In Nigeria, the media—both digital and traditional—are inundated with reports of cancer infections alongside impassioned solicitations for funds for treatment abroad. In major cities of Nigeria, for instance, it is no longer a strange sight to see caregivers soliciting alms from the public for individuals infected with all manner of cancerous growth.
That people resort to public intervention is intuitive evidence of the great socioeconomic burden faced by cancer patients and their caregivers. That most patients plan to travel abroad signaled a huge capital flight from Nigeria owing to medical tourism.
In 2018, Phillips Consulting examined the socioeconomic impact of cancer in an extensive study. Responses were gathered from thousands of citizens either themselves suffering from cancer or who were caregivers, family and friends of those suffering from cancer. The full report can be downloaded for free from the Insights tab on our website.
Cancer has become an increasingly worrying health problem. According to the Global Burden of Disease Study 2015, total deaths due to cancer rose by 17% between 2005 and 2015. By 2030, cancer incidence worldwide is projected to rise by 68% to 23.6 million new cases every year. Cancer was estimated to have caused 8.8 million deaths (one in every six deaths) globally in 2015 and cost the world, in 2010, the best part of US$1.16trillion. Cancer is thus one of the leading causes of death in the world and the most prevalent cause of NCD (noncommunicable disease) death after cardiovascular disease.
Nigeria shares the incompleteness of cancer data with most of Africa. This lack of anything near a complete epidemiological profile perhaps contributes to the country’s inability to adequately tackle noncommunicable diseases (NCDs) such as cancer. One in five Nigerians between the ages of 30 and 70 are likely to die from the four main NCDs. In 2012, 3% of the over two million deaths recorded in Nigeria were caused by cancers.
Although the country has six population-based and 19 hospital-based cancer registries which the National System of Cancer Registries (set up in 2009) tries to coordinate, the country has no national, population-based cancer registry and thus no reliable national cancer statistics. The national cancer incidence statistics supplied for Cancer in Nigeria (2009 –2013) are based on figures derived from only two population-based cancer registries in Abuja and Enugu.
In 2012, however, it was estimated that there were 102,100 new cases of cancer per year. There are also anecdotal estimates that suggest that there are about 2 million people living with cancer.
Our survey showed that women and low-income earners were the most affected by cancer. The cancers reported include blood, bone, brain, breast, cervical, colon, intestine, kidney, liver, lung, neck, ovarian, pancreatic, prostrate, stomach, throat, skin, leg, uterus, mouth, testicular, rectal, muscle, soft tissues, gall bladder, hand, adrenal gland, armpit, eye, face, womb and back cancers.
Irrespective of one’s socioeconomic status, the emotional and financial burden of cancer management is excruciating. The cost of cancer treatment in Nigeria ranges from N850,000 to N2,875,000; and between $10,000 (about N3,600,000 using N360 to $1) and $60,000 (N21,000,000). In Africa, South Africa, Egypt, the Ivory Coast and Ghana benefits from this capital flight from Nigeria. Most respondents reported sourcing treatment funds from personal savings and contribution from friends and family. Nigeria’s National Health Insurance Scheme (NHIS) does not cover cancer, neither do plans from several health management organisations.
Generally, the cost of treating cancer is dependent on the type of drugs prescribed and the number of treatment cycles. Drugs are benchmarked at about N200,000 per dose of drugs. A patient can pay between N150,000 to N1,000,000 for a treatment cycle, and may need as many as fifteen cycles.
Although 89% of respondents reported accurate diagnosis in Nigeria, in some cases, patients have to wait as long as a month before results of their tests can be obtained during which time their conditions may have deteriorated. Predictably, breast cancer was found to be the most prevalent cancer type in our survey, but it remained one of the cancers with high survivability rates. About two out of every three persons who died from breast cancer had travelled to India for further treatment.
