2017; Volume 18, No 8, August
Featured Article
The start of a navigation program at a cancer treatment center in Kenya: Using data for program development
Throughout the year, IAHPC board members contribute a range of opinion pieces and other thought-provoking articles to our newsletter. This month, it is the turn of Dr. Esther Cege Munyoro, Head of the Pain and Palliative Care Unit at the Kenyatta National Hospital in Kenya, a tertiary referral hospital that educates the bulk of healthcare workers in Kenya. Founded by Dr. Esther Cege Munyoro in 2007, the palliative care unit was the first within the public healthcare system in Kenya.
Here, Esther explains how the staff of Kenyatta National Hospital have adapted the knowledge and experience of the American Cancer Society to improve the cancer journey for their own patients.
Imagine finding a lump in your breast and traveling from your home in rural Kenya to seek medical help for diagnosis and treatment in the city – a city that is more than 400 kilometers away. Unknown to you, the big city hospital is congested, complex and confusing. There are no signs showing the various clinics depending on whether you need diagnosis or treatment. No accommodation is offered as you undergo treatment. This is the situation many Kenyans who travel to Nairobi’s main referral hospital find themselves in … but something is happening to change it.
‘Navigation’ is a patient-centric healthcare service delivery model that promotes the timely movement of an individual patient through the complex healthcare continuum. An individual’s journey begins in the neighborhoods where he or she lives and continues to a medical setting where an abnormality is detected; a diagnosis is made, and then treatment, rehabilitation, and support through survivorship or end-of-life care, are given.
Cancer care navigation was originally conceived by Harold P. Freeman, MD, in response to disproportionate late-stage cancer presentation among African Americans in the United States attributed, in part, to an inability to access complex and often confusing existing cancer care services. Freeman started the first patient navigator program in 1990 at Harlem Hospital. Since 1990, the role of the patient navigator in health care, and specifically in cancer care, has grown to incorporate many titles and functions, not only screening, diagnostic and treatment adherence but quality-of-life outcomes as well.
During April to September 2015, Kenyatta National Hospital (KNH) staff, in close collaboration with the American Cancer Society (ACS), conducted a patient needs study to identify barriers to care that cancer patients face while seeking treatment at KNH Cancer Treatment Center. The survey showed that 29 percent of KNH patients surveyed had missed or delayed treatment. The most significant barriers identified by patients were the following:
- Lack of money to pay for treatment and to pay for transportation to treatment.
- Accommodation once in Nairobi.
- Being thirsty and hungry throughout the day.
- Not being able to find their way around the hospital.
- Not understanding their disease or treatment.
The ACS offered mentorship and a grant to start a navigation program at KNH. This program will be absorbed into the hospital in the long term. The process includes a series of visits both to Atlanta by staff members of KNH and visits to Kenyatta by staff members of ACS.
The proposed new navigation program was implemented, new positions were created and relevant staffing brought on board. Space was created, furniture bought and programs/procedures set up to lay the foundations of the program. The Patient Flow Mapping was redone to now include the navigators, and improvements suggested to reduce other barriers. A ‘Patient Resource Guide’ and a KNH cancer website are also being developed. Progress has also been made in the areas of hospitality and accommodation: the Kenya Cancer Association now offers meals to patients coming for chemotherapy and plans are under way to build a hostel. In January 2017, we received the first donation for the building of the hostel. The American Cancer Society partnered with another cancer organization, Above + Beyond Cancer (A+BC), who have committed to help raise money to support the KNH Hostel. Their founder, Dr. Richard Deming, is a longtime volunteer for ACS, and is very passionate about building awareness around cancer survivorship.
Dr. Richard Deming, Founder of Above+Beyond (third from left) and Mr. Brad Anderson (Executive Director) (right) handing over a donation to Dr. Esther Munyoro (second from left) and Ms. Jacqueline Ngure of Kenyatta National Hospital. Mr David Makumi (seated), Chair of Kenya Network of Cancer Association, looks on.
The navigation program at Kenyatta National Hospital started in July 2017 after a baseline survey. In six to twelve months’ time we will review the impact our navigation program/system has had on reducing treatment barriers, and its impact on patients and their treatment experience.