Breast cancer patients in Ghana struggle with limited NHIS coverage and rising costs.

Ramatu Sumani is battling breast cancer for the second time in four years. She was first diagnosed of stage three breast cancer in January 2020.

Despite financial constraints, she was determined to fight the disease relentlessly so she could survive for the sake of her only child who was just five years old at the time.

The 42-year-old mother fought with support from her family and the Cancer Support Network Foundation (CSNF), an NGO promoting cancer awareness in Ghana and supporting economically challenged cancer patients financially and got cured.

She underwent eight rounds of grueling chemotherapy sessions, surgery to take away the affected breast (mastectomy) and 25 fractions of radiotherapy. This intensive treatment was not entirely covered by the National Health Insurance Scheme (NHIS) though information on the National Health Insurance Authority (NHIA) website claims the scheme covers cost of treatment for the disease.  This information is very far away from the reality.

Mrs Sumani’s  story took another turn in August 2020 when the breast cancer recurred, this time, affecting her lungs. Her worst fears had caught up with her.  As a cancer patient living in Ajumaku Beseasi in the Central Region of Ghana and receiving treatment at the Korle Bu Teaching Hospital (KBTH). Life she said has now become unbearable for her.

“The thought of going through this whole breast cancer journey again with limited funds, long travel time to see my doctors and a child to take care of is very frustrating.”

“How do I start, where do I go. Knowing the reality of the battle ahead is what is draining me emotionally because I have been there before. Things are even worst now than how they used to be four years ago. I cannot afford what the doctors are asking for,” she lamented.

Statistics reveal a sobering reality: one in eight women will face a breast cancer diagnosis at some point in their lives. In 2022 alone, World Health Organisation (WHO) data showed that 2.3 million women were diagnosed with breast cancer, resulting in 670,000 deaths globally.

The 2020 Global Cancer Observatory (GLOBOCAN) report estimated 4,645 new breast cancer cases in Ghana, a substantial increase from the 2,062 new cases reported in 2012.

Nearly 50 per cent of these cases result in death, primarily due to late-stage detection and the inability of patients to afford treatment. Most affected women in Ghana are under 50 years old.

The Ghana Cancer Registry underscores breast cancer as the leading cancer among women, accounting for 16.8 per cent of all cancer cases.

Despite this harsh reality and the fact that this year is an election year, it is only one political party that has outlined in its manifesto, a policy that when implemented, could help alleviate the burdens of breast cancer patients. Flagbearer of the National Democratic Congres (NDC), John Dramani Mahama, during the launch of the party’s manifesto in August said he will ensure the establishment of the Ghana Medical Care Trust if elected president.

According to him, this establishment will provide assistance to people suffering from chronic conditions such as  cancers, kidney failure and diabetes, among others.

This when implemented would go a long way in helping vulnerable breast cancer patients too.

Currently, it is just some selected chemotherapy drugs for breast cancer treatment that are covered by the NHIS. With the surgery also, the scheme does not cover the entire cost. The amount it covers is deemed insignificant by patients. Any breast cancer patient who requires mastectomy as part of treatment must have at least  GH₵3000.00 to cover the cost of the surgery. Some patients also require radiotherapy which is very expensive and ranges between GH₵5000.00 and GH₵12000.00. In between each chemotherapy cycle, patients are most times required to run various laboratory tests and scans which are equally not covered by the scheme.

The recurrence of Mrs Sumani’s cancer, she said, has put her in a very dire situation as she has to commute from the Central Region for each doctor’s appointment. Aside the costly transportation, she said she is expected to raise money for her laboratory tests which she does each three weeks.

During a visit to her home, she shared with the Ghanaian Times that making trips between the hospital and home, sometimes up to twice a month depending on the doctors’ requirements was extremely challenging.

“I sometimes must spend a night or two at my sister’s end in Accra, Spintex, but this is not always convenient for me because I leave my nine-year-old son at home when I have hospital appointments.

“Getting through this second time treatment for breast cancer treatment after four years of survival is not a joke. Imagining what I went through the first time alone makes me scared, the financial burden, anxiety and pain. At least at this time money should not be the problem but it is, because the NHIS is not covering everything. I thought things had improved,” she lamented.

She urged the government to offer full coverage for breast cancer treatment to help ease the financial burdens faced by patients.

The challenge of not affording the entire treatment for the disease results in many patients defaulting treatment and resorting to unapproved methods which mostly do not end well. Such patients end up losing their lives in many cases. One of such patients is Cynthia Mensah, a 40-year-old trader who resides in Gomoa Fetteh in the Central Region. She was also diagnosed of stage three invasive breast cancer in 2023. Narrating her ordeal, the mother of five stated that the distance from her house to the KBTH, compounded with financial constraints played a role in the delay she faced after she began her treatment.

She said along the line she had to abandon the treatment she started and resorted to buying concoctions from self-acclaimed pastors that were purported to be very effective against breast cancer.

She indicated that she used to buy one of the concoctions locally called “Yesu Mogya” from a pastor at the second chance ministries at a cost of  GH₵50.00 which according to her was far less expensive than the chemotherapy she was put on.

She shared that she had placed immense hope in the herbal concoction, continuing to consume it daily for weeks despite seeing no improvement. It wasn’t until her breast became enlarged and sore that she realised she needed to return to KBTH.

Upon her return, she restarted treatment, and with support from the CSNF, she completed all eight cycles of chemotherapy, underwent surgery to remove the affected breast, and received radiotherapy.

