Access To Cancer Care in Kenya: Patients, Caregivers and Health Providers’ Perspectives
Mercy Njeru (KEMRI); Charlotte Cross (Open University); Lilian N. Nyandieka (KEMRI); Sharon Mokua (KEMRI); Richard Mutisya (KEMRI); Vera Manduku (KEMRI); Maureen Mackintosh (Open University)
Presentation given at the Kenya Medical Research Institute (KEMRI) Annual Scientific and Health (KASH) Conference, 8th - 10th June 2021.
Background: Access to health care remains a complex notion with varying interpretations and no universally accepted definition. A majority people lack access to healthcare or access basic levels of care. The literature identifies “6As” dimensions of Access: Accessibility, Affordability, Availability, Adequate/Appropriate, Acceptability and Approachability. This paper employs these dimensions in documenting factors that influence access to cancer care in Kenya
Methodology: A convergent parallel mixed methods study design was employed in three counties of Meru, Nairobi and Mombasa. 405 patients were interviewed, four focus group discussions with cancer survivors and 22 in-depth interviews with care givers health workers and policy makers held.
Results: Affordability of cancer services was enabled by National Hospital Insurance Fund but largely depended on cash payment. Challenges included high costs of cancer services. Payments for tests, treatment and indirect costs potentially impoverished the patients through care. Facilities were enabled by county funding, partners, and collaborators. Approachability was facilitated by community outreach services, local networks, awareness and knowledge promotion. However, better linkage between the community and health facility was required, especially for screening services. 30% of survey participants indicated that something they needed at the health facility was unavailable. These included: medication, tests, treatment therapies, pain relief and essential commodities. Qualitative findings identified additional requirements including oncology staff and equipment. Patients also considered aspects of unacceptable care and mentioned fear, stigma, cultural influences, religious and alternative beliefs. Nonetheless, having information and support from family, friends and other patients facilitated acceptability of cancer services. Accessibility in terms of distance and time to reach cancer care services located at County or National referral facility was reported as a challenge for many. Communication including lack of clarity, mis-diagnosis and non-disclosure of relevant information, emerged as an appropriateness concern.
Conclusion: Access dimensions interact and cannot be addressed separately. When these aspects of access to cancer care are facilitated, then access can be improved. Hence, a holistic health system approach is more desirable while emphasis should be made at enhancing diagnostic capabilities at lower levels of care in line with universal health coverage. Adequate insurance, staffing, information are also very important. When challenges to any of the access dimensions remain, then access to cancer care is undermined.