The survey suggested to us a number of courses of action. For instance, all first-degree respondents (cancer survivors) had at least a Bachelor’s degree or a Higher National Diploma, suggesting a positive correlation between a patient’s level of education and cancer survival, perhaps because more education exposes patients to more information. All efforts to increase access to affordable qualitative education must thus be intensified.
As reported earlier, low-income earners are the most affected by cancer. In a low-income country such as Nigeria, the plight of low-income earners becomes a little more desperate. This state of things is compounded by the routine unavailability of cancer treatment services and a lack of the necessary data to drive the battle against cancer. While implementing programs and policies to improve the economic lot of Nigerians, government must fast-track plans it already announced to establish the National Cancer Control Agency. In March 2017, the Ministry of Health inaugurated a National Cancer Control Steering Committee to produce a 5-year National Strategic Plan for Cancer Control from 2018-2022. It is about time to begin implementing its recommendations.
There is still widespread ignorance of the risk factors of different cancers. In 2012, for instance, one in every four newly diagnosed cancer cases in low- to middle-income countries were caused by infections with human papillomavirus (HPV), which causes cervical cancer, and hepatitis B virus, which causes liver cancer. According to the WHO, a third of the cancer incidence in Western Africa is infection-related. This, alongside changes in demographic and lifestyle patterns and the absence of concrete combative policies, will likely contribute to a cancer crisis of epidemic proportions by 2030.
The WHO also estimates that vaccination against both viruses could potentially prevent more than a million cancer cases per year. Government investment in a holistic system of educating citizens about cancer, encouraging routine medical examinations and teaching them about early diagnosis and treatment must improve, supplemented by increased and honest efforts from civil society organisations. For one reason or the other, our location audit of cancer advocacy groups in Lagos and Abuja revealed many nonexistent organization and fictitious addresses.
Most respondents report sourcing treatment funds from personal savings and the contributions of friends and family. In a country where income is low, this is potentially ruinous. The NHIS, established in 2005 to provide citizens with access to quality and cost-effective care, must begin to cover cancer prevention and treatment as a means of palliating the economic burden of cancer on Nigerians.
Some affected respondents reported suffering stigmatization and job losses. While job losses may have resulted from a loss of capacity rather than discriminatory practices, it is important to institute social protections for cancer patients, the most important of which is inclusion under NHIS cover. Explicitly stated protections regarding access to opportunities, and for those in paid employment, to fair treatment, are also necessary.
Following crackdowns on skin lightening products in countries such as Rwanda, Kenya, South Africa and Ghana, regulatory authorities in Nigeria must begin to entertain similar notions. Skin lightening products are widely known to contain potentially harmful chemicals such as hydroquinone and mercury, which have been linked to skin cancer as well as kidney and liver damage. The deluge of products on the market either suggest an ignorance of their risk or an unwillingness to confront a cosmetic tendency with epidemic potential. Nigerian authorities must put in place a wide-ranging strategy of curtailing the use of these products.
Cancer patients spend astronomical amounts of money seeking treatment abroad, up to $60,000, excluding other associated financial costs such visa fees, flight tickets, logistics, hotel accommodation and upkeep for the affected person and his/her caregiver. The sheer amount of capital flight suggests opportunities for investment along the value chain of cancer management in Nigeria.
Ultimately, the task of beating cancer requires the combined efforts of all stakeholders. Guided by insights from the combined health industry, government, NGOs, researchers of all stripes and other interested corporate bodies such as ourselves must provide the basis for effective action against cancer. Though an enormous challenge, our commitment to that task at Phillips Consulting is unflinching.
We will not only direct our significant research capabilities towards plotting the way forward; we are also prepared to support stakeholders in ensuring the effectiveness of cancer management through plugging the gaps in the supply chain of drugs, other medical consumables, and medical equipment; and the effective project management of cancer-related programs and initiatives. Our extensive knowledge of the local environment also ensures that we are equipped to help local and international organisations deliver sustainable outcomes in their efforts towards combating cancer.