Endowment Funds Can Revolutionise Sarcoma Care in Developing Countries

Despite global childhood cancer mortality rates dropping by half over the past 50 years, these promising statistics do not extend to Africa and the Global South, where limited resources mean that most cancers are diagnosed at advanced stages. Consequently, the region reports survival rates of as low as 15% for musculoskeletal sarcomas, a group of […]

Kaposi's sarcoma virus. The World Health Organization predicts a 60% rise in global cancer cases over the next two decades, with an 81% increase expected in low- and middle-income countries. Credit: Shutterstock.

By Nicholas Okumu
NAIROBI, Apr 2 2024 (IPS)

Despite global childhood cancer mortality rates dropping by half over the past 50 years, these promising statistics do not extend to Africa and the Global South, where limited resources mean that most cancers are diagnosed at advanced stages.

Consequently, the region reports survival rates of as low as 15% for musculoskeletal sarcomas, a group of cancers that develop in the bones and soft tissues of the body, when it has spread to other areas of the body from the original location.

Worse still, the World Health Organization predicts a 60% rise in global cancer cases over the next two decades, with an 81% increase expected in low- and middle-income countries (LMICs). As a doctor specialising in the treatment of cancer, I am confronted daily with the realities of cancer care disparities.

Consider, additionally, that LMICs have historically concentrated their limited healthcare resources on combating infectious diseases and improving maternal and child health, which formed the bulk of the disease burden. This focus has left healthcare systems unprepared to confront the growing burden of cancer.

In 2019, over 90% of high-income countries reported comprehensive cancer treatment services readily available in their public health systems, compared to a mere 15% in low-income countries. This underscores the need for solutions that bridge the gap in cancer care quality

The infrastructure gap is undeniable. In 2019, over 90% of high-income countries reported comprehensive cancer treatment services readily available in their public health systems, compared to a mere 15% in low-income countries. This underscores the need for solutions that bridge the gap in cancer care quality.

Each patient’s story is a vivid illustration of the profound inequities in our global healthcare system.

Endowment funds offer a sustainable way to radically enhance cancer care in under-resourced regions. These funds are an investment portfolio that draws its initial capital from donations and thereafter—when managed effectively—becomes interminable.

The aim is to create a financial foundation that supports a wide array of initiatives, including research, treatment, training, and infrastructural development, making equitable, high-quality care a reality for all.

Examples can be drawn from the Aga Khan University Faculty of Health Sciences Endowment and the more famous Harvard Endowment. A large corpus of capital is invested, and the returns generated from that investment are then used to fund initiatives the endowment supports perpetually.

The Aga Khan endowment, valued at approximately USD 63 million (PKR 1,151,195,960), supports academic posts, student scholarships, research, and patient welfare, ensuring long-term financial security for the university.

Unlike project-based funding, endowment funds provide a steady income stream, ensuring long-term support for crucial healthcare initiatives.

This financial stability empowers healthcare institutions to develop a resilient healthcare ecosystem, addressing immediate needs such as awareness campaigns and long-term goals, including specialist training programs.

Additionally, endowment funds shift control from donor preferences to a targeted approach, as every dollar invested is directed towards initiatives with the most significant potential; therefore maximising the impact.

Furthermore, through careful investment strategies, the corpus of the fund can grow over time, creating a perpetual source of funding for sarcoma care.

This financial sustainability is particularly important for a chronic disease like sarcoma, where the need for funding is constant.
The Kenya Cancer Policy 2019-2030 outlines a comprehensive strategy to address cancer control in Kenya.

However, a significant funding gap of USD 399,991,000 over the next five years poses a challenge. Sarcomas represent approximately 5% of this funding requirement.

Therefore, a Kenya Sarcoma Trust is envisaged to fill the staggering funding gap, estimated at $19.9 million over the next five years or 3.9 million dollars annually.

By establishing an endowment fund of 39.4 million US dollars dedicated explicitly to sarcoma care and research, the trust aims to bridge the gap in sarcoma care experienced in Kenya.

This model can be a precedent for how niche healthcare areas can be sustainably funded, empowering healthcare institutions to enact systemic changes and improve patient outcomes. Endowment funds can be diversified to support a broader range of healthcare initiatives in the future, but for now, tackling the significant burden of sarcoma is a crucial first step.

Endowment funds represent a powerful form of innovative financing for healthcare in LMICs. They attract private sector investment and create a sustainable funding stream, aligning with recommendations from organisations urging increased private sector participation in health financing for these countries.

This will form a considerable part of their corporate social responsibility/shared value and provide a new avenue for funding development as traditional donors grapple with dwindling resources.

While endowment funds offer a promising solution, some concerns merit discussion. Establishing a large endowment fund requires a significant upfront investment.

However, alternative fundraising strategies can be explored, such as phased approaches or targeted campaigns for wealthy individuals and organisations. Additionally, concerns about management expertise can be addressed by partnering with experienced financial institutions with a proven track record in managing endowment funds.

The long-term nature of endowment funds shouldn’t overshadow their potential for immediate impact. Strategic allocation of initial investment returns and securing bridge funding through other means can address current needs.

Finally, ethical considerations regarding a focus on specific diseases can be mitigated by using a similar model for other neglected diseases.

Endowment funds can be diversified to support a broader range of healthcare initiatives.

Transparency and accountability in managing the endowment fund are crucial to ensure public trust and continued support. Regulatory frameworks in developing countries must be adapted to facilitate the creation and management of endowment funds.

A collaborative effort is essential to bridge the cancer care gap. Governments, private sector leaders, philanthropic organisations, and high-net-worth individuals must unite to support the creation of well-managed, transparent endowment funds dedicated to cancer care in LMICs.

This innovative financing approach promises to make quality cancer treatment accessible to all, irrespective of geography, marking a step towards making hope a universal reality in the battle against cancer.

Dr. Nicholas Okumu is an orthopedic surgeon heading the orthopedic oncology unit at the Kenyatta National Hospital and formerly the head of the department of orthopedics at the same institution. He is the CEO of Stratus Medical Imaging Solutions, a private health care provider in Nairobi. He is a 2024 Global Surgery Advocacy fellow.