| DAY BREAK | Cost of Healthcare [Part 1]



come back in case you're just joining us you are writing time for the conversation that we are going to have the cost of health care with specific attention to cancer so allow me to just reintroduce my panel again select close er to me on this side dr. effete caribou he is the CEO of National Cancer Institute we also have that Gilbert or sorrow the Claims Manager at nhi F and David McCune me Megumi Radha who is the vice chairman for NCD that's non communicable diseases alliance of Kenya and also the outgoing chairman for the km network of cancer organizations and someone whose story is just about to inspire in just a few minutes a leak Wanda she is a cancer warrior thank you so much Halloween for your time here this morning dr. Alfred let me begin with you the most obvious question why have we seen a rapid rise of cancer in Kenya I think it's multiplicity of factors one generally globally I mean all across the world the cancer burden has been going up so I think Kenya is just just within that larger global increase in cancer cases we globally that has been attributed to changing lifestyles so there are a number of left side lipid factors that will contribute to cancer what the major one is tobacco use worldwide tobacco use is estimated to account for about 20 22 percent of all cancer cases which is also quite a big problem in this country I think the last national survey that we did about two three years ago showed that particularly in men about 23% of adult men smoke so that speaks to quite a big a huge budget badenov tobacco use in this country and so the element of this factors like tobacco alcohol use diet highly processed diet and you know issues of lack of physical activity but we also need to appreciate that where we are where we are coming from in the African setup infection is also a major contribution in this case you're talking about sadly cold cancer and the human papillomavirus which contributes to the self called cancer that is quite that contributes quite a bit of our burden in sub-saharan Africa other infections like you know you know we still although we have we have made quite a birth some it contains in HIV control there are also some you know consulate which IV which is about in this country so if you can select which call Kaposi sarcoma some lymphomas cervical cancer as well so so so I would say generally that the the we share the burden of the risk factors just like this the add the rest of the world does okay but also I think the other thing that with the other we hypothesize that may have contributed to the res number of cases is we have also improved our capacity to detect these cancers so previously where we may be people may not have been had access to diagnostic services that is that has changed over than you know the past five ten years so I would say it's a combination of probably better detection right now because of even a bit more better awareness but also because of you know the dis factors that fuel you know the burden of cancer right is it on to hear your thoughts of this on why cancer has become so popular within our society and the fact that you are the vice chairman for NCD non communicable disease alliance of Kenya I just want you to add on to that that teri has also just told us black HIV some links to some HIV is links up to some cancers yes yes to some just just jump on that stream yes exactly what he has said in terms of them as our society we are so-called becoming middle-class middle-income country as our country develops and we start adopting certain lifestyles that were Hilda to the piece of of the West we definitely we see an increase in non communicable diseases and one of the things with the cancers it shares some of those risk with other non communicable diseases so a new tech things like obesity we have a crisis of obesity in a country that is also facing starvation so obesity is is a major risk factor not just for cancer but for heart diseases for diabetes you know all these other issues around industry industry pollution exposure to certain chemicals so you know we go to industrial area here some of our workers are handling some chemicals like benzene which is a known risk factor without adequate protection so exposure to pollution is also a major risk but actually w-h-o added among the major risk factors tobacco diet alcohol they actually have added air pollution as a major risk factor not just for cancer but also for a number of other respiratory diseases so it belushin is a big issue it is actually been recognized now by whu-oh and that goes for the pollution that we are seeing in our rivers where industries are draining the effluent you know leading with very heavy metals and and people downstream are drinking the same water so is a major there are a number of factors a combination of them we also know that about 10% oh they are about ops some of the cancers not all cancers also do have a genetic link there are few cancers like 10% of breast cancers about 10% of current consoles you have a very strong family kind of a link but that is just 10% so for majority there are risk factors but also there are patients or people who get cancer without any of those risk factors being present because we know cancer is a disease of cells so there are people who will not have any risk factors and then still develop cancer so we'd not be able to shoot actually not brain patient or try to figure out so why did I get I don't drink I don't smoke I'm not exposed to pollution