Concern as confusion rocks agencies spearheading war against cancer

As Kenya’s cancer burden continues to grow, key entities mandated to spearhead the fight against the disease are grappling with major confusion, the Senate has heard.

It has emerged that key bodies tasked with cancer prevention and control as well as cancer care leadership and governance have no clear-cut roles, throwing the execution of duties into disarray to the detriment of patients.

The Senate Health Committee heard on Wednesday that the government is yet to implement the Cancer Prevention and Control Act, No.15 of 2012, which spells out the functions and responsibilities of the National Cancer Institute of Kenya (NCIK).

The Act of Parliament also outlines the role of the National Cancer Institute – Kenya (NCI-K), which is mandated to oversee the coordination of cancer prevention and control in the country.

Appearing before the Senate Health Committee, NCI Chief Executive Officer Julius Melly was at pains to admit that the government has failed to implement the Act, resulting in duplication and overlapping mandates. 

 “The Cancer Prevention and Control Act No.15 of 2012 established the NCIK as a state corporation with mandate and authority to provide policy and advisory to the Cabinet Secretary at the Ministry of Health on areas of relative priorities for implementation of cancer control activities,” stated Dr Melly.

“The Act prescribes functions that seek to ensure each citizen has access to quality, safe and affordable cancer care that upholds human dignity,” he told senators during a sitting presided by the committee’s vice-chairperson, Mandera County Nominated Senator Mariam Sheikh.

“Further, the Act seeks to guarantee control and build requisite capacity for effective, evidence-based cancer management in the country, added Dr Melly. He was responding to questions raised by Nominated Senator Raphael Chimera on the withheld functions and financial challenges of the parastatal.

“The national government has faced some challenges in implementing the Cancer Prevention and Control Act No.15 of 2012, particularly concerning the functions and responsibilities of NCIK.

“The Act provides a framework for cancer control with emphasis on public awareness, protection of human rights and civil liberties, ensuring utmost safety and universal precautions in cancer care; eradicating conditions that cause and aggravate cancer; increasing access to quality and affordable care and creating sustainable capacity for cancer prevention and control.

“The major challenge is duplication and overlapping roles between NCI and the cancer programme at the Ministry of Health,” he said.

The government is set to establish Semi-Autonomous Government Agencies (SAGAs), whose role is to implement the various initiatives in the public sector under the Health ministry.  They include initiatives on cancer prevention, public education and awareness, coordination of implementation policies, development guidelines, protocols and ensuring compliance by hospitals.

SAGA will comprise Kenyatta National Hospital, Moi Teaching and Referral Hospital, Kenya Medical Research Institute, Kenya Medical Supplies Authority, and the Kenya Medical Training College.

Dr Melly further explained that NCIK is grappling with inadequate funding as the money received from Treasury is not enough to carry out its mandate. 
In the documents presented at the Senate, fundraising campaigns are among ways the government agency intends to use to raise funds to cover the deficit. 

However, the legislators led by Senator Chimera questioned why NCI, a body established by law to provide solutions in the fight against cancer seemed, to have more challenges than solutions. 

“What has NCI Kenya done other than lamenting?” Posed Senator Chimera. When you have an entity that is supposed to spearhead the fight against cancer and it is now thinking of even organising fundraising events, we cannot continue like this.  The CS has to be summoned in person.”

Dr Melly, in response, said efforts have been made to minimise duplication of roles, but communication problems and perennial leadership changes in the health sector have hampered meaningful reforms.

“I realised there was a huge communication problem when it comes to uderstanding the NCI mandate. When I took charge, the parastatal’s officers were not even aware that there was an Act which established this institute. By the time they started to understand, there were changes in the top leadership and we had a new Health CS.

“Before she left, we had held a meeting with former CS Susan Nakhumicha and she was scheduled to appear before the Senate to shed more light,” stated Dr Melly.

Senator Hamida Kibwana expressed concern over what she termed as operational inefficiencies.

“Cancer is sensitive. When you have delays, it means losing lives. The continued use of a manual data registry means there is insufficient data collection and analysis on the cancer burden in Kenya. This means that more people are not being screened, late diagnosis, delayed treatment, among others. I have lost people to cancer. This is serious,” stated Senator Hamida.

The Senate also heard that despite massive funding from donors towards cancer, a huge chunk is diverted to HIV/Aids, which also falls under the NCIK mandate.

The developments come in the wake of rising cancer burden in the country, which is drastically emerging as a public health concern.

In Kenya, cancer is the third leading cause of death after infectious and cardiovascular diseases.

One of the functions of the NCI-Kenya is to maintain a National Cancer Registry, which was set up in July 2021.

According to Dr Melly, the registry presently has 55,000 records, with newly diagnosed cancer patients between 2019-2023 hitting 34,419 nationally.

Latest estimates by GLOBOCAN indicate that new cases stand at 44,726 and 29,317 deaths per year, highlighting the critical need to strengthen cancer surveillance in the country.

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