The Ministry of Health has proposed new regulations to weed out health facilities that provide substandard cancer treatment.
That is because, despite its extremely low number of cancer specialists, Kenya has an inordinately high number of clinics that purport to be “cancer centres.”
The new regulations mandate the National Cancer Institute to inspect and confer the ‘cancer centre’ title only to facilities that meet stringent standards.
Owners of uncertified facilities will be liable to Sh200,000 fine or six months imprisonment.
“The management of the cancer centre shall ensure that specialists working in the cancer centres are qualified; [and that] the staff members do not engage in practice outside their area of specialisation,” one set of the regulations says.
Even before the new rules, NCI has been inspecting facilities that provide cancer treatment.
Early last year, NCI said in 2022, at least 105 health facilities applied to be recognised as cancer centres.
Most of these were for-profit facilities, signaling a fast-growing lucrative segment of the health business.
For instance, in 2020-2021 the National Health Insurance Fund paid health facilities Sh1.5 billion to treat 50,000 cancer patients.
The new regulations were published by Health Cabinet Secretary Susan Nakhumicha on April 12 ahead of a national public participation exercise scheduled for April 16 to April 30.
NCI, an agency of the Ministry of Health, is mandated to inspect and designate cancer centres in Kenya. It also coordinates cancer-related research.
The new rules also require a cancer centre to have a multidisciplinary tumour board, which refers to meetings in which physicians from various specialties and other healthcare professionals discuss cases of cancer patients and recommend a treatment plan.
Such is the standard practice in national referral hospitals but is non-existent in many private facilities.
“The team shall meet at least once every week,” the regulations say.
“The meetings shall be attended by representatives of all relevant disciplines depending on the cancer case and the level of care.”
The centres must also ensure that chemotherapy is only initiated under the supervision of qualified oncologists.
The regulations further require cancer centres to employ oncology nurses.
“Every cancer centre shall, where applicable appoint oncology nurses who have at least a higher diploma in oncology and are registered with the Nursing Council of Kenya,” the proposed rules say.
MoH published a set of five proposed regulations. These are Cancer Prevention and Control Standards of Care Rules 2023; Public Awareness and Education Rules 2023; Cancer Registries Rules 2023; Consent to Research Rules 2023 and Inspection and Certification Rules 2023.
In the past, some questionable ‘cancer centres’ were put on the spot for misdiagnosing patients as having cancer or "precancer" and treating them.
Other patients were told they were cured or were improving even though they still had active disease.
Cancer treatment is a multibillion-dollar business in Kenya.
In February last year, NCI reported that from the 105 health facilities that applied to be recognised as cancer centres in 2022, 67 were approved.
However, the majority only provide basic services, mostly chemotherapy.
“The majority 48 (72 per cent) of the designated centres are basic-essential cancer centres that mainly provide chemotherapy services while 16 (24 per cent) facilities are designated as middle-level cancer centres and (seven per cent) facilities were categorised as Comprehensive Cancer Centres,” NCI said in its Status of Cancer in Kenya report.
Majority of these facilities are in Nairobi, followed by Uasin Gishu, then Kisumu, Mombasa, Machakos and Nyeri.
Majority of the designated centres (72 per cent) are privately owned while public facilities account for 18 per cent and are mainly county and national referral hospitals.
NCI said basic centres can provide at least one cancer treatment modality while comprehensive centres can provide highly specialised cancer services in addition to those provided by the basic or middle-level cancer treatment centres.
NCI chairman Dr Githinji Gitahi said the National Health Insurance Fund in 2020-2021 paid the facilities Sh1.5 billion to treat 50,000 cancer patients.
“Cancer accounts for 2.5 per cent of the total payout by NHIF per year,” he said.
According to NCI, the country reports 47,887 new cancer cases and 32,987 cancer-related deaths every year.
The disease remains the third leading cause of death in Kenya and is the second leading cause of non-communicable disease deaths in the country.
Kenya has 58 oncologists, 60 oncology nurses, 12 oncology pharmacists, 10 medical physicists, 27 radiotherapy technologists and two nuclear medicine physicians.