National Cancer Control Strategy 2011 - 2016

Objectives

Kenya’s National Cancer Control Strategy for 2011 to 2016 aims to establish an effective and efficient national cancer prevention and control programme, reduce cancer morbidity and mortality, and improve the quality of life of people affected by cancer.[1][2]Its mission is to improve community wellbeing by reducing the incidence and impact of cancer through efficient, evidence-based preventive, promotive, curative and palliative services accessible to all Kenyans.[3]

• Reduce cancer risk through primary prevention addressing tobacco use, unhealthy diets, physical inactivity, harmful alcohol use, environmental and occupational carcinogens, and cancer-causing infections.[4][5]
• Increase early detection through public and professional awareness, screening guidance, screening capacity and integration with existing health programmes.[6][7]
• Improve diagnosis, referral, treatment and rehabilitation through equipped facilities, clinical guidance, multidisciplinary care, essential medicines and specialist capacity.[8][9][10]
• Expand supportive, community-based and home-based palliative care, pain relief and social support for patients, families, children and other special groups.[11][12]
• Strengthen cancer surveillance, registration, research, information dissemination, partnerships, legislation and coordination across national health and socio-economic plans.[3][13]

The strategy applies principles of ownership, leadership, fairness, equity, accessibility, partnership, accountability, integration, sustainability, evidence-based practice, gender sensitivity and respect for religious and cultural diversity.[2][4]It seeks equitable population coverage and efficient use of limited resources across the cancer-control continuum.[3]

• Reduce tobacco smoking prevalence by 5% by 2016.[4]
• Reduce overweight and obesity prevalence by 2% by 2016 and increase fruit and vegetable consumption by 5% by 2016.[4]
• Promote physical activity, reduce harmful alcohol use, reduce exposure to carcinogens and reduce the burden of cancer-causing infections.[4][5]
• Establish and strengthen national and regional cancer registries, a national cancer data collection and processing centre, and a cancer research database.[12][14]

Implementation

Implementation is designed as an integrated, systematic, equitable and evidence-based programme spanning prevention, screening, diagnosis, treatment, supportive care, palliation, surveillance and research.[15][3]It builds on existing health-system structures, mobilises additional resources and relies on multi-sectoral, multi-disciplinary participation by government, health professionals, communities, patients, civil society, development partners, universities and private-sector providers.[1][15]

• Coordinate national action through the Ministries of Health and the Division of Non-Communicable Diseases, with a strengthened national cancer control programme and taskforce, strategy implementation teams, and advocacy for a statutory National Cancer Institute or comparable central coordinating institution.[16][17][14]
• Engage named partners including Kenyatta National Hospital, Kenya Medical Research Institute, the World Health Organization Kenya Country Office, universities, provincial and regional hospitals, Kenya Hospice and Palliative Care Association, Kenya Network of Cancer Organisations, the Kenya Medical Supplies Authority, insurers and the International Atomic Energy Agency.[18][9][10][19]
• Integrate prevention into reproductive health, HIV/AIDS, occupational and environmental health, community, school and workplace programmes.[4][5]
• Strengthen tobacco legislation, smoke-free environments, cessation services, school health education, healthy-diet guidance, active living, alcohol-control measures and protection from asbestos, radiation, toxic waste and workplace exposures.[4][20][21]
• Prevent infection-related cancers through health promotion, safer sexual behaviour, targeted screening, vaccination advocacy, early detection and treatment for infections including hepatitis B and C, Human Papillomavirus, Human Immunodeficiency Virus and Helicobacter pylori.[5][6]

Service delivery actions include developing screening and referral guidelines, strengthening laboratories and institutional linkages, and improving patient transfer procedures.[6][7]Diagnostic capacity is to be assessed and expanded through 15 designated and equipped diagnostic centres, diagnostic consumables, equipment maintenance, standard operating procedures and training of at least 500 health-care workers.[10]Treatment infrastructure is to include an upgraded Kenyatta National Hospital cancer treatment centre, four regional centres and ten sub-regional centres, supported by quality-assurance guidance, multidisciplinary teams, essential-drug lists and reliable supplies.[9][10]

• Develop national training curricula, train at least 1,000 cancer health-care practitioners, deploy staff appropriately and establish training centres with national academic institutions.[19]
• Integrate palliative care into health services at all levels through legislation, guidelines, training, essential medicines, psychosocial and nutritional support, community services and home-based care.[11][19]
• Develop registry standards and tools, train cancer registrars using the World Health Organization curriculum, procure hardware and software, harmonise surveillance tools and establish a cancer surveillance database.[12][22]
• Conduct research situation analyses, set national priorities, strengthen research centres and partnerships, promote ethics and intellectual property rights, and translate findings into clinical practice, public health interventions and policy.[22][23]

