Cancer Care in Nigeria, Part 1: The Social Cost of Cancer

Cancer Care in Nigeria, Part 1: The Social Cost of Cancer

Clement Adebayo Adebamowo, MD, ScD

Jul 09, 2013

Nigeria, like most developing countries, is undergoing an epidemic of communicable and noncommunicable diseases. Most citizens are aware of the communicable diseases such as malaria, typhoid, tuberculosis, and HIV/AIDS. In contrast, awareness of the noncommunicable disease epidemics is low. There are now a lot of Nigerians suffering from cardiovascular diseases such as hypertension, diabetes mellitus, and, of course, cancer.

Cancer is the most important risk factor for poverty and loss of social status among the middle class in Nigeria. Because of the lack of a system of health care financing and shared risks, cancer care costs are borne through spending down of savings and investments, borrowing often at high economic and social costs, and sale of resources like homes and properties.

When the man is affected, the loss of income to the family can be substantial, since most households are heavily dependent on the man’s income. When the woman is affected, the outcome for the family is equally bad because of the role of the woman as the “de jure” head of the household. The life course of the children is altered and their overall outcome is worse than it would have been. In some communities, the entire community contributes money and other resources to pay for the care of the patient, and when this is not successful – as is often the case, because poverty leads to late presentation with poor outcome of treatment – the loss is felt by all.

When young people (in their 30s and 40s) develop cancer, there is significant economic loss. Their potential future income, contribution to the economy and the knock-on effect of their economic productivity is lost. In our society, many wage-earners support several more people beyond their immediate families and all of these people may suffer when the individual has cancer.

A major challenge for Nigeria, as for all other low/middle-income countries, is how to finance cancer care. Most developed countries have implemented different ways of ensuring that people can afford cancer care. More than 95% of Nigerians cannot afford basic cancer care because it is an “out of pocket” expense. The country has a National Health Insurance Scheme that covers 5% to 6% of its more than 160 million citizens, does not cover cancer care, and is capped at $1,800 a year. The implication is that most people do notice the early signs of cancer and just wish it would go away. They patronize faith healers or just suffer in silence. The poor (some 60% to 70%) of the population already live on only $2/day and cancer just makes them more destitute.

Practicing oncology is low-resource countries is a labor of love. Our patients give our work meaning. Their prayers, their hopes, and their courage make whatever challenges we face pale into insignificance. Their pain and suffering is our pain and suffering. We can use our resources better in order to help our patients and reduce suffering, which I will discuss in my next post.


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