Plan National De Lutte Contre Le Cancer (PNLCC) 2018-2022

Objectives

The National Cancer Control Plan for 2018–2022 seeks to reduce cancer mortality, morbidity and associated social burden, improve quality of life during and after treatment, and move towards a Mauritania where cancer is no longer a major public-health problem. It applies a multisectoral, multidisciplinary framework adapted to national socioeconomic and cultural conditions.[1][2][3]

• Organise cancer control across five intervention areas: primary prevention; screening and early diagnosis; cancer management including palliative care; training, research and epidemiological surveillance; and programme coordination, advocacy and management.[1][4]
• Reduce preventable cancer risks by tackling tobacco use, unhealthy diets, overweight and obesity, physical inactivity, environmental and occupational carcinogens, hepatitis B, human papillomavirus, sexually transmitted infections, parasites and aflatoxins.[5][6][7]
• Increase public awareness and access to information on cancer, promote behaviour change, and improve public perceptions of cancer through community mobilisation and communication activities.[4][7][8]
• Strengthen screening and early diagnosis, particularly for cervical and breast cancer, while promoting early detection of prostate, colorectal, childhood and other priority cancers.[9][4][8]
• Improve diagnosis, treatment and continuity of care through stronger pathology, imaging, radiotherapy, surgery, systemic treatment, clinical protocols and quality assurance.[10][11][12]
• Expand comprehensive palliative care, pain management, psychosocial support, home-based care and support for patients and families.[13][14][15]
• Develop cancer surveillance, operational research and epidemiological evidence through a national cancer registry, hospital registries and research across clinical, biological, health-system and social-science fields.[3][16][17]
• Meet quantified targets that include reducing cancer mortality by 15%, reducing tobacco-use prevalence by 30%, sensitising half the population on physical activity and unhealthy diets, and detecting and managing more than half of precancerous lesions and early breast and cervical cancers.[3][4]

Implementation

Delivery is intended to combine national leadership with decentralised, integrated services, using prevention, screening, diagnosis, treatment, palliative care, surveillance and advocacy. The Ministry of Health, through the Directorate for Disease Control and the national non-communicable disease framework, is expected to coordinate implementation with health facilities, the National Oncology Centre, regional structures, professional bodies, civil society and international partners.[1][18][17]

• Use the National Oncology Centre as the principal specialist treatment platform, while extending screening, referral, diagnostic and treatment capacity beyond Nouakchott through regional facilities, mobile screening and consultations across wilayas.[1][19][9][10]
• Implement cervical cancer screen-and-treat services using visual inspection with acetic acid or Lugol’s solution, cryotherapy or thermocoagulation, with loop electrosurgical excision for higher-grade lesions at regional hospitals.[9][20][8]
• Strengthen the workforce through basic and continuing training in tumour assessment, biopsy, pathology, diagnosis, referral, oncology, palliative care, administration and multidisciplinary practice.[20][10][15][16]
• Develop integrated diagnostic and treatment pathways through management algorithms, standardised protocols, multidisciplinary meetings, referral and counter-referral networks, complete patient records and systematic equipment maintenance.[10][21][11][12]
• Expand palliative care through affordable medicines and consumables, appropriate medical use of morphine, dedicated palliative-care units, multidisciplinary support teams, professional and volunteer training, family accommodation and a patient telephone helpline.[22][13][14][15]
• Establish and institutionalise a population-based national cancer registry, supported by ministerial regulation, a management team, trained staff, dedicated premises, equipment, operating resources and focal points in referral facilities.[22][16][17]
• Operate hospital cancer registries in every cancer-care facility, analyse and disseminate registry data annually, and use the results to assess incidence, trends, survival, geographical distribution, risk factors, service needs and intervention effects.[16][17]
• Govern implementation through a Technical Steering Committee, thematic groups and decentralised structures, using dashboards, component-specific monitoring forms, regular institutional meetings and action plans.[23][24][25]
• Monitor prevention, early detection, care, training, research, surveillance, coordination and advocacy through indicators covering risk-factor prevalence, laws adopted, screening and vaccination activities, trained personnel, protocols, medicine availability, radiotherapy access, functioning registries, research outputs and resources mobilised.[23][24]
• Mobilise resources through political commitment, international cooperation, partnerships, public-private purchasing arrangements, support for civil-society organisations and a proposed cancer-research support fund; no total programme budget or quantified financing allocation is specified.[4][16][17]

Monitoring & Evaluation

The plan establishes monitoring and evaluation as a core implementation function, combining performance indicators, routine follow-up, annual evaluation, cancer surveillance, service-quality monitoring and decentralised reporting arrangements.[1][2]It aims to use cancer information to guide prevention, early detection, diagnosis, treatment, palliative care, training, research, coordination and advocacy.[3][23]

