Rita Essien (not real name) is a middle-aged Nigerian woman battling cervical cancer at the National Hospital Abuja.
According to her story, Essien is not only dealing with the pain and trauma the disease has caused her, but has also lost everything, as she struggles to pay her medical bills in order to stay alive.
Essien was a primary school teacher before being diagnosed with the cancer disease, which has changed her life forever. She says she now relies on support from friends, family members and well-wishers to not only manage her condition, but also sustain a living.
“I have lost everything including my job to manage this disease; the cost of drugs alone is overwhelming. Sometimes they are not even available in the hospital and we have to buy at pharmacies where it is more expensive. If not for the support that I got from people, I could not have made it.
“The cost of treatment is just too much on me. I spend up to N600,000 for radiotherapy every 28 days. I have been on admission in this hospital for the last three months and each night costs N4,000. There are many other costs; there’s N45,000 I pay every two weeks, N18,0000 for blood transfusion periodically”, she told BusinessDay in tears.
Essien is just one of the many cancer patients who continue to groan under huge financial burden due to the failure of the Nigerian government to fulfil its promise of cheaper treatment for a disease that has claimed nearly 500,000 lives in Nigeria since 2016 and counting.
In 2019, the Federal Government introduced an innovative programme to deliver life-saving chemotherapies for cancer treatment to seven teaching hospitals throughout the country.
As a result of the programme called Chemotherapy Access Treatment (CAP), the government assured that citizens would be able to save up to 50 percent of their treatment cost, enabling thousands of additional patients to access affordable care.
Olorunnimbe Mamora, minister of state for Health said CAP would enable cancer patients in Nigeria access lower-priced, high-quality treatment at hospitals and pharmacies and reduce the burden of out-of-pocket payments.
He said the programme would provide immediate payment to participating pharmaceutical companies and drug distributors to ensure sustainability of the system and stock replenishment.
But cancer patients who spoke with BusinessDay at the National Hospital where the programme was launched said they have not seen the impact of this programme, noting that treating cancer is still resource-draining.
Also in 2019, the Federal Government promised to set up a cancer treatment fund, to reduce the burden of treating the disease, especially for indigent patients. After a series of advocacies from civil society organisations, the National Assembly appropriated N728 million in the health budget for the treatment and care of cancer patients. The money was released in 2020, but disbursement of the fund has still not commenced. It is also not still clear how the money is to be managed.
Experts expressed concerns that this trend means more lives would be lost to cancer especially among poor Nigerians who cannot afford the exorbitant treatment cost.
“The treatment scares people. I have seen patients who seek cheaper alternatives, which end up worsening things for them. While attention needs to be drawn on early detection, it is important that patients don’t suffer so much to pay for treatment”, Adaobi Onyechi, a public health expert said.
The latest study on access to care and financial burden for patients with breast cancer in Ghana, Kenya, and Nigeria, published in the journal Clinical Oncology, reveals that Nigerians represent the highest proportion of patients paying out-of-pocket for treatments.
According to the study, 89 percent in Nigeria pay out of pocket, compared to 45 percent in Ghana, and 8 percent in Kenya, where most of the costs are covered by the country’s health insurance scheme.
Nigeria’s National Health Insurance Scheme in 2018 added cancer treatment to its package, but it is still limited and there is no clarity on what is to be covered.
Today, it is common to see cancer patients begging for support. Often, the time spent to raise funds gives cancer more time to spread and reach advanced and critical stages. Many patients, especially low-income earners regard cancer as a death sentence because treatment is simply out of reach for them.
One medication can cost between N100,000, and N300,000 depending on the type of cancer being treated. The cost of full chemo session varies between N600,000 and N2 million. Mastectomy typically costs around N250,000.
Runcie Chidebe, executive director, Project PINK BLUE, a leading organisation in the fight against cancer said though some progress has been made to increase cancer centres through institutions like the Nigeria Sovereign Investment Authority (NSIA), it has, however, not helped in ensuring affordable access, and in some cases made treatment even more expensive.
Also, experts note the radiotherapy machines acquired for the National Hospital in Abuja in 2019, has not had any impact on reducing the cost of treatment.
“I cannot afford cancer treatment if diagnosed. It is really scary. A lot more needs to be done, the cancer fund needs to be managed by NHIS to ensure that only indigent patients access it,” Chidebe said.
“We also need more cancer treatment centres across the country. As of today only National Hospital and LUTH have the best cancer treatment in the country, in other places, they are either not working or obsolete. It’s really scary”, he added.
Meanwhile, Nigeria continues to record cases of cancer and deaths across the country. The World Health Organisation (WHO) estimates that 60 percent of patients with cancer in Nigeria would die, adding that Nigeria records over 70,000 deaths due to cancer yearly.
It said an estimated 116,000 new cases of cancer and 41,000 cancer-related deaths were recorded in Nigeria in 2018.
While breast and cervical cancers are the most common in Nigeria among the female population, prostate cancer is the leading cause of deaths among Nigerian men.
Available data shows that breast cancer kills over 31 Nigerian women every day, and cervical cancer kills over 29 women while prostate cancer kills about 15 Nigerian men every day.
In addition to exorbitant cost, there are barely 10 radiotherapy machines available across the country. This is grossly short of the recommendation of WHO that 200 machines are needed in the country.
The health body also said that out of 3,000 radiation oncologists needed in Nigeria, only 70 are available, and only 20 work in centres that have facilities.
A study has also shown that the waiting time for radiotherapy in Nigeria is generally longer than what is recommended internationally. Experts stress the need to improve access to radiotherapy in order to improve cancer treatment outcomes in resource-limited settings.
