The Problem

 Cancer ranks as the third leading cause of death globally, following infectious diseases and cardiovascular diseases. In Kenya, there are 42,000 reported cancer cases and 27,000 deaths annually, with more women than men being affected. The risk of developing and dying from cancer before the age of 75 is higher in women. While most cancers are undiagnosable, high-burden cancers like breast, cervical,prostate,and colorectal cancers canbediagnosedthrough various screening methods. Cervical cancer, the leading cause of cancer deaths in women and the second most prevalent after breast cancer, is a significant concern. Kenya is among the top 20 countries with the highest cervical cancer burden, recording 5,236 cases and 3,207 deaths annually. HIV-positive women are six times higher risk of acquiring HPV. Cervical cancer claims nine lives every day in Kenya every day, and it is the only cancer that is 100% preventable through screening and early diagnosis, offering a favorable prognosis if detected and treated early. For cervical cancer elimination, the MOH aligns with the global targets of 90:70:90 aiming to screen 1.1 women annually for the next 5 years. Currently Kenya has a screening coverage of 51.6% up from 19.3% at the beginning of the grant.

1.   Service Delivery

a)   Demand generation gaps existing at all levels of care as very few facilities are employing community strategy to raise awareness of the availability of these services.

•    Low awareness of the availability of services

•    Low sensitization on the importance/benefits of screening

•    Priority over other health services

•    Myths and misconceptions surrounding cervical cancer and screening

b)    Screening

•    Reducing workforce after training (61% still deployed in their SDPs).

•    Low confidence in screening

•    Low # of clients esp. in PHC facilities (less practice) •     Competing duties in PHC facilities.

•    HCW motivation

c)    Treatment (coverage at facilities providing at 33%) •  Proximity to a treatment site

•    Referral and follow up (patient tracking)

•     Hesitance in using the device

•    Low # of clients for treatment d)    Referral and follow up

•    Patient/Sample referral •    Patient/Sample tracking

•    Distance to the referral facility

•    Broken patient navigation system

Current work

I.      Community strategy in some counties i.e., working with PHOs and CHVs including nurses to continue spreading health messages using IEC materials and job aids for awareness creation.

II.     Training more HCWs and working with counties on a retention program post training. Conducting mentorship and supervision for the trained HCWs including OJT.

III.      Taking advantage of inreaches and outreaches to reach more women for screening

IV.      Developing a treatment register for all facilities trained in order to facilitate referral of clients.

Planned Work 2024

Continue working with MOH to support resource mobilization to scale up training of more HCW, devices’ procurement and distribution.

 Work on establishing and strengthening patient referral and tracking mechanisms post screening.

2.   Supply Chain

•    Fragmented uncoordinated procurements – partners in the field procure kits according to the need even without consulting with MOH

•    Propirety nature of consumables – with multiple suppliers in the market HPV kits and their respective consumables are not compatible across platforms

•    Poor coordination of available resources – stems from inadequate transparency of key players/partners on their procurement plans or available commodities may result to expiries

•    Fill rate–VIA consumables procured and delivered through KEMSA mostly would not be complete or related consumables delivered at different times.

•    Lab backlogs as a result of delays or unfulfilled delivery of lab commodities in addition to deprioritization of HPV samples especially in POC sites

Current work

I.      Coordinating TWG’s with MOH and partners for the purposes of coordinating activities and supplies available for efficiency purposes and visibility.

II.      Integration of programs both at the national and subnational levels to take advantage and leverage on their resources e.g HIV progam

III.      Partner mapping – for visibility of activities and to know procurements plans

Planned Work 2024

Work with suppliers/distributors on co-packing some of these supplies and consumables for ease in logistics in procurement and distribution/delivery.

Continue supporting MOH in resource mobilization of resources for procurement of commodities through donors and partners e.g. GF, USAID

3.   Data and Data Use Data capture challenges

•    Slow transition from one reporting tool to another i.e., MOH 711 to 745 *(back to MOH 711)

•    Inadequate data tools – distribution of printed data tools not in all facilities (only 49% of facilities now have the updated registers)

•    Limited data

o Inadequate details on MOH 711 currently in use in addition to the new MOH 745 – former tool does not capture all data points needed

o Inadequate data – data not fully reported on the existing comprehensive tool (MOH745)

•    Lack of reporting tools – about 30% of facilities use alternate data capture tools (down from 45%) e.g. using counter books and captured data doesn’t end up on KHIS.

•    Lack of standardization/harmonization of tools for reporting – facilities have different versions of th same tool

•    Uncoordinated printing of tools and partners printing their own tools for their own program or print an outdated version of reporting tools.

•    Reconfiguring/updating of KHIS-2 data points results in loss of some data

•    Limited/inconsistent use of data for planning and management

• Inadequate data available for analytics, planning and decision making e.g, F&Q

Current Work

I.      Technical assistance to MOH to revise the aavailable tools to capture required indicators. 

II.      Secured some resources and assisted MOH print and do targeted distribution reporting tools. 

III.      Leveraging on partners i.e., USAID and assisted MOH in targeting capacity building of HRIOs for data management from the 47 counties.

Planned Work 2024

Continue supporting MOH mobilize resources for printing and distribution of more reporting tools to facilities

Continue working with MOH at both levels advocating on the use of data for informed decision making e.g, planning distribution of commodities, oncology drugs, device placement

4.   Health Financing

•    CaCx screening and treatment of PCL services are heavily reliant donor support - not sustainable.

•    Services charged at L4 and L5 facilities as a co-payment for the service offered.

•    Most counties did not have a dedicated budget for procurement of screening supplies and consumable for their and rely on the national govt. for this.

•    Most services offered by tertiary institutions are not entirely covered by NHIF or require preauthorization

•    Additional costs to be incurred in the screen and treat spectrum i.e., sample transportation, analysis/tests etc.

•    NHIF covers for some services require pre authroization which doesn’t always guarantee approval and most patients would end up paying out-of-pocket.

•    NHIF covers are mostly capped or rebated so it pauses a limitation/challenge for patients who would exhaust the cover

Next Steps

•    Advocacy rooting for alternative funding from donors or partners to compliment financial efforts from national and subnational levels.

•    Use of data to forecast and quantify the needs for example screening of eligible women, treatment of cancer through chemo and radiotherapy.

•    Market shaping efforts in working with manufacturers and suppliers demonstrating the need for the services and/or products needed i.e. HPV supplies, treatment devices, oncology drugs.

•    Tecnnical assistance for MOH to plug into the available funding opportunities for cervical cancer e.g., the Global Fund “New Funding Model - NFM” that presents an opportunity for integration with HIV; collaborative grant writing and leveraging on such opportunities.

•    Leverage opportunities within CHAI and MOH to inform SHIF coverage of screening.