National Cancer Control Plan of Ethiopia

Objectives

The Integrated National Cancer Control Plan 2025–2029 provides Ethiopia’s national, evidence-based framework for reducing cancer incidence, morbidity and mortality, improving survival and quality of life, and ensuring equitable care across prevention, early detection, diagnosis, treatment, survivorship and end-of-life care.[1][2]Its vision is an Ethiopia free from the preventable burden of cancer; its mission is to reduce cancer-related morbidity and mortality through nationwide collaboration and strengthened capacity; and its headline goal is to reduce premature cancer mortality by 15% by 2029.[3]

• Apply an integrated cancer-care continuum comprising prevention, early detection and recognition, diagnosis and treatment, psychosocial support and survivorship, and supportive and palliative care.[4]
• Prioritise breast cancer management, cervical cancer screening and treatment, childhood and adolescent cancer control, and other cancers, including colorectal, prostate, non-Hodgkin lymphoma and liver cancers.[5]
• Reduce cancer risk through tobacco and alcohol control, healthier diets, physical activity, human papillomavirus vaccination, hepatitis B vaccination, infection control and action on environmental and occupational carcinogens.[6][7]
• Improve early diagnosis, timely referral and access to accurate, affordable, high-quality diagnostic and treatment services, with particular focus on breast, cervical and childhood cancers.[6][8]
• Strengthen cancer surveillance, cancer registries, research, partnerships, innovation and community engagement, while integrating cancer control into the National Health Sector Transformation Plan.[3]
• Apply principles of equity, accessibility, patient-centred care, evidence-based practice, leadership, accountability, sustainability, partnership and systematic integration.[3]

The plan aligns with the World Health Organization Global Strategy to Accelerate the Elimination of Cervical Cancer, the Global Breast Cancer Initiative, the Global Initiative for Childhood Cancer and the Global Initiative for Cancer Registry Development.[9]It references global targets including 90% human papillomavirus vaccination of eligible girls, 70% cervical screening coverage, 90% treatment coverage for cervical precancerous lesions or disease, early-stage diagnosis of 60% of breast cancers, completion of breast cancer diagnosis within 60 days, 80% completion of comprehensive breast cancer treatment, and at least 60% childhood cancer survival by 2030.[9]

Document-level objectives also include reducing tobacco use by 30% by 2029, reducing harmful alcohol use by 10%, reducing insufficient fruit and vegetable intake by 25%, reducing physical inactivity by 10%, and reducing overweight and obesity by at least 15%.[10][11]The plan seeks to establish prevention and childhood cancer early detection and referral within primary health care, reach at least 50% of the population with prevention information, screen 70% of eligible women aged 30–49 for cervical cancer, identify 60% of breast cancer cases at stages I and II, and train at least 50% of health workers on cancer.[8]

Implementation

Implementation uses a people-centred, multisectoral and health-system-wide model, linking community and primary-care prevention and early detection with diagnostic centres, specialised treatment facilities, rehabilitation, survivorship and palliative care.[5][12]National delivery is intended to be phased and adapted to Ethiopia’s cancer burden, resource landscape and service capacity, with prioritisation based on disease burden, equity, feasibility, implementation effectiveness and cost-effectiveness.[13]

• Lead national coordination through the Federal Ministry of Health, particularly its Disease Prevention and Control Lead Executive Office and Non-Communicable Disease Desk, with technical support from the National Technical Working Group.[6]
• Assign regional coordination and leadership to Regional Health Bureaux and deliver services through healthcare providers across primary, secondary and tertiary levels.[14]
• Re-establish the National Cancer Control Committee, chaired by the Minister of Health, to provide advisory oversight, while a Ministry of Health technical working group coordinates cancer-control activities and reports to the committee.[15]
• Engage government ministries, regulatory bodies, universities, professional associations, civil society organisations, patient groups, communities, development partners, private providers and international agencies in advocacy, regulation, training, financing, technical assistance and service delivery.[16]
• Integrate cancer services with reproductive health, family planning, HIV, immunisation and wider non-communicable disease programmes, particularly at primary-care level.[15]

Operational delivery includes expanding comprehensive cancer treatment centres, decentralising breast cancer chemotherapy, strengthening pathology, laboratory medicine, imaging, interventional radiology, radiotherapy, nuclear medicine, blood services, essential medicines and multidisciplinary oncology teams.[13][17]It also includes harmonised workforce training, pre-service education, mentorship, fellowships, accreditation, quality assurance and task-sharing to increase service capacity across care levels.[18][19]

For prevention and early detection, actions include routine, school-based and outreach vaccination; health promotion in schools, workplaces and communities; tobacco cessation; organised cervical screening using human papillomavirus DNA testing; breast cancer awareness and referral; culturally appropriate public information; and community-based childhood cancer recognition and referral.[10][8][20]Breast cancer delivery is supported by referral protocols, centralised diagnostic scheduling, patient navigation, electronic health records, multidisciplinary care and follow-up systems.[21]Cervical cancer care includes screening, treatment of eligible precancerous lesions, referral of advanced disease, laboratory strengthening, task-sharing, self-sampling and financial-protection measures.[22]

Childhood cancer implementation includes operationalising the Childhood Cancer Technical Working Group, developing early-detection tools, integrating recognition into immunisation and well-child visits, strengthening referral and reporting tools, expanding treatment centres and satellite clinics, improving paediatric intensive-care capacity, and ensuring sustainable access to affordable medicines and supportive care.[20][23]Supportive and palliative care should be integrated into referral facilities and paediatric oncology centres, with opioid availability, pain management, nutrition, rehabilitation, psychosocial support, community participation and home-based care networks.[24][25]

