National Cancer Control Plan of Ethiopia

Objectives

Ethiopia’s Integrated National Cancer Control Plan 2025–2029 provides a national, people-centred framework to reduce cancer incidence, morbidity and mortality, improve survival and quality of life, and reduce the preventable cancer burden through equitable, evidence-based use of available resources.[1][2]It builds on earlier national cancer-control plans and aligns cancer action with the Health Sector Transformation Plan, the Essential Health Benefit Package, non-communicable disease priorities and the Sustainable Development Goals.[3][4][5]The vision is an Ethiopia free from the preventable burden of cancer, and the mission is to reduce cancer-related morbidity and mortality through nationwide collaboration and strengthened prevention, diagnosis, treatment and care capacity.[1]

• Reduce premature cancer mortality by 15% by 2029.[1]
• Prioritise breast cancer management, cervical cancer screening and treatment, childhood and adolescent cancer control, and other cancers, including colorectal, prostate, liver, lung and haematological cancers.[6][7][8][9]
• Apply five interconnected pillars: prevention; early detection and recognition; diagnosis and treatment; psychosocial support and survivorship; and supportive and palliative care.[10][6]
• Prevent cancer by reducing tobacco and harmful alcohol use, improving diet and physical activity, expanding vaccination, addressing infection-related, environmental and occupational risks, and strengthening public awareness.[11][12][13][14]
• Expand early detection through breast and cervical screening, timely referral and linkage to care, with targets to screen 70% of eligible women aged 30–49 for cervical cancer and identify 60% of breast cancers at stages I and II.[15][16]
• Improve diagnosis, treatment, survivorship, rehabilitation and end-of-life care through multidisciplinary, patient-centred services that are timely, accurate, accessible, comprehensive and affordable.[17][2][18]
• Increase childhood cancer survival to at least 60% by 2029, while strengthening early recognition, referral, diagnosis, treatment, supportive care and long-term follow-up.[19][20]
• Strengthen cancer surveillance, registries, research, partnerships, community participation, innovation, accountability and integration across the health system.[1]

Implementation

Implementation uses an integrated, multisectoral and phased health-system approach spanning prevention, screening, diagnosis, treatment, rehabilitation, survivorship and palliative care.[7][21][22]Services are intended to be delivered through Ethiopia’s three-tier health system, with interventions assigned according to facility capability and increased integration into primary healthcare, reproductive health, family planning, HIV, immunisation and broader non-communicable disease programmes.[23][18][21]The approach combines decentralised service expansion, task-sharing, workforce development, digital health, referral networks, quality assurance, community engagement and partnerships to improve access, particularly for underserved populations.[5][23][20][24]

• Lead national policy, planning, coordination, technical support, capacity-building, partnership development and plan dissemination through the Federal Ministry of Health, including its Disease Prevention and Control Lead Executive Office, Non-Communicable Disease Desk and National Cancer Control Program.[4][9][25]
• Coordinate implementation through Regional Health Bureaux, health facilities, universities, professional associations, civil-society organisations, patient groups, communities, development partners, private-sector actors and international agencies.[26][27][25]
• Strengthen governance through national technical working groups, a re-established National Cancer Control Committee, regional cancer-control programmes and multisectoral coordination mechanisms.[28][18][25]
• Deliver prevention through legislation and regulation, health promotion, school and workplace action, smoking-cessation services, routine Hepatitis B vaccination, human papillomavirus vaccination, infection control and culturally tailored public information.[11][29][12]
• Expand screening and early diagnosis through trained primary-care and health-extension workers, clinical breast examination, human papillomavirus DNA testing, visual inspection with acetic acid where appropriate, self-sampling in underserved areas, screening data systems and patient navigation.[30][31][32]
• Strengthen referral, diagnostic and treatment pathways through imaging, pathology, laboratory medicine, specimen tracking, tele-radiology, telepathology, telemedicine, electronic oncology systems and multidisciplinary teams.[30][20][33][24]
• Expand oncology capacity through comprehensive cancer centres, regional chemotherapy services, radiotherapy and brachytherapy, specialised childhood cancer centres and satellite clinics, reliable medicines and blood products, and strengthened palliative, rehabilitation and psychosocial care.[34][35][22][36]
• Build the workforce through pre-service education, continuing professional development, fellowships, accreditation, competency standards, mentorship and regional sharing of specialist expertise.[30][33][24]
• Monitor implementation through the Ministry of Health monitoring, evaluation, accountability and learning framework, routine supervision, a mid-term review in years 2–3, an end-term review, annual monitoring against predefined targets, and cancer registries covering incidence, treatment, outcomes and survival.[9][25][37]
• Strengthen evidence and accountability by integrating cancer information into District Health Information Software 2, linking screening and registry data, establishing population-based and facility-based registries, and using service, referral and quality data to guide resource allocation and programme improvement.[30][18][21][38]

Monitoring & Evaluation

The plan establishes a Monitoring, Evaluation, Accountability and Learning framework combining routine programme oversight, periodic review, cancer surveillance, registries, service data and trackable targets. Monitoring is intended to inform implementation improvements, resource allocation, policy development and accountability across the 2025–2029 cancer-control programme.[25][37][18]

