Adoption of a national cancer-control policy imperative

Cancer treatment is expensive anywhere in the world. However, in countries such as Bangladesh, people are especially vulnerable since public healthcare facilities to treat such ailments are very limited. The out-of-pocket (OOP) expenditures for families is phenomenal. Treating a cancer patient turns out to be a very difficult task for most families, except the affluent ones. A recent study conducted by the Bangladesh Institute of Development Studies (BIDS) has found that the average OOP expenditure per patient is nearly Tk 548,000. That is a staggering amount.

The cost burden for poorer households is devastating financially. Since the treatment is only available in the capital city, it is extremely expensive for such families to bear. The study tells us that nine out of 10 respondents in the survey viewed that the huge expense is not just for the medication, but it also involves the costs of the diagnostic tests that, in most cases, are done in private hospitals and centres. So, a patient may be admitted to the lone public cancer hospital in Dhaka, but all these tests, recommended by specialists under whom the patient is taking treatments are carried out in some other medical facility, the bulk of which are private. This is something one does not see in other countries. In most Asian countries, specialised cancer hospitals have most diagnostic facilities under the same roof, but not so in Bangladesh. The government cancer hospital in Dhaka itself in a poor state, as many of its equipment remain out-of-order most of the times. This deprives poor cancer patients of treatment at low cost.

As patients are forced to scurry between hospital and external diagnostic centres, the costs begin to mount up. But beyond the cost-factor, there is also the question of early detection of cancer. A lot of time is wasted in going from centre to centre, having tests done, sometimes waiting for days to get the results and then getting the requisite appointment of the specialist. This in turn diminishes the probability of early detection of cancer cells in the body, which certainly adds to the cost burden on patients. The survey states that patients' OOP expenditure is Tk 331,243 if cancer diagnosis is done at the first stage and almost Tk 700,000 if the diagnosis takes place at the 4th stage. It is because of these experiences, we have tens of thousands of patients going abroad, particularly to India and Thailand (those who can afford it) in the hope of finding a more affordable and efficient treatment.

In the absence of any cancer policy, there is little incentive for the private health sector to change its modus operandi, which till now has largely been  charging whatever it deems fit for cancer patients. With the increase in pollution at different spheres, from air to water, change in life style and food habit, the incidence of cancer has increased alarmingly over the last decade. It is time for policymakers to look at this deadly disease from a broader healthcare perspective. As stated before, adoption of a national cancer-control policy would set the stage for the government to take charge of certain matters and force change in the interest of safeguarding public health.

Hospitals would have to ensure critical diagnostic facilities. A nationwide insurance mechanism could be introduced whereby all citizens would be covered slashing treatment costs significantly. While there will be significant pushback from the medical establishment, the first step would be to establish a specialized cancer treatment hospital in every divisional headquarters of the country supplied with necessary doctors and diagnostic and treatment facilities, so that cancer can be detected and treated at the very early stage.