The increasing burden of cancer in Kenya has serious implications, particularly for women. Understanding how women access breast-cancer treatment services is essential for mitigating its effects. Dr. Vincent Okungu, one of the senior faculty members at Institute of Healthcare Management and a Strathmore Business School alumna, Dr. Sultan Sherman from the Master of Business Administration Healthcare Management, Programme, have published an article on the American Journal of Public Health Research on 30th June 2018. Dr. Sultan Sherman is the Head of Outreach Centers, Mombasa Cluster at Aga Khan University Hospital.
Their collaboration to the research, “Access to Breast Cancer Treatment Services in Mombasa County, Kenya: A Quality of Care Analysis of Patient and Survivor Experiences,” identified lack of equipment, distance to facilities, unavailability of specialized personnel, high cost of care and cultural stigma, as the main barriers of access to cancer services.
These barriers impact on quality of care in terms of timeliness, equity, effectiveness, patient-centeredness, safety, and efficiency. Poor quality of care was exhibited in reports signaling wrong and late diagnosis, poor outcomes in surgery, severe burns, broken down equipment, among others. There were also social consequences of being diagnosed with breast cancer including loss of business and termination from employment. Concerted efforts including investments in health workers, equipment, and awareness creation are required to support access to quality breast cancer care.
Kenya is one of 106 developing countries that lack access to medicine and experience a high burden of non-communicable diseases (NCDs) globally, cancer causes more deaths than HIV/AIDS, TB and malaria combined. With over 70% of the global cancer burden in LMIC (Low and Middle-Income Countries). In Kenya, the number of newly diagnosed cancer cases rose by 46.4% between the years 2012 (28,000 cases)  and 2015 (41,000) . It is estimated that daily cancer mortality rate in Kenya is the highest of the NCDs and registered a 6% annual growth rate between 2010 and 2014.
Currently, cancer is the leading cause of hospitalization and mortality at the Kenyatta National Hospital (KNH), Kenya’s largest national referral facility. The hospital’s cancer registry indicates that 53% of all patients admitted in 2015 were due to cancer-related morbidity. The rapid growth in cancer mortality rate suggests that cancer could be on course to be the leading cause of NCD-related deaths in Kenya. The deaths (about 76% of all cases) are mainly caused by delays in treatment due to lack of personnel and equipment, and late detection of nearly 80% of reported cases.
Some of the recommendations presented in this study illustrate that timely access to quality health services is key to treatment outcomes. The findings of this study indicate that poor access to quality breast cancer treatment services leads to poor health outcomes. Service unavailability including long distance to facilities, lack of timely follow up, lack of specialists, lack of equipment, etc., have been documented in this study. For these factors, there is a high potential for increased mortality from breast cancer in Mombasa County. There is already evidence suggesting that women are more susceptible to NCDs than men. Besides, being treated by personnel not trained in oncology as well as interrupted treatment cycles raise questions about patient safety and treatment effectiveness. Not only did patients experience severe burns but also the risk of metastases leading to the spread of cancer to other organs.
This study has linked patient safety and treatment effectiveness concerns to severe shortage of manpower with the right skill mix to diagnose and treat breast cancer. The shortage of skilled manpower including cancer specialists potentially leads to misdiagnosis, poor surgical procedures which in turn result in more costs and poor health outcomes for the patient.
In conclusion, the study illustrates that to improve quality of care for breast cancer, systems for early detection should be put in place including promoting the empowerment of women to access healthcare, developing infrastructure for diagnosis and treatment, and mammography screening.