• Establish and institutionalise a population-based national cancer registry, supported by hospital registries in cancer-care facilities, trained personnel, dedicated premises, equipment, operating resources and focal points in referral structures.[22][16][17]
• Collect, archive, analyse and disseminate registry data annually to measure cancer incidence, trends, geographical distribution, survival, disease evolution, risk factors and service needs, and to assess preventive and curative interventions.[16][17]
• Integrate cancer information systems with the national non-communicable disease monitoring and evaluation system and strengthen data collection, collaboration and epidemiological capacity.[16][26]
• Develop activity-and-indicator dashboards through the steering team and relevant directorate, establish comparable mechanisms in decentralised structures, complete component-specific monitoring forms regularly at every level, and use action plans and institutional meetings to track implementation.[23]
• Use cancer-registry data to monitor temporal and geographical patterns and assess medium-term impacts over 10 years and long-term impacts over 10 to 20 years.[23]
• Complement routine surveillance with observational studies, including case-control and cohort studies, and knowledge, attitudes and practices surveys to assess strategy effectiveness and information, education and communication activities.[23][16][17]
• Monitor primary prevention through tobacco use, obesity, overweight, unhealthy diets, carcinogen exposure and the adoption of laws and regulations.[23]
• Monitor early detection through screening campaigns, awareness sessions and media messages, awareness materials, vaccination campaigns for hepatitis B and human papillomavirus, strengthened services and trained health workers.[23]
• Monitor diagnostic, treatment and palliative-care quality through management of precancerous lesions, use of protocols, medicine availability, access to radiotherapy, availability of specialists, training modules and palliative-care units.[23][24]
• Monitor training, research, surveillance, coordination and advocacy through functional registries, people trained, completed and funded research, research-coordination arrangements, stakeholder commitment, resources mobilised and improved coordination.[24]
• Establish monitoring and evaluation of patients’ diagnostic and therapeutic care, supported by quality assurance across all treatment modalities, multidisciplinary meetings, clinical standards and referral and counter-referral systems.[12][15]

Quantified programme targets include reducing cancer mortality by 15%, reducing tobacco-use prevalence by 30%, sensitising half the population about physical activity and unhealthy diets, and screening and promptly managing more than half of precancerous lesions and early cervical and breast cancers.[3]Additional targets cover training health personnel, standards-based treatment, cure rates, breast self-examination awareness, mammography awareness and lifetime cervical screening.[4]Baseline evidence includes a 2016 study recording 1,115 new cancer cases and 112 deaths, while a 2008 STEPS survey reported high levels of insufficient physical activity, tobacco use, overweight and obesity.[27][5]

Implementation weaknesses include a registry that has not yet been institutionalised, lacks dedicated data-collection and data-entry staff, premises, logistics and financial support, and is affected by insufficient data collection and professional collaboration.[28][22]Existing awareness and screening activities are not consistently coordinated or documented, and patient follow-up is short, with many people lost to follow-up.[29]Although the plan specifies annual registry-data dissemination and broad monitoring mechanisms, it does not provide a fully detailed indicator-definition framework, comprehensive reporting timetable, evaluation methodology or clearly assigned formal accountability responsibilities.[16][17]

Costing & Financing

The plan identifies substantial resource needs for cancer surveillance, prevention, screening, diagnosis, treatment, radiotherapy, palliative care, training, research, medicine supply and quality assurance, but it does not provide a consolidated programme budget, detailed costed workplan, financing allocations, quantified funding gap or economic assumptions.[3][11][16]

• Provide a dedicated operating budget for the national cancer registry, including premises, equipment, trained staff, data systems and focal points, as the absence of a dedicated budget line is identified as a threat to surveillance.[22]
• Mobilise human, financial and material resources through advocacy, partner engagement, international cooperation, financial support for relevant non-governmental organisations and a proposed cancer-research support fund.[6][4][16][17]
• Develop public-private partnerships for purchasing services and engage the National Health Insurance Fund and social-affairs services among potential support structures.[13][16]
• Invest in imaging, radiotherapy, pathology, diagnostic platforms, equipment maintenance, trained personnel and decentralised cancer services, without quantified investment requirements.[10][21]
• Improve affordable access to anticancer, supportive and palliative-care medicines and consumables, while addressing frequent supply interruptions, high morphine prices and inadequate maintenance.[29][13][12]

Historical expenditure illustrates the financial burden of overseas treatment: in 2008, estimated oncology evacuations cost 1.5 billion Ouguiyas, also reported as 4 million Euros.[30]The National Oncology Centre has enabled local cancer treatment free of charge since 2009, reducing the need for referrals abroad.[1]Reported service financing included care for indigent patients and National Health Insurance Fund coverage, but the source does not provide a complete financing structure or value for these arrangements.[19]

Early-detection examinations for liver, prostate and thyroid cancers are described as prohibitively costly, while the resource gap affecting the registry includes missing logistical and financial support.[28][9][10]No monetary value is supplied for required infrastructure, medicines, maintenance, training, research, palliative care, public-private partnerships or international financial assistance.[13][4][16]