Nigeria’s cancer burden is painfully high, no thanks to a poor health system. So when the Chairman, House of Representatives Committee on Health Institutions, Paschal Obi, urged the Federal Government afresh to build more cancer centres in the country, it served as another poignant reminder of how the government allows situations to degenerate, an editorial post on Punch explains.
It is time to take stock of what we do know and what we do not, and consider the best approach to the prevention and treatment of cancer.
Cancer remains a dreaded affliction and the risk increases with age. It is complicated; the solutions are too. The most common cancers are the same as for the general population: lung, breast, prostate, and colorectal.
Experts say evidence from some cancer types (including cervical and colon cancers) suggests that earlier detection will improve survival.
But the odds are stacked against cancer patients right from the moment they have the disease and though deadly, many of them are killed by the system rather than the disease.
The figures are grim. According to the National Cancer Control Plan (2018–2022), annually, the disease is responsible for 72,000 deaths in Nigeria, with an estimated 102,000 new cases each year.
Deaths from cancer have started to decline in high-income countries, according to Cancer.net, an online journal.
“These countries have resources for wide-scale cancer prevention programmes and modern treatment facilities,”
Prevention efforts include access to cancer screening programmes and public health campaigns. These programmes create awareness of cancer risk factors that people can change, including smoking, sun exposure, and obesity. High-income countries also have large cancer centres and hospitals, state-of-the-art research facilities and access to cancer drugs.
But the incidence of cancer diagnoses and deaths is rising in low and medium income countries. A Global Cancer Observatory report stated that Nigeria recorded 115,950 cases of cancer in 2018 with breast cancer taking the chunk of it – 22.7 percent.
Next was cervical cancer with 12.9 percent and prostate cancer with 11.3 percent, making them the three most prevalent cancer types in the country.
According to the WHO, breast cancer kills 40 Nigerians daily; cervical cancer kills a Nigerian woman every hour, while prostate cancer kills 26 Nigerian men daily. It is the second-leading cause of death among the elderly, following heart disease.
Among adults aged 85 and older with no history of cancer, the risk of a cancer diagnosis in their remaining lifetime is 16.4 percent for men and 12.8 percent for women.
But despite the depressing situation, the Nigerian government has shown little commitment towards relieving the plight of cancer patients. Patients have to wait endlessly for treatment and many die before they even have the chance to be treated.
In 2019, the then President of the Nigerian Medical Association, Francis Faduyile, lamented that Nigeria’s public hospitals had just eight radiotherapy centres for cancer treatment, but only four of them were functioning.
“It is obvious that anybody who has cancer in Nigeria currently is doomed to die because some of them go to Ghana, some of them go to India, but those who cannot afford to travel abroad will have a long wait and by the time it is their turn, it must have gone beyond redemption; most of them die miserable deaths,”
This lays bare the implications of having only four functional radiotherapy centres for an estimated population of 200 million.
In 2016, the then Minister of Health, Isaac Adewole, said that ideally, there should be a minimum of one radiotherapy machine for one million people, meaning Nigeria should have about 200 machines at the minimum. Common cancers require radiotherapy as a component of therapy at some point in the course of the management of the disease.
“We have seven but none of the seven machines is working today,”
In a February 26, 2017 editorial titled, ‘FG, intervene in cancer machines scarcity,’ this newspaper had dwelled heavily on the challenges confronting cancer patients, but nothing has changed since then. The Federal Government’s investment in health is simply abysmal and cannot guarantee any meaningful development in the sector.
In 2018, Nigeria proposed a budget of N340.45 billion for the Federal Ministry of Health, which amounted to about four percent of its N9.1 trillion total budget. In the same year, Morocco, with about 37 million people, spent $30 million just on breast cancer, according to a 2019 report by DeepAfricAI, a Moroccan start-up working to alleviate the problem of breast cancer. As of 2017, Morocco had 28 Linear Accelerators, a device most commonly used for external beam radiation treatments for patients with cancer, while Nigeria with about five times the population of Morocco, had 18 LINACs, with about nine out of use and the rest in private hospitals too expensive for the average Nigerian.
But the problem goes beyond adequate funding. There is also the challenge of good leadership and management of resources. In 2002, during the administration of Olusegun Obasanjo, the Federal Government initiated the N17 billion VAMED hospital project to refurbish eight teaching hospitals across the country. It was upgraded in 2007 with an additional N12 billion contract to include six more teaching hospitals. But it became a corruption scandal. The Senate Committee on Health that investigated the deal said the contract was fully paid for even though the company had not completed its job. Adewole once related how cancer patients died needlessly while a radiotherapy machine that could have helped save them was left in its crate for three years.
There is no reason for the government at all levels not to invest adequately in health. The Federal Government should have six hospitals of international standard and each state government a minimum of one of such hospitals. Nigeria spends over $1 billion annually on medical tourism, money that would be better spent if the country’s leaders were responsible.
The Federal Government should get its priorities right and stop going it alone on railways, airports and ports, areas better left to the private sector participation for effective management. Doing this will free funds critical sectors like health, education and security, which are its core responsibilities to the people.