Implementation is supported by a Monitoring, Evaluation, Accountability and Learning Framework, routine supervisory visits, a mid-term assessment in years two to three, and an end-term review.[16][26]Comprehensive cancer centres are expected to implement population-based and facility-based registries, while registry data should inform national and regional resource allocation, policy development and prioritisation.[26]The plan also calls for integration of registries with national health information systems, standardised documentation and coding, mandatory case-reporting advocacy, data-privacy legislation, registry-management training and sustained multi-source funding.[27]

Monitoring & Evaluation

The plan establishes a Monitoring, Evaluation, Accountability and Learning framework to oversee cancer-control implementation, supported by monitoring guidelines, tools, formative programme-monitoring instruments and routine supervisory visits.[16][26]Annual monitoring and evaluation against predefined targets will assess implementation progress and gaps.[28]

• Conduct a mid-term assessment during years two to three to assess progress and the effectiveness of implemented strategies.[26][27]
• Complete an end-term review to assess overall success, impact, implementation gaps and priorities for programme improvement.[26][27]
• Require National Technical Working Groups to track progress and identify gaps, while Regional Health Bureaux and academic institutions monitor programmes and report progress to the Federal Ministry of Health and international partners.[29]
• Use registry data to inform national and regional resource allocation, policy development and prioritisation of cancer-care initiatives.[26]

Cancer surveillance and research are formal objectives, with the plan seeking to overcome fragmented cancer-registration systems through a unified approach.[3]Comprehensive cancer centres are expected to operate population-based and facility-based registries capturing incidence, treatment, outcomes and survival.[26]The registry strategy includes national population-based and health-facility-based registries, including population-based registries in all five university-affiliated cancer treatment centres.[27]

• Standardise cancer documentation and coding, advocate for mandatory case reporting and data-privacy legislation, train registry personnel, and integrate registries with national health-information systems.[27]
• Link population-based cancer registries to the District Health Information Software 2 platform and incorporate cancer surveillance and service statistics into Ministry of Health planning.[15]
• Expand surveillance through complete Addis Ababa registry coverage, legally notifiable cancer reporting, wider information sources and sentinel population-based registries in four regions.[30]
• Link screening, laboratory and hospital databases through a unique national or personal identifier to strengthen follow-up and data linkage.[31]

The plan includes measurable targets across prevention, screening, diagnosis, treatment and supportive care. It targets a 15% reduction in premature cancer mortality by 2029.[3]It also targets 70% cervical screening coverage among eligible women aged 30 to 49, 60% early-stage detection of breast cancers, at least 50% of health workers trained on cancer, and 60% childhood-cancer survival by 2030.[7][8][32]

Service-performance measures include 30% treatment coverage for cancer incidence, oncology commodity stock-outs below 30%, a 20% reduction in loss to follow-up and linkage of 100% of referred cases to care.[18][33]The other-cancers indicator measures the proportion of cancer-treating centres promptly diagnosing and treating cancers including colorectal cancer and non-Hodgkin lymphoma, rising from a 17% baseline in 2025 to 100% in 2029.[26]

Data systems for monitoring include a national cancer-screening data repository, District Health Information Software 2 integration, specimen tracking, patient navigators and a national childhood cancer registry.[18][32]Quality assurance, accreditation, audits, regulatory quality assurance and post-market surveillance are also identified as mechanisms for strengthening service quality and accountability.[17][19][33]Detailed indicator definitions, reporting frequencies and a complete accountability matrix are not consistently specified in the supplied material.[22][20]

Costing & Financing

The 2025-2029 plan has a detailed budget of 141,026.90 thousand United States dollars, with projected costs presented by strategic pillar and costing category.[34][35]The source does not specify a quantified funding gap, a domestic-versus-external financing split, or detailed economic assumptions beyond cost-effectiveness, affordability and equitable access.[34]

• Allocate the largest identified category amounts to medical equipment at 49,730.68 thousand United States dollars and medicines at 33,153.79 thousand United States dollars.[35]
• Fund awareness-raising, training, workshops, human resources, research and publications, manuals and strategy development within the detailed budget.[35]
• Prioritise the treatment pillar, costed at 65,924.94 thousand United States dollars, followed by prevention at 25,426.86 thousand United States dollars.[34]
• Resource surveillance and research at 10,872.18 thousand United States dollars and evaluation at 5,278 thousand United States dollars.[34]

Financing is expected to draw on mixed health-system sources. In 2019/2020, donors contributed 33.9%, government 32.2%, households through out-of-pocket payments 30.5%, and private employers, non-governmental organisations and other sources 3.5%.[36]Cancer control is included in the Essential Health Benefit Package, while non-communicable diseases account for about 25% of total health expenditure.[36]

Resource mobilisation priorities include identifying donors, development partners, private-sector sources and other funding opportunities; strengthening national partnerships and advocacy; and increasing and sustaining financing for cancer screening.[36]Tobacco and alcohol taxation is identified as a potential revenue source for non-communicable disease and cancer-control activities, although cigarette-tax revenue has not been earmarked for this purpose.[36][37]The plan also calls for a dedicated Ministry of Health budget line for cancer registration and surveillance in the long term.[30]

Financial barriers remain significant: 60% to 70% of families covered by community-based health insurance still incur out-of-pocket costs because services, medicines and technologies are unavailable in government facilities.[36]The annual community-based health-insurance cost per family is 921 Birr.[36]Resource needs include diagnostic equipment, medicines, workforce training, treatment infrastructure, blood services, palliative care, registries and family-support services.[23][38]

Cost-benefit analysis is proposed to assess the feasibility of integrating childhood cancer into universal health coverage.[24]The material also proposes budgeting for equipment service agreements or warranties, overtime compensation for nurses, insurance regulation to reduce financial barriers to diagnosis, and an investment case for cancer prevention and early detection.[31]