Elisha Zira is a civil servant based in Abuja, Nigeria’s Federal Capital Territory (FCT), who earns less than N100,000 as monthly salary.
In January 2020, he was diagnosed with Hodgkin lymphomas, a type of cancer that starts in immune cells of the lymphatic system. And since then, he has almost turned into a street beggar for lacking the required financial muscle to confront the money-consuming disease.
“Since the diagnosis, I have been receiving treatment at the University of Abuja Teaching Hospital (UATH) and I have been hospitalised many times. I have passed through six circles of chemotherapy which is 12 times the administration of the drugs.
“I have spent nothing less than N1.5 million since I started treatment and my monthly salary is not even up to N100,000,” Mr Zira said.
He decried the poor coverage of cancer treatment by the National Health Insurance Scheme (NHIS), saying: “The only thing NHIS covered through my treatment period have been some laboratory tests. Anything outside this is not covered by the health scheme.”
“My treatment is costing me almost N2 million already and I am not done with it yet. If the NHIS covers cancer treatment, I won’t be looking for help everywhere. The drugs for treating cancer are very costly and they can’t be found randomly, so I have to book through the pharmacists that can access them.
“If not for the help I have been getting from people, you can as well guess what would have happened to me by now,” he lamented.
In a similar development, Mabel Jonah, a businesswoman, who for the fear of stigmatisation refused to give her additional details, narrated her ugly experience in her attempt to fund her treatment to this newspaper.
“When it all started, I had to sell everything I owned, I had to pay with almost everything,” said Mrs Jonah, who was diagnosed with breast cancer in May, 2020.
Breast cancer, the most common type of cancer and the leading cause of cancer-related deaths in women around the world, has continued to claim lives in Nigeria.
Mrs Jonah said the aftermath of the diagnosis has changed the course of her life forever. She said her ailment started tearing a deep hole into her pocket after she learnt that her NHIS plan can only cover consultations and minor drugs but not for proper treatment.
“I started my treatment with six sessions of chemotherapy which is very expensive. For my test, application of the medication and the medication itself, I was paying almost a million per session every three weeks. To make it worse, the drugs are not available in any hospital so you have to order them. I did this six times before traveling to the United Kingdom for my surgery,” she narrated.
“When I got back, I continued with the remaining four sessions of the chemotherapy which makes it a total of 10 sessions. Afterward, I started radiotherapy which I did at the National Hospital because that is the only hospital that has equipment for radiotherapy. For five weeks of radiotherapy, I paid about N600,000.”
The ordeal of Mrs Jonah and Mr Zira largely mirrors the financial burden and emotional troubles many cancer patients in Nigeria cope with in the absence of government support and investment into cancer treatment.
Failure of NHIS
Due to the huge out-of-pocket spending for health services, which sometimes leaves poor Nigerians in penury, the government established the NHIS in 2005.
However, 16 years after and despite billions of naira pumped into the scheme since inception, millions of Nigerians, and mostly civil servants, who have been enrolled into the scheme like Mr Zira, say they are not getting quality services.
They say the scheme fails to cover key treatments for serious ailments such as cancer which is very expensive and has left many cancer patients and their families with no option than to sell properties to raise funds.
Some cancer patients also rely on foreign aid and raising funds through social media, a situation health experts blamed on the country’s fragmented health insurance system.
A cursory look at the cancer treatment regimen covered by NHIS shows mostly interventions for peripherals without significant impacts on the patients.
A recent study, which is titled “Access to Care and Financial Burden for Patients with Breast Cancer in Ghana, Kenya, and Nigeria” and published in Journal of Clinical Oncology in 2019, shows that at least 72 per cent of breast cancer patients in Nigeria pay out-of-pocket for their treatment, in comparison with at least 45 per cent in Ghana, and just 8 per cent in Kenya, where most of the costs are covered by the country’s health insurance scheme.
No doubt, poor access to screening and diagnostic services has been found to be the most critical aspect of cancer care and part of the many reasons for alarmingly high mortality rates for cancer in Nigeria and Sub Saharan Africa, when compared to other countries.
About 70,000 deaths are recorded from cancer annually in Nigeria.
In 2020 alone, 78,899 cancer-related deaths were recorded in Nigeria, according to Globocan statistics. Women often bear the brunt as breast and cervical cancers are responsible for more deaths than any others in Nigeria.
While 34,200 men died from cancer in 2020, 44,699 women succumbed to the disease, according to Globocan data.
Estimates from the Institute for Health Metrics and Evaluation suggest that the cancer death rate in Nigeria was 113.7 per 100,000 people in 2017.
Besides, experts believe the cancer figures are underreported because many patients cannot afford the costs and often abandon hospital tests and treatment, meaning they will not be captured in the data.
More interventions, poor outcomes
Rauncie Chidebe is the executive director of cancer advocacy organisation, Project PinkBlue, who described the NHIS interventions in cancer care management in Nigeria as insignificant.
