Primary Health care providers’ perspectives on childhood cancer, traditional medicine, referral practices, and health insurance in Western Kenya

Abstract

PURPOSE Accessing timely childhood cancer care is a significant challenge in low- and middle-income countries. Primary health care workers are key patient navi- gators through specialized care referral systems. Understanding their per- spectives on childhood cancer is critical in improving access to care. METHODS A cross-sectional study was conducted from January to June 2023 in Bungoma County, Kenya. The in-charges of 144 level 2 and 3 facilities completed a semistructured questionnaire on childhood cancer perspectives, traditional, complementary, and alternative medicine (TCAM), referral barriers, and health insurance. Descriptive statistical analysis was performed. For baseline data, frequency distributions were calculated. Mann-Whitney test, chi-square test, and Fisher’s exact test were performed for comparisons of perspectives and health beliefs. RESULTS Of 144 facilities, 125 (86%) were level 2 and 19 (13%) were level 3. Only 14% of the facilities offered full insurance from the National Health Insurance Fund. Most in-charges believed that cancer was caused by chemical exposure (98%) or maternal drug use (90%), whereas 25% cited supernatural causes. Financial barriers were the main obstacle to accessing childhood cancer care (90%), with 69% believing that families could not afford health insurance. TCAM use was common, with 50% of respondents supporting its combination with chemo- therapy. The participants concluded that referral barriers included financial constraints, lack of insurance, and family fears. CONCLUSION We found that delays in childhood cancer care in Western Kenya arises from a combination of provider misconceptions, culturally embedded TCAM use, rigid referral systems, financial inadequacy, lack of insurance, and family fears and beliefs. This study contributes uniquely by focusing on primary health care facility in-charges, whose perspectives directly shape the navigation pathway through the referral system