How NHIF-drugmaker's deal is saving lives of women with aggressive breast cancer

When Lucy Wanjiru was diagnosed with breast cancer early last year, she was told the treatment that could save her life was ‘untouchable’.

She had an aggressive breast cancer that was HER2-positive, where the cells multiply too quickly.

The treatment she needed attacks the receptors that send growth signals to the cells.

Doctors were reluctant to start treatment on patients who could not afford the treatment because the National Health Insurance Fund (NHIF) only financed four of the required 18 sessions, each at more than Sh70,000.

Wanjiru counts herself lucky because she was recently enrolled in an access programme between the Ministry of Health and Roche, the pharmaceutical company that offers the treatment.

“NHIF is covering the full cost of my treatment,” Wanjiru, 44, told the Star.

She gets a five-minute injection rather than a four to five-hour infusion, which saves time and money.

The five-year NHIF deal was announced in July last year but it took several months to start.

The Roche treatment has been shown to extend life for five or more years for many patients with previously untreatable breast cancer.

“These patients (with HER2 positive breast cancer) account for about 20 per cent of the patients that have an aggressive disease,” says Jacqueline Wambua, the general manager at Roche East Africa.

“Statistically, five out of 10 women in Africa will not be alive in five years with breast cancer. And that's very sad, because if you look at the developed countries, nine out of 10 will be alive five years from now, and so we wanted to change that,” she said.

In an interview, she told the Star plans for the public-private partnership began in 2016.

“We started thinking about how to make impact in the public sector, where most of the patients are. At Roche we believe that we need to provide standard of care treatment for women in East Africa regardless of her socioeconomic status. Where a woman lives should not determine the kind of care she receives,” she said.

The treatment is now offered in 13 public hospitals, with NHIF covering the full subsidised cost.

At least 300 patients had accessed the treatment in the hospitals between January and June this year.

Breast cancer is the most commonly diagnosed cancer in Kenya, with 6,000 cases diagnosed each year and 2,500 breast cancer-related deaths taking place.

One of biggest challenges, Wambua says, has been lack of awareness, because a lot of patients seek treatment at stage 3 or 4, when there is not much intervention other than palliative care.

There are also few specialist providers in Kenya because the country has 12 oncology pharmacists, and seven breast surgeons.

However, through the programme, Roche has been training health providers to offer treatment.

“We are supporting scholarships in medical oncology, radiotherapy, medical physicists from the treatment centres,” she said.

“So when you look at that, we've not just provided the drug, but also added value to the whole healthcare system, and to the patient experience, the patients who actually have breast cancer.”

The programme builds on the foundation laid through the 16 Empower Clinics (Enabling and Motivating Partnership Owned by Women to Engage and Reclaim their lives) in different counties.

Empower is a partnership with the government, county referral hospitals, County First Ladies Association, International Cancer Institute, patient organisations and Roche Kenya to demonstrate integrated cancer prevention and treatment within primary healthcare.

“Through empower, 42,367 women have been screened for breast and cervical cancer in the eight clinics (as of July 2023),” Wambua said.

According to the National Cancer Institute, the Coast and Nairobi regions have the highest prevalence of breast cancer in Kenya.

Overall, breast, cervical, prostate, oesophagus and non-Hodgkins lymphoma are the five top cancers in the country.

These five cancers account for nearly half (48 per cent) of the cancer burden in the country, NCI says.

Cervical and breast cancers contribute to almost a quarter (23 per cent) of all cancer-related deaths in the country.

According to the NHIF, Sh3.8 billion went to cancer treatment in reimbursements in the financial year 2021-22.

Former NHIF CEO Peter Kamunyo at that time said this is accounted for six per cent of the total expenditure on claims last year.

Forty per cent of the amount went to chemotherapy, 23 per cent on surgeries with the remaining amount being distributed to other cancer treatment processes such as radiotherapy and imaging.

In total, NHIF catered to 47,000 cancer patients in 2021-22.

Looking at all cancers in Kenya, Mt Kenya has the highest disease burden in the country, according to NCI.

Data presented to the Senate Health committee mid last year indicates that six counties from the region top the first 10 devolved units with the highest number of cases in the country.

The report showed that Nyeri, Murang’a, Kirinyaga and Embu counties have the highest disease prevalence.

In Nyeri, cancer incidence stood at 2,127 for every 100,000 people, followed by Murang’a, which accounts for 2,123 cases and Kirinyaga's 2,033 cases.

The report presented by then Health CS Mutahi Kagwe and then CAS Mercy Mwangangi showed Embu has 1,906 cases,  Taita Taveta 1,884 and Machakos has 1,844 for every 100,00 people.

Kiambu, Meru, Nyandarua and Vihiga top the list of first 10 counties with the highest cancer burden.

Kiambu has 1,793, Meru 1,789, Nyandarua 1,776 and Vihiga has 1,766 cases.

Other counties with high cancer cases are Laikipia (1,740), Makueni (1,692), Kisii (1,670), Tharaka Nithi (1,644), Lamu (1,641), Siaya (1,630), Kitui (1,624) and Nakuru (1,612).

Northern region has the least number of cancer cases in the country.

The cases are least in Wajir (1,221), Mandera (1,224), Garissa (1,257), West Pokot (1,273), Turkana (1,289) and Samburu (1,313).

According to the report, cancer is the third leading cause of death after infectious and cardiovascular (heart-related) diseases.

About 42,116 cases of cancer are reported every year.