Chair of the First Ladies Association, Hon.Nazi Kivutha and Mama Dorothy Nyongo welcomed at the Jaramogi Oginga Odinga Teaching and Referral hospital in Kisumu.The duo led a delegation to evaluate cancer responsiveness within Kisumu County. Photo by Jacob Owiti.
By Lorraine Anyango.
Kisumu County lacks data in cancer management that would be instrumental to inform decisions in investments as well as patients follow up.
This challenge has been fueled by lack of data collection tools, registers and, summary tools among other requirements.
The county also needs linkages with private hospitals in submission of cancer statistics from the facilities.
While giving a progressive report on the cancer situation in Kisumu County, the county health director Dr Dicken Onyango said that data in cancer should be as developed as data captured in the management of HIV and Aids condition.
Dr. Onyango noted that only cervical cancer indicators are well captured and reported on DHIS, against the background of other cancers documented to exits in the county, however one cannot be able to trace the where about of those patients.
“The focus has been on cervical cancer screening, the other cancers are neglected due to inadequately defined indicators.” Dr Onyango said while calling on partners to aid in developing an integrated cancer surveillance system that captures and reports data for all cancers.
The scantly available data shows that in the last ten years, Kisumu county registered 402 cases of breast cancer, 365 identified esophagus cancer, 324 kaposis sarcoma, 328 cancer of the cervix’s, 171 prostate cancer and 164 lyomphoma cancer.
The records further indicate 124 people in Kisumu suffered from cancer of the liver (hepatoma), 76 had colorectum cancer, 46 cancer of the stomach, 45 cancer of the ovary, 26 osteogenic sarcoma and 24 multiple mveloma.
Since 1998 to date there are 22 cancers of the bladder recorded in Kisumu County, another 20 cancer of the pancrease, 15 thyroid cancer , 12 bronchus cancer, 12 endomethium cancer, 11 cancer of the vulva, 10 cancer of the penis, 4 cancer of the stomach and 8 unspecified cancers.
Within the county, cancer patients are receiving interventions and treatment in cryotherapy, surgical intervention and thermo-coagulation
Kisumu County has several cancer screening locations, including JOOTRH, KCRH, Chulaimbo, Kombewa, Ahero, Nyakach, Nyahera, Muhoroni, Gita, Migosi, Lumumba, Rabuor, Airport HC, Ober Kamoth, Kodiaga HC, Katito, Manyuanda, Nyangoma and Bodi.
The county has a total of 19 sites able to screen cervical cancer (Vili/Via) and three sites for I breast, Five sites for cytotherapy and another five with thermo coagulation devices. Kisumu hospice offer palliative care while JOOTRH offers oncology clinic, diagnosis thermotherapy starter package and it’s also the proposed cancer comprehensive center.
The highest number of screening done in Kisumu includes cervical cancer and breast cancer, the screening is done by roughly 30 nurses trained in cervical cancer screening while the county has only 2 oncologists, one at JOOTRH and another in Maseno.
However , there is inadequate opportunities for continuous professional development due to lack of funding for staff who wish to pursue long-term training in oncology – nurses, clinical officers, doctors.
For the last nine months there has been a documented decrease amounting to 324 in the number of cervical cancer receiving via/Vili and an increase of cervical cancer patients on Pap smear while cancer patients with positive Via/vili results increased with 62.
In the same period the number of cervical cancer with suspicious cancer lesions increased by on while 40 more patients were treated using cyotherapty.
The county has partnered with KMET, Africa Cancer Foundation, to support cancer patients, however due to high cost of treating cancer, patients rely on universal Health coverage (UHC), NHIF and cash from funds drives, though funding gaps for patients in the county exists in chemotherapy and diagnostic services – CT scan, MRI.
Apart from gaps in data, the county still has to grapple with inadequate equipment, lack of radiotherapy, few numbers of cancer care staff including specialist.
The screening programs are also working in alone, there is no integrated screening program for all cancers.
Some of the recommendations that Dr Onyango gave included initiating an integrated cancer screening program rather than stand alone as well as development of on integrated cancer surveillance systems that captures and records data from all centers.
