A review of Kenya’s cancer policies to improve access to cancer testing and treatment in the country

Abstract

Background: Cancer is the third-leading cause of mortality in Kenya, resulting in unique challenges to the country's health system. An increase in the number of cancer cases in Kenya over the past decade resulted in legislative actions and policies to guide delivery of cancer services. Kenya's new national cancer control strategy and past policy efforts provide an opportunity to synergise information and enhance understanding to improve cancer diagnosis and treatment in the country. The objectives of this study are to (1) document policy-modifiable factors based on a review of policy documents and results of a key informant survey and (2) develop recommendations to improve policies affecting cancer testing and treatment services in Kenya. This study builds upon our previous study Improving Access to Cancer Testing and Treatment in Kenya (Makau Barasa et al. J Global Oncol 2(216), 2017). Methods: The study applied an in-depth systematic review of Kenya's cancer policies and guidelines, a qualitative analysis of results from a section of a semi-structured key informant survey focused on the opinions of clinicians delivering cancer services as well as cancer support groups and advocacy leaders, and a stakeholder analysis identifying key policy-makers and implementers. Details of the complete key informant survey were published in our previous study. Results: Kenya's cancer policies have guided progress made in providing the legal and implementation frameworks for the development and delivery of cancer services at the national and county levels. Some policy implementation gaps are noted. These include inadequate financing for cancer services, limited research and data to support policy formulation, and the concentration of cancer services in urban areas. The key informant survey identified policymodifiable actions that can address some of the gaps and improve the delivery of and access to cancer testing and treatment services in the country. Some of these include addressing the financial barriers affecting cancer testing and treatment services; increasing stakeholder engagement in training health personnel to deliver cancer testing and treatment services; decentralising cancer services and improving cancer surveillance and research; and increasing education and awareness about cancer symptoms, screening procedures and treatment options. A set of priority policy actions were selected from the study findings and used to develop recommendations for Kenya's policy-makers and stakeholders.

Geospatial evaluation of trade-offs between equity in physical access to healthcare and health systems efficiency

“… 21 24 40–42 Kenya’s health system has focused on efficiency, and the placement of its facilities have been associated with rural–urban disparities in geographical access to primary care services. 22 43 The health system in Malawi has pursued propoor policies, but its level of economic development has hampered efforts to address urban–rural inequities in accessing primary care services for maternal and child health. 23 In the Geo-PSA model, strong Moran’s I correlations between travel time to the closest facility and population density, like those observed in Kenya and Malawi, suggest that the placement of facilities favoured efficiency over equity compared with countries with weaker correlations (Rwanda and Tanzania).…”

“…The countries have also adopted different approaches to implementing government health policies addressed towards achieving equitable health service delivery. [21][22][23][24] Finally, questions regarding tradeoffs between equity and efficiency are particularly pertinent as they expand access to care for cancer and other chronic diseases. [25][26][27] In order to empirically evaluate the association between population density and travel time, we obtained multiple geospatial data inputs described in online supplemental file 1.…”

Building a Sustainable Comprehensive Multiple Myeloma Program in Western Kenya

“…The noncomprehensive coverage of cancer care by NHIF, as observed at MTRH, has been suggested to contribute to poor outcomes according to a Kenyan qualitative study. 30 In an American registry study, limited access to treatment as a result of inadequate insurance coverage was found to be a contributing factor to lower survival among patients with non–Hodgkin's lymphoma. 31 For Kenyan patients with MM, the current inadequate NHIF coverage, therefore, portends less-than-optimal survival outcomes.…”

Risk Assessment of Aflatoxin and Fumonisin in Fish Feeds, Kenya A Review

“…Despite the improved diagnosis, treatment and awareness within communities, the burden of cancer continues to rise in the country that is coupled with immense challenges. There is still insufficient general knowledge to the public, pathology and radiology services are weak, with inadequate infrastructure and human resources (Makau-Barasa et al, 2020). Other serious issues surround the affordability and availability of cancer commodities, which impedes access to services by cancer patients.…”