The Problem.

Cancer is the third leading cause of death in Kenya after infectious and cardiovascular diseases, accounting for 7% in overall mortality. The number of new cancer cases has risen from approximately 32,000 in 2012 to 48,000 in 2021 with an estimated annual mortality of 33,000. The risk of developing cancer before the age of 75 years (%) in Kenya is 18% among women and 14.3% among men while the risk of dying from cancer by the same age is 12.7% in women and 10.3% in men. Breast, cervical, prostate, oesophageal, and colorectal cancer are the most common types of cancers in the country with breast and cervical leading in mortality among women, prostate and oesophageal among men.

The Cost of treating cancer varies by type and increases by stage. On average, the cost of treating a cancer patient via chemotherapy is approximately US$ 1,365 per patient per year. The cost of treating stage I, II, and III breast cancer ranges from $1,340.38 to $1,542.58, cervical cancer range from $841.50 to $1,575.93. Breast and cervical cancer treatment in the private sector is almost 10 times more expensive than in the public sector.

The main challenges with cancer prevention, treatment, and control

 1) High cost of cancer diagnosis and treatment.

 2) Limited-service availability and poorly coordinated cancer management and referral.

3) Lack of public awareness and knowledge on cancer prevention and control.

 4) Inadequate human resource and capacity for cancer prevention and control.

5) Lack of multi-sectoral coordination structures and collaboration for effective risk factor reduction and cancer prevention.

 6) Limited funding for cancer prevention, treatment, and control.

 7) Limited cancer research both in capacity and availability to inform policy.

The goal

CHAI is committed to reducing the cost of cancer care & treatment to patients by optimizing the supply chain process, increasing access to affordable, efficacious, and cost-effective products and longitudinal patient monitoring for optimal treatment outcomes.

CHAIs Approach and Impact to Date….

Lack of data greatly impeded chemotherapy supply chain visibility thus limiting the programs’ ability to make data driven supply chain decisions and interventions. CHAI supported the National Cancer Control Program (NCCP) to develop manual reporting tools i.e. the daily activity register (DAR), summary tools for both patient treatment and commodity management which all feed into the digital national oncology dashboard that provides visibility into national level patient burden and medicines availability.

The dashboard aggregates data from paper-based facility level reports input through the Kenya Health Information System (DHIS2). 

This information has enabled the program to mobilize resources and respond to systemic gaps in the supply chain of medicines. For example:

·        With data from the dashboard, the NCCP with support from CHAI, conducted a quantification and utilized the outputs to advocate for additional funding from the government. Consequently, an additional US$ 1 million was made available for procurement of cancer medicines through the national program,2021/22 and 22/23 financial years. The portfolio of fully funded drugs is to increase from 23 to 50 most consumed chemotherapies by the end of 2023.These drugs are offered for free at the regional Cancer centers country wide.

·        The dashboard facilitated decision-making including averting expiries of stock worth $120,000 by enabling redistribution to facilities where the stock was needed.

·        Since 2021, patients receiving treatment have doubled in Kenya due to improved availability of drugs resulting from better planning and unlocking resources.

·         Facility reporting improved tremendously from 14% in Dec 2020 to an average of 84% in 2022.

 Pathway

From quarter three of last year (2022), we have been developing a pharmacy patient and commodity management system for longitudinal patient tracking for better treatment outcomes together with National cancer control program (NCCP). A digital patient electronic medical record and dispensing tool (Oncology Dispensing tool- ODT) will be housed at the cancer treatment centres and the lower levels of care that conduct screening services. The ODT will have a connection to the DHIS – the national data aggregation and reporting platform and into the oncology dashboard and eventually the MOH Data warehouse. Patient and commodity tracking registers will be incorporated into the ODT thereby eliminating any manual interaction with registers. This tool will have Service delivery, supply chain and data repository components such as.

·        Patient clinical documentation

·        Diagnostic testing and results – to manage patient labs and ease results return

·        Patient tracking along the referral and linkage pathway - ensuring that patients who are suspected to have cancer at the lower levels of care reach the designated treatment centres thus enabling earlier detection an timely treatment initiation.

·        Information on patient needs and outcomes will be available to guide policy and planning, resource mobilization and guidelines improvement, development, and research.

·        Commodity management per patient per facility.

·        Through availability of patient level data, forecasting and quantification will be more accurate for better budgeting and planning for more resource mobilization.

Transition and sustainability.

We are at 90% completion of the oncology dashboard, and it is fully owned by the NCCP. The hosting of both systems will be with the ministry of health. The National Cancer Control Program now has a dedicated officer who manages the day to day running of the oncology dashboard in terms of training personnel from new cancer centers and creating accounts for pharmacist to manage their facilities. We envision the same for the pharmacy tool.