WORLD CANCER DAY: HOW CAN THE LAW SUPPORT CANCER PREVENTION AND TREATMENT IN NIGERIA?

 

In 2018, an estimated 115,950 new cases of cancer were recorded in Nigeria.[1] Whilst these figures undoubtedly pale in comparison with those recorded in countries like the United States of America[2] and Australia[3], certain factors operate to render the chances of survival and the quality of life of an average Nigerian struggling with cancer far more bleak than that of individuals diagnosed with the disease in other climes. The intersection between these factors and the law shall be explored subsequently.

LAW AND PREVENTION

Tobacco use, alcohol use, dietary factors including low fruit and vegetable intake, physical inactivity, obesity and exposure to physical, chemical and biological carcinogens have been identified as major risk factors of Cancer by the World Health Organisation. However, at present, the legal framework in Nigeria only addresses one of these risk factors: tobacco use.

The National Tobacco Control Act was enacted in 2015 and it contains detailed provisions on the regulation and control of the production, sales, advertising, promotion and sponsorship of tobacco products, was enacted. For instance, Section 12 prohibits the sponsorship of events which are aimed at promoting tobacco products, the engagement of celebrities to promote the use of tobacco products or other similar promotion activities geared towards encouraging the use of tobacco products. Additionally, Section 20 of the National Tobacco Control Act mandates producers of tobacco and tobacco products to ensure that health warnings are affixed on not less than 50% of the packages of the products.

However, the question however remains: how effectively shall these robust provisions be implemented? More so, why has a similar law not been passed to regulate alcohol use in Nigeria?

LAW AND EARLY DETECTION OF CANCER

The practice of screening for the most common forms of cancer is still abysmally low in Nigeria. In a recent study, only about 10.2% of federal civil servants in North Central Nigeria had ever taken a pap smear test.[4] A similar trend has also been observed with prostate-specific antigen (PSA) screening and mammograms; people rarely ever voluntarily take these tests until they experience symptoms of ill-health. This common practice often causes late detection of cancer and severely limits the chances of successful treatment.

In view of this, the National Cancer Control Plan (2018 – 2022) has listed cancer prevention as one of its priority areas. As part of its implementation plan, it has listed steps such as developing health promotion programmes on healthy lifestyle, legislating against smoking, alcohol and carcinogenic chemical content of processed foods, incorporating HPV vaccination into the National Programme on Immunization, instituting new-born screening for early signs of some common childhood cancers like retinoblastoma in all health facilities, implementing HPV-DNA testing/VIA and management of precancerous lesions at the primary healthcare level, instituting digital rectal examination and prostate specific antigen (PSA) in prostate cancer screening at all levels and so on.

As always, this strategy appears fool-proof on paper. However, key matters such as the possibility of early detection, chances of survival and the quality of life of cancer patients do not hinge on how excellently the steps to be taken are articulated, but rather on how effectively the plan is executed. According to the Control Plan, the Ministry of Health shall be the lead actor in the implementation of the plan and shall work in partnership with non-governmental organisations, civil society organisations and the private sector.

This however raises several questions. Since the health sector is already severely underfunded, how does the Ministry of Health propose to make the requisite financial contribution for the acquisition, installation and maintenance of the facilities required to conduct the screening for common childhood cancers in all primary health care centres or the machinery required to conduct digital rectal examination at all levels? Will the non-governmental organisation, civil society organisations and private sector be made to bear the entirety of the financial burden of the implementation plans? How sustainable is the plan in place? These and many other questions arise once the initial euphoria of the well-articulated steps set out in the Control Plan has worn off.

LAW AND INFRASTRUCTURE

Nineteen years has brought the Nigerian government no closer to fulfilling its commitment to allocate at least 15% of its annual budget to the health sector under the Abuja Declaration of 2001. Nearly two decades later, Nigeria has failed woefully in its undertaking to invest the much needed capital into its health sector, as it has never invested more than six percent of its budget to the health sector.[5] Indeed, the highest percentage that has ever been allocated to the sector since the declaration was 5.95% of the annual budget which was apportioned to the sector in 2012.[6]

And where has this lackadaisical attitude adopted by the government left the provision of infrastructure for cancer treatment in Nigeria? In 2014, World Health Organisation stated that Nigeria has only 9 radiotherapy centres in the public hospitals to cater for the cancer population in Nigeria.[7] Five years later, the President of the Nigerian Medical Association remarked that only four of these centres were functional.[8] In a country where the number of prevalent cases over a period of 5 years is put at 211,052![9]  This is the unfortunate reality in a country where there is no legal framework putting the government under the legal obligation to allot a fixed percentage of its budget – which may be subject to upward review – to the health care sector.