Mr Chidebe, who is a member of the World Cancer Day advisory group, a Geneva-based group and hosted by the Union for International Cancer Control (UICC), said though Nigeria has rolled out unique plans for cancer treatment, “these plans have not translated to actual interventions because the government does not see cancer treatment as a priority.”
He said, for instance, NHIS only provides coverage for minor drugs that do not include major cancer treatments which he believes cancer patients are in dire need of.
Meanwhile, in 2018, the Nigerian government reportedly launched a $250 million National Cancer Control Plan for 2018-2022 with the goal of reducing cancer prevalence and mortality rates.
According to the government, the plan aims to increase the “number of comprehensive cancer care centres in the country that can offer radiotherapy as part of treatment for cancer patients.”
It added that the plan provides direction as to how the country’s health ministry envisions cancer control efforts in the next five years.
The plan stipulates that Nigeria needs N60 billion to fight cancer. Part of the idea is to have a national screening starting from a pilot of national breast screening.
But two years away from 2023, advocates say the plan is still on paper with no real implementation.
“To be honest, funding is a serious issue for cancer treatment. The NHIS is not covering the major treatment drugs and services. The trust fund is being delayed by several administrative bureaucracy. On the other hand, the annual health budget has never been enough”, said Mr. Chidebe.
Plans underway -Minister, NHIS
Contacted for clarifications on what NHIS covers with regards to cancer, the schemes’ spokesperson, Emmanuel Ononokpono, said such information is not in his purview and so could not speak on the issue.
But the executive secretary of the NHIS, Mohammed Sambo, during a retreat earlier in the year, said the scheme is expanding coverage of essential healthcare services for all Nigerians.
“NHIS on its part is currently reviewing its benefits package to accommodate some drugs and services for Cancer and other communicable and non-communicable diseases,” Mr. Sambo said.
He said the scheme is working with the International Labour Organisation (ILO) on the actual valuation of its comprehensive benefits package.
“In that package, we already have some of the new generation chemotherapy, chemo drugs and others are included,” he said.
“While we are doing this, we need to look at how we are going to finance the new package, otherwise we are going to deplete the pool we have been able to put together.”
Earlier in 2019, while participating at a National Health Dialogue organised by PREMIUM TIMES, Nigeria’s health minister, Osagie Ehanire, announced plans to institute a cancer treatment fund towards reducing the financial burden of treating cancer,
“There will be a creation of a fund, either a cancer treatment fund or whatever we decide to call it. It is important and can be driven by investment or donation,” the minister said.
The minister said the new fund will help reduce the cost of treatment and diagnosis, noting that the funding plan will draw support from the private sector.
But two years after the pronouncement, cancer communities in Nigeria say they are yet to start benefiting from the fund.
Speaking during a recent walk against cancer, the founder of Medicaid Cancer Foundation, Zainab Bagudu, confirmed that efforts are ongoing to ensure the inclusion of cancer treatment into the country’s health insurance scheme.
Mrs Bagudu, who is also the wife of Kebbi State Governor, Atiku Bagudu, said: “For a very long time, we have been working with the NHIS to ensure that cancer care in all its ramifications is included in the health scheme. By cancer care I mean, screening, diagnosis, treatment and even palliatives.
“Presently, there is a list of drugs one can obtain under the NHIS, some surgeries and even screenings like mammography. Although we are not where we want to be yet, we are confident that soon more progress will be made.”
Also corroborating the minister, Mrs Bagudu said the federal government has begun the process of disbursement of the fund, noting that for the first time in the history of Nigeria a cancer health fund was created by the incumbent Muhammadu Buhari-led administration, “where over N730 million was set aside for the use of indigent cancer patients.”
“I am on the committee so I personally know what is happening, and plans are underway for the disbursement of the fund to the six tertiary units that were selected to control the fund,” she said.
“This is worrisome. The ripple effect is that cancer patients will continue to pay out-of-pocket for treatment and those who cannot will be left at the mercy of God. If we don’t make cancer control a priority, you’ll be surprised at the kind of cancer deaths that will happen in this country in the next 5 years.”
Aside poor funding and testing, Mrs Bagudu said awareness level on cancer is still very low especially in rural communities, which she says partly contributes to late diagnosis.
“Majority of Nigerians in the rural areas still access care from traditional medical healers before going to the hospital so we need to include our primary healthcare centres in these awareness campaigns.
“There is a need to provide screening services at the PHC level where our people in the village can go when they see lumps, where we can teach them what to do and we can most importantly provide them with solutions.”
The Director of Clinical Services at the National Hospital, Abuja, Aisha Umar, said cancer patients account for 40 per cent of patients received at the hospital.
“But the problem is that they come late because of this the outcome is not the way we expect.
“We want people to be aware that there is a disease called cancer that can kill if discovered late. if cancer is diagnosed in the first, second stages the outcome is better but most times, we see it in the third and fourth stages and the outcome is not usually good”, she said.
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