Cancer in Nigeria, Part 2: Registries and Cancer Centers, Prevention and Cost

Cancer in Nigeria, Part 2: Registries and Cancer Centers, Prevention and Cost

Clement Adebayo Adebamowo, MD, ScD

Jul 16, 2013
Even with the low level of development, we can use our resources better in Nigeria—with better and earlier identification of cancer, implementation of low-cost, early-detection strategies, improved patient navigation that decreases patient and medical delay before presentation and before treatment, improvement of the referral system, regionalization of services, and monitoring of the quality and efficiency of care delivery so that there is optimum use of scarce health care resources.

For a population of over 160 million people, Nigeria does not need more than 6 to 8 population-based cancer registries in different regions of the country to reflect the diversity of the population. These can be supplemented by hospital-based cancer registries. From a technical, implementation, and epidemiologic point of view, these would be sufficient to serve our needs. The federal government, in collaboration with development partners like the Institute of Human Virology Nigeria, understands this and is implementing it in collaboration with the World Health Organization, the International Agency for Research on Cancer, the International Prevention Research Institute, and other international agencies.

Good quality data is urgently needed to convince policymakers about the urgency of the cancer problem, its epidemiology, pattern, and distribution, and to guide them in policy implementation and resource allocation. About two-thirds of cancers in Nigerian women are either of the breast or the cervix. This is good and bad news. Good news in that we can, with appropriate intervention, engender a significant reduction in the cancer burden of Nigerian women through appropriately targeted intervention. Bad news because we are currently not doing so.

Given the size of Nigeria, the current status and spread of health care institutions, development of regional cancer treatment centers that integrate and scale up existing infrastructure at a resource-appropriate level is probably the most equitable and just way to provide cancer care to a large proportion of the nation at reasonable social and economic cost. The matter of an ultra-modern national cancer center requires considerable thought and planning. Such a center will cost hundreds of millions of dollars in capital costs and tens of millions of dollars in recurrent costs. How does one contextualize a single 5-star national cancer center that draws preferential funding from the government’s general revenues and is not accessible to the majority of patients with cancer in a country like Nigeria? What is the comparative effectiveness, cost/benefit, and appropriate locus of such a strategy within a comprehensive, systematic, and resource-level-appropriate response to cancer in Nigeria? How does such a center serve the cancer problems of the average Nigerian who lives on $2 a day?

Fair and equitable use of limited government resources to provide cancer prevention and care is also a human rights issue and an ethical issue. Access to highly subsidized care by a limited few either because of privileged access to services, resources, or support from general government funds is an injustice to the majority who do not have such access.

Putting in place preventive services requires planning, organization, implementation, monitoring, evaluation, and cost-effectiveness research, none of which are easy or free. There are models that can be used to provide these services efficiently even in a low-resource environment like Nigeria. The Centers for Disease Control and Prevention, Bill and Melinda Gates Foundation, National Institutes of Health, and other organizations are directly and indirectly funding several breast and cervical cancer screening programs in many parts of the country. We need leadership and coordination at the government level to manage different interventions and reduce overlapping coverage in urban centers with little or no coverage of rural areas. While many of these programs have ambitious targets of hundreds of thousands of women screened, compared to the population and the need to cover 70% to 80% of the population, a lot needs to be done in this regards.

Most cancer drugs are available in Nigeria, but the costs are prohibitive, distribution is inefficient, and efficacy is uncertain (in some cases because of unverifiable sourcing/importation while in other cases because of poor supply chain management). The pharmaceutical industry needs to work more closely with hospitals to build demand, ensure efficient and safe distribution of drugs, and support development of specialized oncology services. We need to put in a proper business model to manage cancer care—one that engages the public and private sector and brings some discipline and regulation to the sector.

We should re-visit the application of subsidies for certain sectors of cancer care, especially the aspects of cancer care that are not easy to abuse (e.g., radiotherapy or chemotherapy). Nobody will take an anticancer drug when he does not have cancer just because the drugs have been paid for by the government. However, drugs can be taken from the public to the private sector or sold across the border to other countries where the drugs may cost more. In contrast, the potential to abuse radiotherapy services is more limited.

Development of infrastructure for modern cancer care is probably beyond the ken of most low- or middle-income country governments. This requires strong public-private partnerships, a sustainable business model supported by fair regulatory framework, and judicial support for enforcement of contracts that will ensure that all stakeholders get fair and equitable treatment within the system. Patients would get high-quality, reasonably priced treatment, drug companies are ensured a predictable and stable market for their products, government sees that citizens have access to health care, and oncologists practice high-quality clinical practice and have job satisfaction.

Many patients have been treated and cured of cancer in Nigeria, which we are thankful for, and many more cancers are being prevented. Having said that, many cancers cannot be prevented and are not curable here or anywhere else. We all should continue to do the best we can and support those with cancer with compassion and love. We can also improve our efforts to support medical professionals with education and training, which I will discuss in my next post.


The ideas and opinions expressed on the ASCO Connection Blogs do not necessarily reflect those of ASCO. None of the information posted on is intended as medical, legal, or business advice, or advice about reimbursement for health care services. The mention of any product, service, company, therapy or physician practice on does not constitute an endorsement of any kind by ASCO. ASCO assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of the material contained in, posted on, or linked to this site, or any errors or omissions.
Back to Top