Access to childhood cancer care in Kenya

Childhood Cancer in Low- and Middle-Income Countries Between 2020 and 2050, more than 13.7 million children worldwide are expected to develop cancer, with the vast majority living in low- and middle-income countries (LMICs). In these regions, survival rates remain below 30%, in stark contrast to the 80% survival achieved in high-income countries (HICs), where strong healthcare systems, effective data collection, and advanced treatments are well established. To address this disparity, the World Health Organization launched the Global Childhood Cancer Initiative in 2018, aiming to raise the global survival rate of several common and curable childhood cancers to 60%. Over recent decades, the burden of disease in LMICs has shifted. Once dominated by infectious diseases, these countries now face rising rates of non-communicable diseases such as cancer, reflecting broader socioeconomic change. Research shows that childhood cancer care in resource-limited settings is not only possible but also cost-effective. Yet the reality remains grim: only 10–20% of affected children in LMICs receive a diagnosis, while many others die at home without medical care. This dissertation explores the barriers that prevent timely cancer treatment for children in Kenya, focusing on the implementation of the Awareness Program in Bungoma County, developed with support from the AFAS Foundation and in collaboration with Moi Teaching and Referral Hospital (MTRH), the Princess Máxima Center in the Netherlands, and the local Ministry of Health. Bungoma County, home to about one million people, was chosen as the starting point for the program. Its aim was to improve recognition of childhood cancer among frontline healthcare providers, thereby facilitating earlier referrals. The program combined live training sessions, an SMS-based learning platform, a public radio campaign, and posters depicting key cancer symptoms. MTRH, the only referral hospital in western Kenya for pediatric cancer care, treats around 300 children annually, though an estimated 1,500 should be accessing its services. Understanding why so few children reach the hospital was therefore a central question. Research conducted for this thesis revealed barriers at multiple levels. Families often faced overwhelming financial challenges, cultural beliefs, and reliance on traditional healers, which delayed care-seeking. Primary healthcare workers themselves frequently lacked knowledge about childhood cancer, sometimes holding misconceptions or resorting to alternative treatments. Even when trained, structural challenges such as absenteeism and limited resources continued to hinder access. Although the SMS-based training proved effective in boosting knowledge, retention declined over time, underscoring the need for refresher courses. The evaluation of the Awareness Program showed that while knowledge among healthcare workers improved, actual referral rates did not rise significantly. Most children still presented at advanced stages of disease, illustrating how deeply rooted the barriers remain. Despite these challenges, the program represents an important first step in shifting the landscape of childhood cancer care in Kenya. It has since expanded to other counties, and its lessons point toward the need for sustained education, regular reinforcement of knowledge, broader public awareness campaigns, and collaboration with traditional healers to encourage earlier referrals. The growing availability of health insurance and inclusion of childhood cancer in national health coverage provide further grounds for optimism. Ultimately, improving survival from childhood cancer requires more than medical expertise alone. It demands a holistic approach that addresses economic, cultural, and systemic barriers while ensuring that no child remains invisible to the healthcare system. This thesis shows that while the path is complex, progress is possible, and with continued investment and innovation, every child has a chance to survive.