One of the greatest challenges for her was getting transport to go to the hospital for her 25 fractions of radiotherapy. Payment was made by the CSNF for it, but she lacked money to transport herself to and from Gomao-Fetteh each day for the procedure.

Ms Mensah revealed that she resorted to sleeping at the hospital premises for close to two weeks because the radiotherapy sessions are taken each day except weekends, until a good Samaritan came to her rescue and raised some funds for her to use as transport.

“Those two weeks were hell. Sleeping in the open and enduring mosquito bites all because I could not afford transportation from my house to the hospital each day. Despite all the frustration I was determined to go through it all for the sake of my children,” she said.

Ms Mensah who is a divorcee expressed her gratitude for receiving financial support for her medical bills from the CSNF but raised concerns about the plight of individuals who relied solely on the limited coverage provided by the NHIS for breast cancer treatment.

“I knew people who stopped treatment because they could not afford X-rays, the frequent laboratory tests, radiotherapy and surgery. Some have sadly passed away,” she said.

The devastating impact of breast cancer cannot be underestimated as it affects thousands of families in Ghana. The government stepping in to offer some relief to those affected by the disease by incorporating the treatment of the disease on the NHIS was expected to bring some hope to vulnerable and economically challenged patients however this is not the case because these vulnerable patients still struggle to get through treatment. Those who require radiotherapy must raise the full amount for it because the NHIS does not cover any part of radiotherapy, yet most breast cancer patients require that as part of treatment. Doctors at the KBTH are worried about the high number of young women who are lately being diagnosed of breast cancer in Ghana.

The Head of the Breast Unit of the hospital, Dr Florence Dedey reacting to the issue stated that many of these young women present with middle or late-stage breast cancer which require more aggressive treatment like multiple cycles of chemotherapy, surgery to remove the breast and many fractions of radiotherapy.

For her, prevention is always better than cure so she is advocating for intensified awareness creation about breast cancer to save lives, especially in rural communities where access to healthcare is a challenge.

Just like Mrs Sumani and Ms Mensah, there are hundreds of other breast cancer patients who are struggling to pay for their treatment. Many are people who have been referred from various regions across Ghana to the KBTH which is the largest referral health facility in the country.

Mrs Deborah Adu recounted how her sister, a  34-year-old resident of Adeiso in the Eastern Region, Ms Betty Ampoful,  tragically lost her life to the disease in September 2024. 

She told the Ghanaian Times that the family was waiting to raise an amount of GHC2,500.00 for a CT scan the doctors had requested for when Betty succumb to the disease, after two months of waiting for the funds to be raised for the investigation.

“After depending on the benevolence of people to support our chemotherapy bills it got to a point where we needed to do a CT scan to ascertain the extent of spread of the cancer and also to find out whether Joice was responding to the drug but unfortunately, we could not get the money for that. We waited for weeks which turned into two months and eventually lost her.”

“If the health insurance covers things like the scans I do not think my sister would have died now. If it must be done, it must be done well,” she added.

Another breast cancer patient, 23-year-old Dede Hose, has endured the harsh reality of the disease for the past year. Initially diagnosed with stage two breast cancer in October 2023, her condition has worsened to stage four despite undergoing treatment.

Her situation is severe, but due to her young age, she has received significant support from compassionate individuals and organisations following public appeals on her behalf. This was necessary because the NHIS did not cover the specialised chemotherapy doctors believed could help her.

Her cancer has now metastasised beyond the left breast, spreading to her lungs, liver, and bones, causing her intense daily pain. Even the wound care for the cancerous lesion on her chest is not covered by the NHIS.

As a result, she must purchase her own medication, cotton, and gauze for wound dressing every two days, and pay GH₵ 40.00 before the wound can be dressed.

A consultant general surgeon, KBTH, with special interest in breast cancer, Dr Josephine Nsaful in an interview with the Ghanaian Times said though the NHIS does not cover every aspect of the treatment of breast cancer, it helps reduce the cost to some extent and urged the public to prioritise screening for early detection of breast cancer. Early detection of breast cancer, she said does not require very aggressive and expensive treatment, adding that for very early stages the NHIS covers the costs of treatment significantly because many of such patients might not require radiotherapy or even surgery.

Early detection of breast cancer, she stressed was highly possible with regular mammograms and other screening methods, underscoring the relevance of frequent awareness creation.

She hoped that a time would come that the NHIS will cover the entire treatment of breast cancer, including services like scans, X-rays and laboratory tests.

Breast cancer patients, like Mrs Sumani, feel entitled to full coverage of their treatment under the NHIS, as the NHIA claims to offer this support on its website and public statements. For them, it is a matter of right, as their survival depends on comprehensive care. Yet, others, like Ms. Mensah, view it differently due to limited awareness, seeing it as a privilege from the government. She hesitates to demand improved benefits, opting instead to plead for a better outcome.

This contrast underscores the need for clearer communication about what patients should rightfully expect and receive, aligning coverage promises with the harsh realities of treatment costs.

Attempts to obtain a response from the NHIA regarding this issue were unsuccessful. If the challenges faced by vulnerable breast cancer patients are not adequately addressed by incorporating comprehensive treatment for the disease into the insurance scheme and expanding access to cancer care across Ghana to reduce travel distances, the breast cancer death toll will continue to climb. Even those fortunate enough to achieve remission will remain trapped in a cycle of pain and anxiety due to the inadequacies of the current support system.

BY RAISSA SAMBOU