DENNIS MBEGAH: The human resource challenge in Kenya's Cancer management

Currently cancer is amongst the top 3 killers in Kenya.

In Summary

• It is estimated that the incidences of cancer have risen by 29.4 per cent in the last decade from an estimated 32,000 to 47,887 new cases annually.

• The deaths caused by cancer have also risen during the same period from 28,500to 32,987.

Dr Miskellah Dennis Mbegah.
Dr Miskellah Dennis Mbegah.

Today, February 4, the world marks the World Cancer Day whose theme is “Close the Care Gap” and it’s coming right at the end of the just concluded National Cancer Summit where a report on the status of Cancer in Kenya was launched. The report paints grim picture of where we are as a country and its time, we classified Cancer as an issue of National concern and allocated significant resources towards eradicating it.

Currently, cancer is amongst the top three killers in Kenya, coming only 3rd to infectious and cardiovascular diseases. It is estimated that the incidences of cancer have risen by 29.4 per cent in the last decade from an estimated 32,000 to 47,887 new cases annually. The deaths caused by cancer have also risen during the same period from 28,500to 32,987. These are not just numbers, they are families grieving, breadwinners lost, children orphaned and empty dinner seats, heartbroken widows and widowers not to mention the financial distress that accompanies the treatment and  funerals.

The cancer scourge in Kenya has proven that it is not just a health problem but also a socio-economic problem that behooves all of us to reflect on what we can do to fight it. It is for this reason that on this aptly themed day that Kenya Medical Practitioners, Pharmacists and Dentists Union, KMPDU, have decided to highlight one of the major gaps in Cancer management in Kenya which is the poorly organised and managed human resources for healthcare. KMPDU represents 10,000 doctors working both in public and private sector and it is well positioned to tell the country what really ails the crocodile. I beseech the nation not to ignore the alligator.

Kenya has 12,000 registered doctors, 14,000 Clinical Officers and 58,000 nurses serving a total population of 54 million. Out of these, there are less than 100 oncologists (cancer treatment specialists) translating to a ratio of 1 oncologist for every 540,000 Kenyans! This acute shortage coupled with the multiple county and national strikes by healthcare workers due delayed salaries, lack of career progression and long working hours have contributed to the worsening of the number of cancer deaths in the country.

While it is true that Cancer is a global problem, some types of cancers have nearly been eradicated in some parts of the world through intentional investments on screening, vaccination and early diagnosis and treatment programmes. These are the low hanging fruits that Kenya can start working on. Cervical cancer, which is the leading cause of death in Kenya, claiming almost nine lives daily is for example preventable through vaccination and treatable when diagnosed early. The challenge is having adequate number of well trained, motivated and resourced personnel to carry out such activities.

Training a cancer specialist is not cheap, be it a nurse of a doctor and that is why the Constitution envisioned training to be a national function of the Ministry of Health. Let the ministry use the Cancer status report to work out the human resource staffing needs then hire the much-needed health workers. They should also do in service training of those already in employment.

The University and Medical Colleges curricula should also be revised to reflect the new health challenges. Once the trainings have been done, let these highly skilled and specialised workers be a national asset that can be shared and be distributed across the nation based on need and availability of infrastructural support, it serves no purpose for a county to train a radiology oncologist, yet they have no radiotherapy services.

We can create ten centres of excellence for various cancer types, equip them well and put adequate human resources. These centres can then offer a hub and spoke model which the surrounding facilities can plug into for knowledge acquisition and patient referral. All these coordinated activities can only occur if we have centralised and standardised human resource management system especially from level 4 to level 6 facilities. We cannot manage cancer in 48 different ways by 48 governments.

With cancer, we are all affected, and it is high time we all come together to have a joint and well organised response to it. I challenge the government of President William Ruto to declare cancer a problem of great public health concern and lead from the front in tackling it. May we spare a moment to remember all those who have died from cancer and celebrate the victors.

Miskellah Dennis Mbegah is the National Deputy General Secretary of KMPDU and an obstetrics and gynaecologist and Kenyatta National Hospital

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