“There is need to support dissemination of cervical cancer information through community dialogue as well as partner to support dialogue forums for sub county dissemination of information on cancer.” Dr Onyango added.
by Lorraine Anyango.
Medicines used to treat chronic disease have been taking a large proportion of total volume in the health facilities in Kisumu County in the last four months.
It’s further expected that chronic disease medicine volumes will increase dramatically if continued access is provided under the Universal health care program.
This is according to a recent medicines situation report submitted by the County Pharmacist dated March 18th 2019.
The chronic disease medicines are regularly provided and used for the lifetimes of individuals who need them.
Additional problems of affordability that faced people living with chronic diseases due to the lifelong nature of treatment and the frequent need for combination therapy have been reduced and nearly eliminated since the launch of the UHC pilot program in the county.
Pre- UHC pilot program, was characterized with low availability of medicines in the public sector, and patients were often forced to purchase some of the essential medicines in the private sector. This has however changed. High medicine prices were largely responsible for increase the cost of treatment.
During the same period, Kisumu County decided to decentralize their procurement process in an effort to meet local needs through increased local involvement, accountability and flexibility.
Kisumu County has shifted from push to pull distribution systems thereby creating the need for health facility data for distribution planning and ordering.
Under UHC, Kisumu country was allocated 510 Million shillings for health products and technologies and basic equipment.
Even with this allocation, Kisumu County department of health has faced challenges when attempting to address the medicines supply gap.
The challenges arises due to the county level budget for procurement of health products for primary health care not being maintained, so as to complement support from the national government.
Kisumu county government owes KEMSA a total of Ksh 77,526,555.98 in unpaid invoices for essential medicines and medical supplies delivered to Kisumu county health facilities, even though KEMSA has made efforts it may not always manage 100% fill rate.
Essential medicines and medical supplies that were supplied at the inception of UHC pilot have been used by most facilities well within the period ending 14th March 2019 with some stocks still in place although a few of the facilities have reported stock outs of some of the commodities.
KEMSA, however, failed to supply some essential medicines up to date, and these have been stocked out in nearly all the facilities. The most significant ones include ceftriaxone 1g injection, albendazole 400mg tablets, nifedipine 20mg SR tablets, chlorhexidine digluconate 7.1% for cord care, benzyl penicillin 5mu inj, phenobarbitone inj. and ampiclox 500mg capsules.
“There’s need to budget for county level procurement of stocked out medicines since such a situation is bound to occur again.” Dr Lawrence Otieno the County pharmacist notes.
Pharmacy workforce shortages constitute a major capacity limitation to the provision of pharmaceutical services and access to medicines in Kisumu County. The county currently has 46 pharmacists and 35 pharmaceutical technologists against a minimum requirement of at least 70 pharmacists and 190 pharmaceutical technologists.
“Recruitment of additional pharmacy workforce should be considered when developing medicines policies and pharmaceutical services and integrated into broader human resources for health strategic plans.” Dr Otieno adds.
The relative contributor to the county burden of disease of HIV/AIDS, TB and malaria, is relatively is huge in Kisumu county. The implications for the delivery and use of pharmaceuticals are profound.
However medicines for HIV/AIDs, TB and malaria drugs are supplied by the national government through KEMSA free of charge to the county. Whereas antiretrovirals and TB medicines are supplied on monthly basis, antimalarials and family planning commodities are supplied on quarterly basis.
In February 2019, the Health Information Systems department at the Ministry of Health introduced data sets for reporting of tracer essential medicines and non-pharmaceuticals onto the DHIS2. Kisumu county department of health is keen to embrace the usage of this reporting platform as it will give a clear visibility of the medicines availability across the county health facilities. Consumption reports from the month of March going forward will be submitted through DHIS2 rather than excel based emails.
Analysis of consumption is complicated by the diversity of commodity management systems used by health facilities. The need for more comprehensive information system is particularly acute in low level health facilities especially those that do not have trained pharmaceutical personnel.
As the county shifts from the Excel based reporting to the DHIS2 platform for reporting of tracer commodities, there’s need to support the sub county pharmacists to adequately tackle the challenges involved with reporting.