A looming national cancer crisis; Nigeria needs to build capacity fast.

A looming national cancer crisis; Nigeria needs to build capacity fast.

115,950 and 70,327. That’s the number of new cases and mortality respectively attributed to cancer in Nigeria according to a 2018 Globocan. As the battle against infectious diseases such as malaria, HIV/AIDs and cholera succeeds, cancer silently creeps up. A WHO report in 2016 suggested that cancer and other non-communicable diseases may overtake some infectious diseases as the leading cause of death on the continent by 2030. Nigeria being the most populous nation in Africa will take a significant share of these casualties. Infact, the WHO forecasted a 75% rise in cancer mortality in 2030 should Nigeria fail to take the necessary actions needed to mitigate the disease. Unfortunately, cancer only became a national priority in 2008 when the first national cancer control plan was set up. By 2018, a more comprehensive cancer control plan was set up for the 2018-2022 period. In this plan, a budget of over 300 million USD was proposed (the federal government is providing 75% of this budget). Although a sizable amount, this represents only a small fraction of the budget…..a small fraction compared to the severity of the problem. It is 2020 and it remains to be seen how this investment is paying off…

According to the American repository clinicaltrails.gov, there are only around 19 cancer clinical trials recorded for Nigeria. With less than 10 comprehensive cancer treatment centers, (most of which are underequipped) for her 200 million strong population, there is no gainsaying Nigeria needs unprecedented change in its cancer management approach. The covid19 pandemic created a unique instance of reckoning; as even the wealthy Nigerians were unable to fly to their “healthcare havens”, clearly, the time for true change is now!

Nigeria must up her game in all industries; healthcare, science and technology being no different. Although there are commendable efforts by a number of local and international organizations in the fight against cancer, more commitment from both private citizens and the government is required if Nigeria hopes to avert this looming cancer crisis.

I have broadly outlined some key areas that are paramount for Nigeria to win this fight against cancer.

1. Oncology capacity development

By upgrading the existing “comprehensive” cancer treatment centers, Nigeria will expand her capacity to provide cancer care consequently optimizing current radiotherapy, chemotherapy and surgical procedures. In addition, Nigeria and Nigerian civil society organizations can engage more productively with leading global initiatives such as the Union for International Cancer Control (UICC) and the Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries (GTF.CCC). The activities of these organizations support the creation of global facilities and strategies for the financing and procurement of affordable cancer management products to improve capacity in developing nations.

Furthermore, our cancer registry is rather obsolete. It is high time we entered the digital age of cancer information management; How can we hope to effectively manage a disease if we do not know how many people are affected? A collaboration between the Nigerian cancer registry and leading local healthcare companies like Helium Health and/or Ola Browns Flying Doctors may go a long way in fixing this digitization bottleneck.

2. Nurture and invest in world class cancer research and training locally

Nigeria needs an army of cancer experts if she hopes to prevail over the impending cancer crisis in the coming years. By enabling a strong and competent cancer research environment, Nigeria can quickly build a new generation of highly skilled experts. A good strategy will be the establishment of a “national cancer research institute”, which amongst other things will serve as a primary center of excellence in cancer research training, whilst acting as a bridge to foster local and international collaboration between basic cancer researchers and clinicians. Resources from TETFUND and PTDF can be repurposed to specifically train the researchers at this institute. Having such an institute will be extremely beneficial for the nation not just for cancer but also other fields of biomedicine, this center if properly funded and staffed may be positioned to lead Nigeria into a scientifically modern age.

3. Providing a universal health insurance cover for cancer treatment by the NHIS

Cancer treatment costs in Nigeria is responsible for leading many families into extreme poverty and debt. Having fancy facilities and highly trained experts without a strategy for ensuring that every Nigerian can get treatment for as cheaply as possible only amounts to a colossal social and moral failure. The NHIS in 2019 announced some partial coverage for cancer, whilst this is praiseworthy, the move to full coverage should be the priority. The NHIS should also prioritize exploring the pharmaceutical access programs of several by big pharmaceutical companies like Novartis, Sanofi, Merck, Pfizer, Roche etc. These programs are designed to support developing nations obtain the much needed oncology products for a fair bargain.

4. Foster an atmosphere of collaboration between key stakeholders

Key stakeholders particularly in the non-profit sector need to create a new culture of collaboration. Fighting cancer should not be a competition modelled after a divide and rule militaristic strategy. NGOs, civil society organizations and other social enterprises in the cancer management domain can take lessons from the successful strategy of collaboration adopted during the HIV/AIDs crisis. There is enough room for everyone to succeed and thrive, the primary purpose for these organizations is not profit making, right?

On the part of leadership, setting up a functional and sustainable healthcare system benefits all citizens including the political class. We are not reinventing the wheel here; by copying and implementing what works in other societies, we can improve quality of life and other key metrics for cancer patients whilst strengthening our local research and treatment capacities.

In conclusion, I believe Nigeria is capable of delivering the above-mentioned changes under the right political environment. It is time to learn from our failures and build a more prosperous future together. In a post covid19 world, survival of our nation will depend on how quickly and effectively we can establish self-sustenance across industries. All hands must now be on deck because battling cancer will require much more commitment from the government and citizens than is currently available.

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