoting early detection and screening and initial care for several NCDs, including breast and cervical cancer.  While COVID-19 resulted in disruptions of these services, the team has managed to adopt the model of care by expanding telephone-based consultations, providing medications for longer durations, and enhancing triaging of patients to minimize the need to visit health facilities.

What have we learned so far?

While these efforts are laudable, much more needs to be done. And as we observe World Cancer Day, Grace’s story, which is also featured in a recent World Bank study about the Economic and Social Consequences of Cancer in Kenya: Case Studies of Selected Households, exemplifies the hurdles countries across the globe must navigate to reduce the threat of cancer.

The report highlights four priorities for strengthening the national cancer response in Kenya:

• Improve health seeking behavior by raising awareness and knowledge of cancer, lowering barriers to care, strengthening the quality of care, ensuring access to supportive counselling, and urging households to enroll early in Kenya’s National Hospital Insurance Fund.
• Continue to promote financial protection by progressively expanding the benefit package to cover more interventions and more people over time and identifying ways to cover non-medical costs which can be considerable.
• Strengthen the capacity of the primary health system to prevent, detect, and promptly treat most of these cancers, as this will ultimately save lives and minimize health care costs.
• Empower cancer survivors and family members to play a critical role in the cancer journey, advocating for patients, and establishing support groups to mitigate fears and foster solidarity.

How the World Bank supports cancer prevention

The World Bank plays an important role by supporting developing countries’ efforts to strengthen health systems.  The Bank’s overriding strategy is to help countries accelerate progress towards Universal Health Coverage through three pillars: expanding financial protection, so that no one is tipped into poverty because of catastrophic health spending; increasing coverage of quality health services for the poorest 40 percent of the population; and fostering a healthy society, including through investments that reduce risk factors. Cancer cuts across all three pillars.

The World Bank’s portfolio of about $US 1.5 billion (as of 2019) for health systems and health services operations is aimed at addressing non-communicable diseases. The World Bank provides financial support, policy advice, and technical assistance to reduce key risk factors for NCDs, including cancer. World Bank also helps countries strengthen early detection and screening, promote risk reduction, revamp health systems, and facilitate reforms to shift attention from costly secondary care to primary health.

For example, in Tamil Nadu, the sixth most populous state in India, the Bank has supported the state’s work to strengthen the management of NCDs, with cancer being one of the main priorities. Similarly, in Argentina, the Bank has assisted the country’s efforts to improve and expand its health services to tackle cancer and other NCDs, especially among the most vulnerable.

World Cancer Day is a reminder that, both individually and collectively, we must provide universal access to primary care and expand financial and social protection to all against the deadly plight of cancer. Failure to do so, will have devastating impact on families and society at large. - Miriam Schneidman/Renzo Sotomayor, World Bank