Cancer care financing in Nigeria: A scoping review of the literature

Abstract

Introduction

Cancer care presents a huge financial burden to patients globally. This burden is particularly significant in low- and middle-income countries (LMICs) with high poverty rates and minimal sustainable funding models. In Nigeria, the most populous country in Africa with over 100,000 new cancer cases yearly, out-of-pocket costs for cancer care exceed the GDP per capita. The objective of this scoping review is to describe the available options for cancer financing for patients in Nigeria and to make recommendations for researchers and policy makers based on a review of the literature.

Methods

We conducted a comprehensive search of PUBMED, Economic Literature and African Medicus Index databases using a search strategy based on the core concepts of “healthcare financing”, “cancer patients” and “Nigeria”. There were no restrictions by publication timing or study design. However gray literature was excluded. Two independent reviewers conducted abstract screening and full-text review. Conflicts were reconciled by a third reviewer or by consensus where necessary. Data abstraction, synthesis, and analysis were performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines.

Results

From 408 screened articles, 19 studies met the eligibility criteria, covering a time frame from 2008 to 2024. Most of the studies (14/19) were original research and based in urban (14/19) settings. The majority covered financing options for cancer treatment (16/19), while others covered screening and diagnosis. The available sources of cancer financing can be classified into out-of-pocket (OOP) insurance (public and private), family/relative support, loans, and non-governmental funding. Importantly, OOP was the predominant source of health care financing. Studies reported on the adverse impact of high OOP costs on catastrophic healthcare spending, delays in diagnosis as well as adherence to treatment. Studies unanimously recommended expanding private and public insurance coverage for improving financial risk protection against catastrophic health payments.

Conclusion

Evidence suggests that healthcare financing options are grossly limited for cancer patients in Nigeria with most patients paying OOP. We recommend the implementation of mandatory health insurance and expanded coverage for cancer care services. There is also a need for research into financing options available to patients across different settings, especially in rural and underserved regions. Furthermore, more rigorous study designs to capture financing options for both direct and indirect costs of cancer care are necessary.