I exercise I tried you can still get cancer important I'm David you know in this financial budget for this year that your teacher ed the syntax is what we call it the drinking in the tobacco got up higher do you think changes will reduce that intensity with their health we need to tax versus in tax them a vehicle to the wall but also combine that with adequate public health messaging so that it's not just that alcohols become very expensive Kenyans need to know alcohol is a group 1 carcinogen it is they are disturbed by WH o so we need to combine that so that they know I'm not stopping or reducing alcohol because it's expensive I'm reducing my intake of alcohol because it is a risk factor for major non communicable diseases so this has to be combined with public health message industry I want to live to see a day when the bottle of alcohol which ever brando make has that warning that says this product can cause cancer not just like it is harmful to your health that's very ambiguous abroad so if you feel like the messages dream lies like the we've done so we need to combine those and public health messaging with increasing the taxes so people make a conscious decision to to drink or not to drink or to smoke or not smoke based on their health should be a health choice so here on Daybreak we always love your feedback we appreciate your comments your callings your tweets and your SMS is double – for double – that's our SMS line our twitter handle a citizen TV kenya hashtag daybreak that's their ticket into the conversation but here's what we are asking you this morning what more what should the government do to reduce the cost of cancer treatment there you go what should the government do to reduce the cost of treatment remember hash tag daybreak double – for double – SMS line if they're 140 characters won't do for you you can even call in share your story ask a question zero seven one nine triple seven triple seven or seven four two nine six one three four three so suddenly I personally know your story we're going to get to your story in just a bit share with Kenyans and hopefully they'll leave feeling a bit inspired but deal but let me come to you cancer treatment so expensive in Kenya what is it about cancer that makes it so expensive thank you the first of all equipment to diagnose and treat cancer very expensive to procure it has taken us over 50 years for us to develop it's a PET CT scan that was launched the other day naga con hospital live alone we are 50 years you remember the reason passed many Kenyans were traveling to India for purposes of getting services of a PET CT scan I thank God that I can University Hospital has invested in a PET CT scan we are talking of radiotherapy equipment and we are talking of things like the latest equipment in town the halation equipment which cost in excess of two hundred and fifty million u.s. dollars to invest in that doesn't come easy and you will note that if you look across the country you'll realize that it's only in care nets whereby cannons can be able to access radiotherapy treatment well cross others in private health care facilities it's in very few facilities that have invested in cancer equipment and as such it makes it could been very expensive so one the cost of equipment the other thing personnel we are we have very few doctors oncologists in this country and as such excessively request that we de come to the urban areas even nairobi Eldoret or Mombasa and as such seeing doctors is also quite expensive live alone that the medication many of the medication that becomes a patients require is expensive it is sold by pharmaceutical Jan's we are talking of companies like nobodies blacks and others he takes a lot of money yes in research with the nipple ku 19 medication quite expensive there's been a debate that inferior in other jurisdictions whereby like in India by they've licensed generic producers of dad but in other countries also a bit difficult area thank God the government allowed generics to be sold in this market otherwise the cost of cancer treatment could be very expensive well you get to hear it firsthand from our cancer survivor who is seated right here but let's just pick it up from there that Gilbert has talked about infrastructure earlier on this week here on Daybreak on Tuesday to be more specific we had the series of healthy silly karaoke who are speaking to our very own as some gotoku here is what she had to say on that issue of infrastructure we are also looking at investment in terms of infrastructure additional infrastructure support we have in the last few years put up nine chemotherapy centers okay you know across the country right now we are putting up radiotherapy centres four of them we are calling them Centers of Excellence and in the process of being constructed as it were we have secured the budgets to also be able to equip this with indicia we also note that the kayuu referral teaching and referral hospital will be opening up its doors as a referral hospital that is high-end at level six in the coming a few months again it has or comes along with a specialized care care for cancer patients of course the more you fire on canotary Farrow continue to give care as it were but as you can imagine from the numbers I've shared with you the capacities are completely stretched sure we have seen also in the private sector especially the Agra can invest you know in the cancer treatment including investing in the PET scan all right so you've heard from Susilo care care there the