Introduction: Kenyatta National Hospital (KNH) is the only public hospital in Kenya delivering comprehensive cancer care. It receives patients from all over the country and beyond. In 2015, KNH partnered with the American Cancer Society to conduct a survey that sought to know the barriers patients have while accessing cancer treatment at KNH. The outcome from the survey led to the designing and implementation of a patient navigation program within the Cancer Treatment Centre (CTC). The program mitigates barriers that patients face while seeking cancer care at KNH. A patient navigator identifies and resolves real and perceived barriers to care thus enabling patients to implement care recommendations. Prior to the start of the program, a baseline survey was conducted on 453 patients. Findings revealed physical, psychological, and clinical barriers as the main patient challenges to timely access to cancer care at KNH CTC.
Objectives: To understand both the current level of patients’ challenges in relation to access of transportation, lodging, and treatment literacy resources during cancer treatment at KNH and the success of the program set to eliminate the barriers identified.
Methods: A cross sectional survey was administered using standard questionnaires before the start (baseline) and 1 year after implementation of the navigation program. Systematic random sampling was used to select the 3rd of every new patient and 7th of revisiting patients at 2 surveys: baseline and 1 year later. Representative sample sizes were 460 respondents at baseline and 416 at 1 year.
Results: Survey data showed that 29% of patients had missed or delayed treatment and indicated the most significant barriers to care included:
- Money to pay for treatment
- Money to pay for transportation to treatment
- Accommodations once in Nairobi
A comparison between baseline and year 1 surveys indicated an increase in the uptake of National Hospital Insurance Fund (NHIF) coverage from 82.0% in 2017 to 93.0% in 2018. Knowledge about the diagnosis improved from 82% in 2017 to 95% in 2018. Clinic physical accessibility in less than 30 minutes improved from 42% in 2017 to 75% in 2018. Patients’ knowledge about duration of treatment and treatment options improved from 29% in 2017 to 44% in 2018. Delays in treatment were reduced from 25% in 2017 to 19% in 2018.
Conclusion: Patients have a lot of barriers to accessing cancer treatment in Kenyatta Hospital Cancer Treatment Center but ways are available to mitigate these barriers. The findings 1 year after navigation program implementation revealed a positive impact on cancer care services. There is increased service satisfaction, increased patient knowledge regarding cancer care, increased uptake of NHIF services, improved follow-up and adherence to treatment, and reduced waiting time in starting treatment. It is important to reduce barriers to treatment so that we get better treatment outcomes.