LAW AND QUACKERY

Achieving success in the war against cancer in Nigeria has been severely impeded by the number of quacks purporting to provide alternative treatment to cancer patients. Studies and reports have shown that early detection of cancer is often prevented by the consultation of quacks at the onset of the disease.[10] Furthermore, effective treatment of the disease is usually made impossible when persons who have received cancer diagnosis elect to resort to quacks who peddle their trade under the guise of alternative treatment options.

Whilst the law cannot compel an individual to submit to a certain form of treatment, it can however hold quacks accountable. Laws ought to be enacted to ensure that the quacks are prosecuted and appropriately punished where cancer patients (and indeed persons suffering from other ailments) die in their care or after prolonged treatment at their hands.

THE WAY FORWARD

It is imperative to enact laws which regulate other factors which have been shown to increase the risk of a person having cancer. In the same way that tobacco use and promotion has been regulated by the National Tobacco Control Act, a law ought to be passed to regulate alcohol use and the advertisement of alcoholic beverages. Existing legislation and regulations on affixing warning signs on potentially harmful products must also be strictly enforced.

Also, as funding has been shown to be at the core of the problem of implementing existing polices and providing the much needed facilities for cancer treatment, it is necessary to enact a law which shall compel the government to allocate a fixed percentage of its annual budget – which shall be subject to upward review to reflect changes due to inflation – to the health sector. Additionally, the government should also explore the option of channeling the proceeds obtained from the taxation of tobacco, alcohol and other substances which increase the risk of cancer to funding cancer treatment.

The menace of quackery which has eaten deep into the practice of medicine, especially as it relates to the management of cancer patients should also be addressed promptly by a detailed legislation which shall provide adequate punishment for offenders.

Since every Nigerian is guaranteed the right to life under the 1999 Constitution of the Federal Republic of Nigeria (as amended), it is imperative for the government to deploy the full machinery of the law to address key matters like prevention of the disease, early detection, provision of infrastructure and punishment of quacks, all of which will enhance the chances of survival of those who are struggling with the disease.  Cancer diagnosis is not a death sentence in many climes; it ought not to be one in Nigeria.

 

 

 

 

[1] The Global Cancer Observatory, ‘Nigeria’ (2018) <https://gco.iarc.fr/today/data/factsheets/populations/566-nigeria-fact-sheets.pdf> accessed 4 February, 2020.

[2] The Global Cancer Observatory, ‘United States of America’ (2018) <https://www.who.int/cancer/country-profiles/usa_en.pdf> accessed 4 February, 2020.

[3] The Global Cancer Observatory, ‘Australia’ (2018)<https://www.who.int/cancer/country-profiles/aus_en.pdf?ua=1> accessed 4 February, 2020.

[4] Hyacinth Hyacinth et al ‘Cervical Cancer and Pap Smear Awareness and Utilization of Pap Smear Test among Federal Civil Servants in North Central Nigeria’ (2012) 7(1) PLoS ONE 7.

 

[5] Ebuka Onyeji, “Nigeria: Budget 2019 – Buhari Proposes N46 Billion for Capital Expenditure in Health” (Abuja, 9 October, 2019) <https://allafrica.com/stories/201910090353.html> accessed on 5 February, 2020.

[6] Ebuka Onyeji, “Nigeria: Budget 2019 – Buhari Proposes N46 Billion for Capital Expenditure in Health” (Abuja, 9 October, 2019) <https://allafrica.com/stories/201910090353.html> accessed on 5 February, 2020.

[7] World Health Organisation, ‘Country Profile: Nigeria’ <https://www.who.int/cancer/country-profiles/nga_en.pdf> accessed 4 February, 2020.

[8] Punch Newspaper, “Only Four Cancer Treatment Centres Functional in Nigeria – NMA President” (23 April, 2019) <https://punchng.com/only-four-cancer-treatment-centres-functional-in-nigeria-nma-president> accessed on 5 February, 2020.

[9] The Global Cancer Observatory, ‘Nigeria’ (2018) <https://gco.iarc.fr/today/data/factsheets/populations/566-nigeria-fact-sheets.pdf> accessed 4 February, 2020.

[10] Chima Oji et al, ‘Oral Cancer in Enugu, Nigeria, 1998 – 2003’ (2007) 45 British Journal of Oral and Maxillofacial Surgery 301.