CEO of health so we've procured we have a budget secured which will also go into building centers of excellence within this same here and nine chemotherapy doctor offered is it therapy centers is this true because you deal with this on a day-to-day basis as a doctor has infrastructure improved thus making your work easier and treatment for cancer victims it's true and I just want to reiterate what our common sexually you know measurement treats to our two days ago I wanted to weigh in to relate that to cost of treatment I think why the cost of treatment has been a major issue in this country is more or less the economic issue of demand and supply there is huge demand and yet the supplier has been fairly limited particularly in the public sector I think that's why as as government we have come in to to enhance access across the public sector I'll give an example about three four five years ago the cost of the develop in this country was at Cana tourism hospital a session would a setback a patient 500 shillings what else in the private sector is in this town one would be required to to contribute up almost to about 10,000 connections possession so I know he's about to talk about this when NH I have stepped in to push on the cost of care allowing patients to even be able to access be able to pay for that access in a private sector that had a knockdown effect event on the commercial a hostel itself it was from a waiting period of close to 1/2 2 to 3 years patients waiting for the develop a treatment we saw that come down to just about two months currently so I think the the the the deliberate investment by government to spread this outside Nairobi to in autumn or chicken for a hospital to the four regional centers or residence at the community I talked about that's a technology effort to make sure that we create we supply more of the service and that has a knockdown effect on on the pricing it's the same for for the custom of medicine over the past one year we have actually seen khemsa which is the national drug supplies agency under the Minister of Health embark on a noble procurement of other medicines because for sure over the past but custom it seems how we have dependent or nah you know for my sweetie cause or local suppliers who's operating on very small volumes so hence and does not believe the oppressive draft behind but I think as we increase this investment infrastructure investment and as we improve you know we look at it holistically at national level so that we have volumes bulk be no bulk purchases of medicines of supplies of equipment that are quite for cancer care will progressively see the cost of so kill but let me walk you into it the conversation as the Claims Manager for nhi F does nhi have cover all cancer patients and cover them fully so whether someone comes in with cervical cancer prostate cancer blood cancer et Cie whatever consent is as NH I have covered that fully cancer patients thank you this year's nhf covers cancer patients comprehensively one thing on to tell Kenyans and I'll quote from the scriptures is that my people perished because of lack of sufficient knowledge we do cover cancer treatment under than college packets unto Tolkien is that currently NSF administers round about thirteen benefit package which includes among others the inpatient outpatient surgical kidney transplantation the Alice's emergency of equation and including the oncology package to be trying to share with the extensively under the oncology package we do cover the following chemotherapy how many sessions I'll go to the details radiotherapy and branch each era which is among the latest technologies in town under chemotherapy nhf is obliged to cover for first-line chemo we do pay up to twenty five thousand shillings for a session and we obliged to cover up to a maximum of six sessions translating two hundred and fifty thousand under secondly or what we call complex cancer nhf is obliged to cover up to Kenya shillings 150 and up to four translating to Kenya shillings 600,000 if you look at the cumulative figure for the Kimo alone we cover in excess of 750,000 which is adequate to cover to cover for treatment but as I mentioned earlier when you began the show cancer treatment is covered in other packages we are talking of from Co surgery whereby we do cover for oncology such as surgical procedures and oncology and depending on the service level of the facility and the contract type we do pay comprehensively under the radiology package which has among others the MRI CT scan ultrasound and the latest kid on the block that is the PET CT scan which was launched daga can we do cover comprehensively for example for purposes of diagnostic imaging for the PET CT scan Ataka can Hospital Nationals between Sharon's fund is obliged to pay Kenya shillings sixty nine thousand five hundred per family package for purposes of diagnostic imaging we also do pay for the MRI for purposes of staging whereby we pay up to fifteen thousand for radiotherapy and in this matter of let this been a rapid improvement in the doctor up in this country we are talking of the latest technology which is the IMET image modulated radiotherapy treatment which is offered in Cancer Care know so Gilbert what happens now if you come in with also another with a non communicable disease if now a patient also has cancer II diabetes cardiovascular disease HIV does the cover still cover that as well and others a different conversation we do cover we look ever for comorbidities that is patients who ill