• Integrate monitoring and evaluation into the Ministry of Health’s existing framework, using a formative programme-monitoring tool and routine supervisory visits.[37]
• Conduct a mid-term review during years 2–3 and an end-term review to assess progress, effectiveness, overall success and impact, and use findings to improve implementation.[37]
• Undertake annual monitoring and evaluation against predefined targets, with National Technical Working Groups tracking implementation, identifying gaps and contributing to reviews.[9][28]
• Strengthen accountability through federal and decentralised coordination, performance monitoring, challenge resolution and reporting to the Federal Ministry of Health and international partners.[28]
• Maintain population-based and facility-based cancer registries in comprehensive cancer centres, covering incidence, treatment, outcomes and survival.[37]
• Strengthen surveillance by institutionalising cancer registration within Ministry of Health structures, expanding Addis Ababa registry coverage, using all relevant data sources and establishing sentinel population-based registries in four regions.[21]
• Link population-based registries, cancer surveillance and service statistics to the District Health Information Software 2 platform to support Ministry of Health planning and decision-making.[18]
• Improve data quality and patient follow-up through unique patient identifiers, linked screening, laboratory and hospital databases, registry-facility interaction, more frequent data-collection visits and dissemination of registry reports.[21][38]
• Monitor risk-factor prevalence and health-promotion activities regularly, including tobacco, alcohol, diet, physical activity, overweight and obesity, vaccination coverage and other non-communicable disease indicators.[11][13][14][21][39]
• Track early detection, including cervical screening coverage among eligible women, breast cancers diagnosed at stages I and II, diagnostic turnaround times, referral completion, loss to follow-up and health-worker training.[30][40][16][41][42]
• Monitor breast-cancer diagnosis and treatment through stage at diagnosis, referral of late-stage cases, diagnostic completion within 60 days, treatment progress, side effects, adherence, patient navigation and patient feedback.[43][44][45]
• Use cervical screening and treatment reporting, timely human papillomavirus test results and follow-up systems for women with positive findings.[31][32]
• Establish a national cancer screening data repository and integrate screening data into the District Health Information System 2 for longitudinal tracking.[30]
• Establish a national childhood cancer registry and monitor awareness, community recognition, referral, diagnosis, treatment initiation, survival, supportive care and long-term follow-up for childhood cancer.[30][17][19][46]
• Monitor treatment coverage, oncology commodity stock-outs, survivorship and rehabilitation services, quality assurance, accreditation, certification, audits and post-market surveillance.[20][33][24][47][48][49]
• Track the proportion of cancer-treating centres promptly diagnosing and treating specified other cancers, increasing from a baseline of 17% in 2025 to 100% in 2029, with annual milestones of 26% in 2026, 40% in 2027 and 62% in 2028.[37]

Although the plan includes indicators, targets, registries, routine supervision and scheduled reviews, the supplied material does not provide a complete consolidated indicator framework, full indicator definitions, data ownership arrangements, reporting templates, evaluation methodology or detailed reporting frequencies beyond annual monitoring and the specified review points.[9][28][37][21][38]

Costing & Financing

The plan recognises cancer control as resource-intensive and calls for sustainable financing, cost-effective prioritisation, resource mobilisation and financial protection, but the supplied material does not provide a total 2025–2029 budget, programme-level allocations, quantified financing gap or comprehensive economic assumptions.[5][50][23][1]

• Prioritise interventions according to disease burden, equity, feasibility, implementation effectiveness, service availability and cost-effectiveness.[34][4][7]
• Develop a cancer-control resource-mobilisation strategy covering existing and potential donors, development partners, private-sector sources, partnerships and national advocacy.[50]
• Increase and sustain financing for screening, and use cost-effectiveness and cost-benefit analysis to support investment decisions.[50]
• Formulate funding frameworks and secure funding and technical support from international donors and partners through the Federal Ministry of Health.[28]
• Mobilise and allocate regional financial resources for cancer prevention and control through regional governments and Regional Health Bureaux.[25]
• Use mixed health-system financing. In 2019/2020, donors contributed 33.9% of total health financing, government contributed 32.2%, and household out-of-pocket payments contributed 30.5%.[26]
• Recognise that non-communicable diseases account for about one-quarter of total health expenditure, while gaps in publicly available services leave insured households facing out-of-pocket costs for services, medicines and health products.[5]
• Use community-based health insurance as a financial-protection mechanism; its reported annual cost per family is 921 Ethiopian Birr.[5]
• Consider tobacco and alcohol taxation as a potential cancer-control financing source. Cigarette tax increased from 33% to 54% of the average retail price under legislation implemented in February 2020, but tobacco-tax revenue is not earmarked for non-communicable disease or cancer control.[5][27][18]
• Establish a dedicated Ministry of Health budget line for cancer registration and surveillance, and absorb Addis Ababa registry staff into Ministry of Health structures as a long-term sustainability measure.[21]
• Budget for long-term equipment service agreements or warranties when procuring imaging equipment, to reduce downtime.[38]
• Mobilise resources for medicines, diagnostics, treatment equipment, specialised staff, training, screening scale-up, radiotherapy, palliative care, rehabilitation and service expansion, including through public-private partnerships.[38][22][36]
• Develop and cost a rehabilitation-services package, and assess the economic feasibility of integrating childhood cancer care into universal health coverage.[22][36][51]

Financial constraints identified include high patient costs, limited public cancer services, underfinanced infrastructure, uncertain long-term funding, donor dependence for some registry activities, and insufficient technical and financial resources at national and regional levels.[52][5][50][23][27]