Monitoring and evaluation are intended as management functions supported by a baseline cancer situational analysis, guidelines, tools and a national framework.[17]Monitoring includes screening coverage and referral performance, facility use of guidelines, equipment and staffing inventories, medicine stock-outs, trained personnel, palliative-care availability, registry outputs, annual cancer status reports and research publications.[7][9][10][19][22][23]The strategy calls for increased budgetary allocations, stakeholder and partner financing, grant-writing and financial-management guidance, and inclusion of cancer treatment and care in health-insurance schemes; it does not specify monetary budgets, funding gaps or costed allocations.[11][9][19][23]

Monitoring & Evaluation

The strategy establishes monitoring, evaluation, surveillance, cancer registration and research as core management functions for improving cancer prevention, diagnosis, treatment, palliative care and policy. It calls for continuous review of intervention progress and impact against planned timelines, supported by a baseline cancer situational analysis and a formal monitoring and evaluation framework, guidelines and tools.[2][17][14]

• Conduct routine, continuous cancer surveillance covering incidence, prevalence, mortality, diagnostic methods, stage distribution, survival and aspects of care received.[3]
• Establish and maintain a dedicated national cancer registry, strengthen existing registries, create regional registries, and develop a national cancer data collection and processing centre.[3][12]
• Develop and harmonise registry and surveillance tools, train registrars and surveillance personnel using the World Health Organization curriculum, procure data-system hardware and software, and establish a cancer surveillance database.[12][22]
• Strengthen data collation, analysis, dissemination and use, including annual cancer conferences and annual cancer status reports.[22]
• Monitor primary-prevention outcomes including tobacco smoking prevalence, overweight and obesity, fruit and vegetable consumption, physical activity, harmful alcohol use, aflatoxin exposure and awareness of cancer-related risks.[4][20][21]
• Measure progress towards reducing tobacco smoking prevalence by 5% by 2016, reducing overweight and obesity prevalence by 2% by 2016, and increasing fruit and vegetable consumption by 5% by 2016.[4][5]
• Track environmental and occupational carcinogen exposure through measurements in air, water and soil, workplace emissions records, post-exposure care, occupational cancer reports and radiation-protection enforcement reports.[21][24]
• Assess prevention of cancer-causing infections through community knowledge, attitudes and practices, strategy-review reports, and screening or vaccination coverage for human papillomavirus, human immunodeficiency virus and hepatitis B.[24]
• Evaluate early detection through facility use of screening guidelines, screening coverage and uptake, service capacity, workforce availability, programme integration, referral times and adherence to referral guidance.[7]
• Monitor diagnostic and treatment services using situational analyses, centre establishment and output, trained-worker numbers, stock-outs, protocol use, multidisciplinary teams, equipment functionality, quality-assurance reports and facility inventories.[9][10]
• Evaluate palliative care through the availability and use of guidance and curricula, trained providers, target-group awareness, relevant policy documents, facilities providing care, community programmes, support groups and services for special groups.[19][12]
• Assess research through priority-setting, research-centre outputs, publications, curriculum adoption, trained personnel, research-budget proportions, extra-budgetary support, fund-management reports and evidence of research use in policy and practice.[22][23]
• Support accountability through stakeholder participation, clearly defined roles and mandates, taskforce and implementation-team reports, database-use records, and records of institutions using monitoring and evaluation documents.[4][14]

The material identifies reports, indicators, annual conferences and institutional responsibilities, but does not provide a consolidated reporting schedule, detailed evaluation methodology or a fully specified accountability structure.[9][10][19][12][22][23]

Costing & Financing

Financing priorities centre on mobilising resources for comprehensive cancer control, particularly prevention, diagnosis, treatment, palliative care, surveillance and research. Primary prevention is presented as a cost-effective long-term approach, and approximately 40% of cancers are described as preventable through interventions addressing modifiable risks.[2][4]

• Advocate for increased government budgetary allocations for establishing the comprehensive cancer control programme, cancer diagnosis, treatment and cancer research.[11][9][23]
• Mobilise non-budgetary resources and financial support from stakeholders and partners for cancer diagnosis, treatment, programme implementation and research.[11][9][19][23]
• Integrate cancer prevention and control plans within health-sector plans and include cancer treatment and care in health-insurance schemes.[11][9]
• Develop grant-writing and financial-management guidance to strengthen mobilisation and administration of cancer research funds.[19][23]
• Allocate available resources appropriately across cancer-control activities and pursue equitable population coverage through efficient and cost-effective use of limited resources.[3]
• Invest in awareness, workforce capacity, equipment, medicines, diagnostic and treatment infrastructure, surveillance, registration, palliative care and research.[1][15][6][11]

Resource constraints include shortages of financial and human resources for palliative care, inadequate funding and training facilities for research, limited treatment infrastructure and weak health-system capacity.[15][3]No total programme budget, currency-denominated allocation, unit cost, funding-gap estimate, financing target or detailed economic assumption is provided in the supplied material.[11][9][19][12][22][23][14]