from more than one illness so long as you have fully paid-up member of nhf we do cover that it is under the radical package who can become a under the renal dialysis package Robin nhf is obliged to pay 9500 shillings per session and we pay for two sessions in a week 76,000 in a month that is big sessions for any other ailment we discovered an inpatient treatment under the 13 packages that I mentioned that energy fund ministers all right so I've purposely held on salad just a little bit because after the commercial break I want you to hear her story and hear hi Johnny but before we do that let's take a look at your feedback on SMS and on Twitter as well level 2 for double – that's our SMS line Lazzaro on Twitter good morning to you you say a recent cancer has different HIV and AIDS as a number of one killer disease in Africa we are appealing for rapid response from the developed nations and the way developed nations rather the way they response to HIV and AIDS that's Lazaro's thoughts on on twitter hashtag daybreak is a ticket into the conversation the cost of health care is not reduced casting about so sir Kyoko you say the Kenyan government should invest in working equipment and skilled human resources to offer detection and treatment on x across all regions people sensitization is also key so that we learn how to offer support systems to patients on SMS double – for double – that's another avenue that you can use to send in your feedback all right so glad is good money to you you say hi daybreak hi to reduce this cancer in Kenya let the government make collaborations with a prominent herbal doctors they are ignoring but they can all right and yes that's a point we will have to be discussing dr. Alfred will be discussing the issue of herb all cannabis has an option and it is you welcome back thank you so much for sticking with daybreak as promised let's hear Sally's story so Sally walk me through this take me through it the first time a doctor told you sorry you have cancer what's the first thing that came to your mind that was in 2007 and console wasn't talk talked much about that time so for me it was death hmm yes that's a first thing that come to you yes how did you break the story to your loved ones even before breaking the story to my loved one there were how the doctor broke this story to me I mean he just said you have stage to cervical cancer and we have to do total hysterectomy and you know I'd lost two babies so I was expecting that maybe would prepare me and take me through the journey but he just said we have to go to theatre because you are at risk of this spreading so even before I went home to break these nurses it was already too heavy on me I tried it I took some a lot of time to tell it to my my sister I'd lost my parents who have a sister who doubles up as a mother she lived with me since her husband my parents passed on so I took almost a week before telling her cause she's hypertensive and I thought if I tell her this it will break her heart so first I went to my my employer I was privileged to be working with a medical organization so I explained to them what the doctor said and they said I also have HIV and they said because of your hitch every condition this cancer will spread so what the doctor saying is just okay but anyway the way he did it was wrong he could have at least taken you through counseling before breaking the news but yes this is the right step to do so you had to worry about the HIV and the cancer as well which I didn't worry me much because I was already on treatment at one nine to twelve yes but now the fact that my room was going to be removed and I've already lost two babies and I will have more that really shocked me right and I've seen many people dying of cancer so for me I just knew this is 2007 when twenty thirteen years here you are seated yes looking healthy how did having cancer and I used past tense how did having cancer change your life did you have to make changes financially socially do you have to cut out of your friends spiritually how did having cancer change your life in what in one word I would say it has humbled me yes the pain has humbled me and also getting to know who had the true friends what the true relatives were they true people you can depend on and I'm humbled because I must say that after the cervical cancer it's actually real cut again in the column and I can say that I've lost three of my body organs so I had total hysterectomy and then it went to the : i lost patron my colon and then the rectum no this is because of cancer and all this is because of what do you have there with you and now as I say I'm a survivor and a warrior too for that matter but I'm healed from cancer I'm actually cured and I'm here to tell kenya's that not all cancer diagnosis equals death I survived and there are many others who have survived but it left me with a disability not visible though but it is a disability and I would like to ask a colleague a floor manager if if you cover these things that I'm having here today and they covered under under nhf now this these are called colostomy bags so after I lost my after I lost my rectum there's a special passage that I use for passing stool throw my my body so I have to use this elf to cover it with this special bag that is just a colostomy bag it's not available in this country what we have here is this it's not available this is what we have available in the country okay and if you compare it with these other ones this is donations we get from overseas and