National Cancer Prevention and Control Plan

Objectives

The National Cancer Prevention and Control Plan provides Morocco with a comprehensive, equity-oriented framework to reduce cancer incidence, morbidity and mortality, improve quality of life for patients and families, and ensure more impartial and accessible care. It promotes targeted, sustainable action adapted to national resources and socio-cultural context, founded on equity, solidarity, quality, excellence and cancer patients’ rights.[1][2][3]

• Reduce avoidable cancer risks through tobacco control, healthier diets, physical activity, obesity and alcohol reduction, infection prevention, vaccination, occupational protection, environmental-risk control and consumer protection.[4][5][6][7]
• Strengthen surveillance of cancer incidence, mortality and behavioural, occupational and environmental risk factors, alongside research on prevention, care and population needs.[7][8]
• Prioritise organised early detection of breast and cervical cancer, supported by public awareness, accessible screening, diagnostic confirmation, quality assurance and reduced financial barriers.[8][9][10]
• Improve diagnosis and therapeutic management through specialised infrastructure, medicines access, national clinical references, quality standards, trained staff and coordinated services across three levels of care.[11][12][13]
• Extend palliative care to prevent and alleviate physical, psychological, social and spiritual suffering, while strengthening pain management, family support and patients’ rights.[14][15][16]
• Support cancer control through communication, social mobilisation, legislation and regulation, training, research and social support.[3][17]

Implementation

Implementation combines multisectoral prevention with a tiered health-service model, coordinated planning, civil-society participation, regulatory action, workforce development, information systems and monitoring. The plan was prepared by the Lalla Salma Association against Cancer and validated through a steering committee and a joint Association-Ministry of Health committee, with an ad hoc commission established for follow-up and monitoring.[2][18]

• Mobilise the Ministry of Health, the Lalla Salma Association against Cancer, civil-society organisations, health professionals, public and private providers, education and environmental bodies, occupational settings, communities and other relevant sectors.[2][6][15][16]
• Deliver prevention through public campaigns, school curricula, targeted education, smoking-cessation services, tobacco taxation and regulation, healthy-lifestyle programmes, vaccination, workplace measures and environmental controls.[4][5][6][7]
• Integrate early detection into health services by using primary care and general-practitioner settings for screening and referral, provincial and private facilities for diagnostic confirmation, and university, regional and private oncology centres for multidisciplinary management and follow-up.[9]
• Organise cancer care across three levels: level 1 for information, detection, referral and follow-up; level 2 for diagnostic confirmation and principal treatment capacity; and level 3 for specialised management, training and research.[11][19][20][21]
• Develop oncology infrastructure, including regional and proximity oncology centres, specialised oncogynaecology and paediatric haemato-oncology services, radiotherapy capacity, pathology and laboratory services, chemotherapy day hospitals and supportive-care resources.[12]
• Improve treatment continuity through multidisciplinary consultation, standardised cancer records, referral communication networks, appointments arranged before referral, traceable treatment decisions and shared follow-up information between public and private providers.[13][20]
• Expand palliative care through a three-level network of reference, proximity and primary-care centres, using residential units, hospital and primary-care outreach teams, home care, respite admissions, family support and community participation.[15][16]
• Apply quality assurance and monitoring through written standards, audits, accreditation, care-level indicators, cancer and hospital registers, mortality-data improvements, standardised information collection and programme reviews.[7][10][13]
• Train multidisciplinary clinical, technical, supportive and administrative teams through initial, specialist and continuing education tailored to service level and workload.[20][21][14]
• Use annual cost tables for programme activities, including prevention and palliative care. The prevention subtotal is 578,700 thousand Moroccan dirhams, while the palliative-care total is 86,000 thousand Moroccan dirhams.[22][23]

Monitoring & Evaluation

The plan establishes monitoring and evaluation as a cross-cutting function for prevention, early detection, diagnosis and treatment, palliative care and programme implementation. It combines cancer and risk-factor surveillance, service-quality assessment, patient follow-up, information systems, research and institutional follow-up arrangements, although many excerpts do not define a unified reporting timetable, consolidated targets or plan-wide accountability framework.[24][7][25][23]

