At home one afternoon, I received a call with some disturbing information. My colleague at Cape Coast Teaching Hospital in Ghana told me that a girl called Akua — a 3-year-old whose name has been changed here to protect her identity — had come to the hospital with her eye protruding from its socket. My colleague suspected cancer, so she sent the mother to the radiology department to obtain a head CT scan before being admitted into the hospital ward.
A $250 million National Cancer Control Plan is increasing treatment facilities nationwide — but most people still cannot afford to use them.
However, four hours later, Akua and mother still had not arrived at the ward. I placed a phone call and learned the truth: Akua’s mother had decided to return home with her ill child because she could not afford the CT scan. She could not even pay for the diagnosis, let alone the treatment. For her, it was the end of the road.
Sadly, Akua’s story is all too familiar. While childhood cancers only account for about 1% of all cancers, a 2015 review of cancer registries across 18 African countries found that the proportion of childhood cancers out of all cancers ranged from 1.4% in Ghana to 10% in Rwanda.
And many children do not get the cancer care they require because their parents cannot afford it. Every year, there are projected to be over 1,000 new cases of childhood cancer in Ghana. Only about 300 of these children will receive any form of treatment due to poor health accessibility and health-seeking behaviors. This situation is common across sub-Saharan Africa.
But when cancers are identified and treated in a timely manner, results from other areas of the world show that around 7 out of 10 or even as many as 9 out of 10 children can survive.
There are several ways for the situation to be improved.
First, reduce delays in seeking care. A major challenge when addressing childhood cancers is late presentation to health facilities.
In a study published in 2016, researchers identified two major barriers to seeking care for childhood cancer in Ghana: a lack of community knowledge about cancer and cultural practices and religious beliefs. Many patients will seek care from alternative medicines and spiritual healers before visiting health care facilities. This leads to late presentation and poor prognosis.
Reducing delays in seeking cancer care will require local and national awareness campaigns. Community programs, such as radio and television talks in local languages and dialects, or community gatherings can help to reduce stigma, while also educating parents on common symptoms and prevention strategies of childhood cancers. Teaching community members that childhood cancers are treatable when detected early will encourage them to seek treatment early.
It is also imperative to address cultural and religious barriers to timely health-seeking behaviors. A cervical cancer education campaign at churches in Ghana was found to increase participants’ knowledge of cervical cancer, its seriousness, and the perceived benefits of treatment.
Community, religious, and traditional leaders should likewise be educated on childhood cancers and empowered to encourage their communities to seek care when needed. Community health nurses should also be educated on common childhood cancers and aid in early referrals for earlier diagnosis and timely treatment.
The importance of community outreach around childhood cancers cannot be overstated. As of the writing of this piece, Akua’s mother has not returned to the hospital with her child for chemotherapy treatment, despite the hospital waiving the treatment costs for her. We’ve tried to contact her, to no avail.
Second, reduce the delays in reaching and receiving care. Patients face significant delays in arriving at health facilities. With only two major cancer treatment centers in Ghana, patients often have to travel long distances to reach these facilities.
The cost of transportation, in addition to poor road infrastructure, is a major barrier to seeking health care. Policy interventions must address these transportation barriers. One solution is to expand the number of treatment centers.
Even when patients reach health facilities, they face significant delays in receiving and remaining in care.
Many parents, like Akua’s mother, are unable to afford the cost of cancer treatment. Childhood cancer diagnosis and treatment in Ghana cost anywhere from $1,400 to $5,000 — according to unpublished estimates from the treatment centers in Accra and Kumasi — which is out of reach for the roughly 50% of Ghanaians who live on less than $5.50 a day. Many families have indeed been pushed further into poverty due to payment for cancer treatment.
In most higher-income countries, health insurance provides access to health care that would otherwise be unaffordable. In 2003, Ghana initiated a national health insurance scheme. But 17 years later, childhood cancers are still not covered — despite recent studies demonstrating that the treatment of childhood cancers in Ghana is cost-effective, at $1,034 for each disability-adjusted life-year averted. This provides a strong case for the coverage of childhood cancers within the national health insurance scheme.
Receiving care is also often delayed due to the limited medical capacity. Currently in Ghana, there are only five pediatric oncologists for a population of over 30 million and only about 1 radiotherapy machine per 10 million people. Approximately 50% of cancer patients referred for radiotherapy never start treatment, and only 7% of Ghana’s pediatric surgical burden is currently being met.
These figures emphasize the need of more cancer treatment centers in Ghana with adequate diagnostic, treatment, and case management capabilities. The Ministry of Health and Ghana Health Service must do more to prioritize cancer care, starting with the renewal and implementation of the national cancer policy that expired in 2016.
The establishment of additional treatment centers around the country will help decentralize care, reduce the distance that patients need to travel, and reduce the burden on existing facilities.
Children with cancer represent the most vulnerable among us. It is our moral imperative to improve access to treatment for childhood cancers.