this is what we have in this country but also getting it is not easy sometimes you might have the money and you don't get it and I would say one of these would cost you can easily 300 yes and how many do you use you see like it's a closed porch so I could even you stand on this the reason being that it doesn't have this severe we take ten in a week in the day because this this it does it hold 10 in a day and that is not as as far as this one right yes so you can imagine how many Kenyans can afford this so Gilbert is that covered that covered under nature for the colostomy bag currently it is not because it's not very many healthcare providers I've taught them in this country but for the other bag we do cover yeah but maybe even cheap in check maybe what any jf need to look at is covering all the rehabilitative ratios from devices and products because these are rehabilitation for it for people who have had corrective surgery so they need it for life has she been clearly it should be car and human in the grass or should prosthetic limbs if a patient has cancer of the bone and they have computed the lake you know that means that that that patient needs a prosthetic limb to walk a woman has had a breast removed they need a prosthetic breast it's part of the habilitation because a patient who is not worried habilitated will go to depression will you have a lot of social distress they keep seeking healthcare because of of mental issues so maybe to do very well in the strict message to energy a cancer rehabilitation products the whole range and then we also get our cancer to stock a good quality buds because they can import if these are coming from overseas they can import for patients stock of good quality buds and involve the users talk to Sally another and that they all the patients there are thousands in this country some are using juwes and they die a pass and all sorts of things which are really lower their dignity so if any cancer can import good quality bugs talk to these people and get them to low what does a good quality butter not only just that but the accessibility and availability of it cause it's amazing you can have the money today but then they are not in stock so how much is the one that you have to import this one is edges between seven and a hundred and a thousand thousand bonus so dr. Alfred does it does the treatment of cancer make it more difficult when someone has a non communicable disease as well yes of course because for example what is now is what he had mentioned about cocoa mobilities or another disease that alongside cancer of course that will add onto onto the cost that is involved because you'll have to take you know a la magie since you know to also manage the other condition disease hypertension or diabetes Aditi but I think those are conversion about how would it work how the cost of treatment but I think that is highly individualized because largely when talk about cancer treatment there will be three four main modality that you're talking about a patient with a very we're both era p eq therapy surgery or some form of targeted therapy sometimes immuno therapy or some other forms of targeted therapy now I think depending on the stone that's why I is saying it depends on the individual condition of the patient because it depends on things like you know the stage in which the condition is detected the individual has to that patient in terms of you know male and female what desires you are trying I trying to – no – like Farkas when we learn about she wanted to she had salt or cancer and she is add through you know – you know still baby sha you may have do that still have you know children in future so that's I'm saying the number of variations that we are depending with a person yes so but in many cases a patient with quite a competition of those things so maybe sure many times we'll see a patient require surgery to remove the diseased part of the deceased organ chemotherapy and so commonly we'll see a patient requiring a combination of those three so that then drives the the cost and then again also we need to realize that they put the direct cost and indirect costs because you appreciate us to travel the patients coming from Butera or from it we become a toxicity therapy not National Hospital other than the cost of the actual did you therapy that we get we need to think about how do I travel from Chile to Nairobi and when why spend devolution is still pretty young still a young baby yes what from the ground from where you are and you just brought it abuse what would you want to see devolution doing in terms for cancer patients not that have been so specific cancer patients do I have to come all the way from what year to receive treatment and we are working with the county governments because the what we appreciate is that different a different levels something can be done at different levels for instance patient follow-up and patient support is possible there's a core concept of palliative care that includes you know pain management includes psychosocial support includes rehabilitative care those are some of the services that can possibly be provided at the lower level so that we live the fairly specialized services like the therapy or chemotherapy a patient could come and access the the specialized services at a central level but can continue the supportive care at the county level so of special address a question the the county governments and invest in some of the supportive care so that the patient does not have to come