• Maintain follow-up through an ad hoc commission established during plan development, alongside validation by the steering committee and the joint committee of the Ministry of Health and Association Lalla Salma against Cancer.[2][18]
• Strengthen cancer surveillance by institutionalising the Grand-Casablanca-Region population cancer register, establishing hospital registers in public and private oncology units, processing data through the Regional Health Observatory, and considering a second population register in another region.[7]
• Improve mortality surveillance by training physicians in death-certificate completion, checking certificate quality and linking cancer and mortality registers.[7]
• Monitor occupational, behavioural and environmental risks through workplace exposure records, regular prevalence studies, reporting by exposed people, centralised surveillance and knowledge, attitudes and practices studies.[7]
• Oversee tobacco control through a proposed multisectoral body responsible for tobacco-consumption surveillance and monitoring and evaluation of tobacco-control activities.[4][5][26]
• Apply quality assurance to early detection through written standards, systematic audits, accreditation, computerised information collection, stakeholder feedback and periodic external reviews.[10]
• Measure early-detection performance using quantitative and qualitative indicators covering tests, examinations, treatments, compliance with procedures and timelines, patient satisfaction and cost evolution.[10]
• Track diagnostic and therapeutic management through indicators at each care level, including delays from consultation to diagnosis and treatment, treatment adherence and interval compliance, loss to follow-up, diagnosed and treated cases relative to expected caseload, and patient satisfaction.[13]
• Ensure traceability through standardised cancer records, patient follow-up notebooks, documented multidisciplinary decisions and an activities-management information system recording diagnosed and treated cases, severe adverse events and major quality indicators.[13][14]
• Maintain palliative-care records and information systems for monitoring, evaluation and traceability, supported by research on need, protocols, care practices, stakeholder needs, morphine requirements and medico-economic issues.[15][16]

Important evidence gaps remain. The source identifies limited historic follow-up, with follow-up of under two years for 74% of cases and five-year loss to follow-up of 96%, preventing reliable five-year survival estimation.[27]Several excerpts specify no detailed indicator definitions, reporting schedules, evaluation methodologies, numerical targets or named bodies accountable for overall implementation.[8][11][21][25]

Costing & Financing

The plan recognises cancer care as financially burdensome for households and includes provisional costing tables for 2010–2019, but the supplied excerpts do not identify funding sources, financing commitments, resource-mobilisation arrangements, funding gaps or a complete economic framework.[24][26][22][28]

• Recognise that cancer management entails high costs, that more than two-thirds of the population lack medical coverage, and that patients can bear up to 90% of costs for certain cancers.[2]
• Address affordability through prevention, which is characterised as economically efficient in the long term, and through measures to reduce barriers to diagnosis, treatment and anticancer medicines.[3][17][10][12]
• Improve medicine affordability by promoting generic medicines, reducing sale prices, coordinating purchasing, revising distribution margins and medicine-price calculations, and encouraging local manufacture.[12][13]
• Assess prevention through research on the cost-benefit ratio of prevention measures; assess early detection through periodic review of test cost and cost evolution.[8][10]
• Provide resources for infrastructure, specialised equipment, workforce development, information systems, home and facility-based palliative care, transport and social support, although no unit costs or financing allocations are specified for these inputs in most excerpts.[12][21][14][16]
• Include prevention cost tables showing a total of 510,000 and a prevention subtotal of 578,700 thousand Moroccan dirhams, alongside annual cost totals for 2010–2019.[26][29][22]
• Include palliative-care table totals of 86,000 thousand Moroccan dirhams, comprising listed component totals of 5,000, 6,000 and 75,000 thousand Moroccan dirhams.[23]
• Present additional programme-table totals of 11,000, 79,000, 60,000 and 150,000, and an overall table figure of 8,197,700, but the excerpts do not clearly identify their units or relationship to the other totals.[28]

Palliative-care financing provisions include seeking reimbursement of home-care fees, paid transport between hospitals and patients’ homes, and pricing palliative care equivalently to intensive care.[15][16]The source does not provide an overall confirmed programme budget, a financing envelope by institution, or quantified unmet funding requirements.[24][28]