For decades, Kenya’s public health battle lines were clearly drawn. HIV was treated as a national emergency, and the response reflected that urgency. Testing was decentralised and made free. It was relentless campaign after relentless campaign. Treatment was first, subsidised. and then later fully integrated into public care. As a result of all the awareness campaigns, HIV shifted from a death sentence to a manageable chronic condition.
That success quietly reshaped public perception. You have probably heard of the phrase, “It is better to have HIV than cancer.”
The comparison is not medical per se, just structural. It reflects a reality in which HIV testing is routine and free, antiretroviral drugs are consistently available, once again, for free, and long term care is predictable. Cancer, by contrast, is still encountered late, diagnosed expensively, treated unevenly and survived unevenly. Where HIV benefited from early detection and sustained public investment, cancer remains a disease most Kenyans meet when options are already narrowing. And if we are being honest, cancer is now (has always been) considered a death sentence.
This contrast is the result of policy choices.
Late diagnosis by design (?)
According to data from Kenya’s National Cancer Institute and hospital based studies, between 70 and 80 per cent of cancer cases in Kenya are diagnosed at Stage III or IV. At these stages, not only is the treatment more complex, it is also more expensive and less likely to succeed. Each year, the country records approximately 47,000–48,000 new cancer cases and over 27,000 cancer-related deaths, numbers projected to rise sharply over the next two decades as the population grows and ages.
Late diagnosis is often framed as an individual failure. That it happens out of fear, denial or ignorance. Nothing could be further from the truth, as the data clearly suggests. Delayed presentation is largely the predictable outcome of a system in which screening is neither routine nor universally accessible, and early diagnosis carries a financial and emotional cost many households cannot afford.
National screening uptake remains low, estimated at around 16 per cent, despite cancer now ranking among the leading causes of death in Kenyan health facilities. For most people, testing only begins once symptoms disrupt daily life, by which point the disease has often advanced.
The cost barrier to knowing early
Unlike HIV testing, cancer screening in Kenya is fragmented and inconsistent. While some public facilities offer limited screening (particularly for cervical cancer) services are unevenly distributed and often dependent on donor support or awareness months. As if a disease that is raging your body will wait until October or whatever month is “Cancer awareness month.” For many patients, especially outside major urban centres, accessing screening still means travel, time off work and out of pocket payments.
Mammograms, biopsies, PSA tests and colonoscopies are not routine preventive services for the average Kenyan, mostly because a financial decision has to be made. In this context, delaying a hospital visit cannot be deemed as denial because people postpone diagnosis knowing that confirmation may usher in costs they cannot sustain.
Read on – Where to Get Free Breast Cancer Screening and Treatment in Kenya
What government could do differently
Kenya’s experience with HIV demonstrates that large scale public health shifts are possible when prevention is prioritized. So why isn’t cancer, a disease that is killing hundreds of thousands, given the priority it deserves? We just need to apply the same logic that was applied in combating HIV to cancer, and fortunately it would not require reinventing the health system, but reorienting it.
One immediate and achievable step would be to make basic cancer screening free across government hospitals, starting with high burden cancers. The precedent already exists. Cervical cancer screening using VIA and Pap smears is offered free or at low cost in some public facilities, proving that nationwide rollout is feasible with political commitment.
A realistic model would include:
- Free basic screening for cervical, breast and prostate cancers at all Level 4 and Level 5 public hospitals
- County led outreach clinics to extend screening beyond referral hospitals
- Clear national guidelines so access does not depend on geography or timing
Free screening would not eliminate all cancer related costs, but it would shift diagnosis earlier. And what a ton of difference that would make, because at that point treatment is less expensive and survival outcomes are significantly better.
Beyond cost removal, cancer screening could be integrated into existing primary care and HIV infrastructure. Kenya already has community health volunteers, maternal health clinics and HIV care systems reaching millions. For starters, screening for cervical cancer could be done alongside HIV clinic or, and this to me is a brilliant idea, clinical breast exams to be carried out during maternal health visits.
Health insurance reform also has a role to play. Current coverage models absorb costs mainly after diagnosis, when care is most expensive. If medical facilities could focus on a prevention approach and prioritize full coverage for diagnostic tests and biopsies, then they would eliminate co payments that discourage early presentation. From a fiscal standpoint, early diagnosis is cheaper than funding late stage treatment and palliative care. Not to mention it is easier to treat at that stage and by extention, cure.
A system built to react, not prevent
It is not that the cancer in Kenya is uniquely aggressive. But it is still on the rise, why? Because prevention and early detection remain underfunded and secondary. Oncology units continue to absorb the shock of late stage disease, while investment in screening and public education lags behind the scale of the problem.
The result is a health system that meets cancer when it is already advanced, reinforcing the belief that cancer is inevitably fatal and discouraging early engagement with care.
Until prevention is treated as seriously as treatment and until early diagnosis is made affordable, routine and accessible – the saying will persist. Not because it is true, but because the system makes it feel that way.