for the what you call the definition Chipman to nairobi and still get come supportive treatment never Billiken lab they should be able to provide some of the services you are nutrition support you are you know some simulations it's require even you know blood transfusions every so often so that some of the services are within you know the capacity of of the devolved you know states and even some of the specific treatments and that's why the RCS talked about in the past one year we have said about ninth most of the unit's cause we don't need to travel to from so then doctor helped me understand this misdiagnosis yes which has been a course also to one's pockets why are we mr. Venus is such a popular thing going out to cancer is it is if we have been qualified doctors so is it a matter of negligence why I wouldn't say I would say it's how our health system has been shipped over the pastor okay there has been resources seemingly have been more focused on you know communicable disease but I think we were trying to manage what of the biggest button over the years you know HIV malaria TB at some point was really a big problem in this country so quite a lot of investment you know because of I think of trying to money that inadvertently I think quite a bit of investment went words infectious you know illnesses so we could say that at some point the non-comic abilities were not as well proud chest as the infectious ones so when you look at our health workers then they are not as well attuned to you know easily detecting cancer or the hypertension as the art objecting appreciate any health work in this country and quickly tell you this is I suspect this is this is TB I think this is malaria but when we come to something like cancer then then that becomes a bit more you know a bit more we require a bit more training for them to be able to ask me to quickly also think about so that Kansas does you know featuring among them the option that we think could be a diagnosis but I think those are thing is that you we also need to appreciate that cancer as well sometimes is not some of the symptoms that cancer present we do not mean specific you know I can do an example of something like blood cancer leukemia you will have very vague signs and symptoms things like just general fatigue you know having fevers running on and off so sometimes they could be confusing so I think why sometimes that appeared like misdiagnosis is because health records have tended to go forward they know fast which is infectious in there so we will see patients being treated for typhoid repeatedly because the health work I tend to think when you see this kind of symptoms the most likely scenario is take photos before they start think about Sam likes drama cancer or cancer so David one of the ways of mitigating the cost of treatment for cancer is support groups for survivors it's one thing for you to go through cancer it's another thing when it costs you Millions to you know just treat it it's another thing when you don't have basic supportive basic support system in Canada we have support groups for cancer patients and cancer survivors how popular are they are Kenyans willing to sit in a circle like this and sort of share the stories to help them through their journey yeah we do have support groups in this country some a hospital-based others are community-based because there are different types of support groups some have a very specific population where you find people with colorectal cancer for example have a support group like a sari and an her group there are others which serve maybe parents of children who who's whose children have had cancer so a parents kind of support group there are others who serve just about everyone which is maybe a very generic group so whether they're men women any type of cancer they admit typically every two weeks or every four weeks to share their journey and help each other in terms of how are you coping what are the tricks of getting through whether it's diet getting through chemotherapy and what lessons have you learned so they very play a very very important role and leave the actual part of the continuum of treatment because typically if a patient is diagnosed with cancer they probably think we are the only ones they've never met anyone who had cancer or they always hear these things vaguely so when it affects them the one thing they want to connect with is a group of people who've walked that journey and in speaking of which Sally how have you did manage your finances since 2007 when the doctor broke the news to you how did you manage your finances I must say that I was privileged because I was working for an organization that the very good medical cover so they could pay the cover and of course nhi F and if it went overboard then they would even chip in so I would say that I was privileged then if it happens to me now I don't know what I would do because I can't even afford to pay my inner Jeff right now speaking of in haif Gilbert what is NH I have to make sure that they caution Kenyans from high costs of treatment for cancer is there anything any chef is doing yes nhf is working over grief to ensure that the question Kenyans from out-of-pocket catastrophic expenditure one of the things that we've done a tentative is to strategically purchase health care services was that we've engaged some pharmaceutical giant and run to salute Johnson pharmaceuticals who moving eased and we were able to reduce the cost of drugs for prostate cancer there's a drug that they sell in the market known as Abdera tron asserted called zhiting which initially when it was introduced in this market was going for 250,000 but after negotiations with the Johnson pharmaceuticals we were able to reduce to reduce the cost by 60% and it's available to a membership the other thing that we are doing also engaging like-minded institutions to that extent we are currently speaking with Jon Faddis they run a program called access rabbi for 200 shillings members can be able to get access to cancer drugs we are talking of tamoxifen appraisal and others 200 shillings per month we are the very tail end of those negotiations and very soon we will be putting about 15 molecules live alone cancer diabetes hypertension respiratory diseases available to Kenyans we are also talking with healthcare providers and I give you an example of a gakuen hospital whereby we were able to negotiate the cost of the PET CT scan which is used for diagnostic imaging from a height that cost of about hundred thousand to 69 thousand we are also in talks with other providers like Nairobi West who have invested in the latest technology in the market known as Elysium we are looking into ways and means to cochon Kenyans from out-of-pocket expenditure we are also partnering with the national government through the health insurance subsidy program whereby persons of older persons people with severe disabilities orphans are able to be registered through the national government information is scheme yeah David we need to take a quick commercial break but I can tell you have a point you'd like to know yes I think what the initiative initiative is taking a certainly come very very commendable but I think we need from civil society and representing patients groups we need to change the whole structure of how they do business I think all these medicines tell us what cancer should be handled by kamsa 100% cancer do bulk patches you know negotiate with industry and everyone else and then make sure that all cancer service providers are getting the dollars from cancer because it's advantage of economics of still so the benefit will allow me to go to the patient so then again we also make it less complicated some patients don't know which is complex teaming which is simple which is what let's a Kenyan who has a nature NH iuf card access screaming because we must up there access treatment on the basis of your NH iuf card if you cost some money but cancer is a pro it is a big problem that is capable of bringing down our economy so we need to just get to a place where I have a card I go and get treatment 100% how fast it is done yes okay great let's take a look at your feedback on SMS and on our Twitter handle at citizen TV Kenya that's all Fisher hunter the hash tag daybreak is your ticket into the conversation tom moore i you say the government should invest more in equipment and personnel people should we talk more about cancer since with the early detection treatment is cheaper if discovered in late stages it's expensive all right still sticking to twitter cost of health care most specifically on countries our conversation this morning cos ito you see this nhf coverage is a fog I am in Mombasa other and lately lights and lately lighthouse I need a bio a chemical a biopsy rather and at the moment the reception is kept insisting that nhi EFT only covers only civil servants how come how come I only pay a hundred thousand a month Gobert is it not we do cover concept experience I'll give you a chance to answer to that one let's listen to John John you say I just wish the government would drop all the other agendas and deal with health and do it perfectly not just Bora who do MA but who Duma Bora all right SMS double true for double – before we get Gilbert's thoughts on that question from one of the viewers Patrick from near you say government should open up Centers for this disaster why is the government allocating money eg to luxury projects like the SGR rather than basic projects like health care like health brother and you continue to say that secondly the government is caring for cancer victims who are state officers instead of sensitizing the young generation and the entire Kenya on dangers of cancer the government should care for 14 million Kenyans not few popular citizens alright still on SMS double – 4 double – that's where you can put in your thoughts and share it with us John from Hobart very good morning you say would it be possible for the government to have a policy framework for cancer prioritized equipment of model cancer centers with about 2% of our annual financial budget 70% of ESAC recoveries and 20% local revenue per county all right going into the framework of cancer rosemary rose rather you say cancer is a major public problem globally and in Kenya the health sector should incorporate screening as part of routine checkup when patients seek any medical service David what you've just said has been echoed let's take a look at the last on an SMS Tina you don't see where you're watching from good morning you say that the gentleman from nhf should be more sincere the chemo color is very limited they only cover six sessions yet I had 16 sessions why can't it why can this be the case all right Oh rather why can it be case by case all right so Gilbert will give you a chance to answer to those comments when we come back from the commercial break so let's do that let's take a breathe and come back with closing comments stay with us

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