National Cancer Control Monitoring, Evaluation, Accountability and Learning (MEAL) Framework 2023-2027

Objectives

The Cancer Monitoring, Evaluation, Accountability and Learning (MEAL) Framework provides Kenya’s integrated results and performance framework for implementing the National Cancer Control Strategy 2023–2027. It aims to establish a coordinated system for monitoring, evaluation, accountability and learning, enabling stakeholders to track results, support timely strategic decisions and adapt implementation in response to changing circumstances.[1][2][3]The long-term direction is a nation free from the preventable burden of cancer, reducing premature cancer mortality by one third by 2028 while improving people’s experience and quality of life.[4]

The framework seeks to reduce cancer incidence, morbidity and mortality, promote down-staging of disease and improve survival through stronger information management, evidence use, research, surveillance and coordinated action across the cancer continuum.[2][5]Its values emphasise community and survivor involvement, equity, inclusion, patient-centred care, sustainability, improved access and evidence-based innovation.[4][6]

• Strengthen prevention and risk-factor control through tobacco control, healthy lifestyles, environmental and occupational protection, hepatitis B virus and human papillomavirus vaccination, and social and behaviour change communication.[7]
• Expand screening and early diagnosis for cervical, breast and colorectal cancers, alongside individualised screening for prostate and oral cancers.[7]
• Improve diagnosis, treatment, palliative care, survivorship and rehabilitation through strengthened imaging, pathology, laboratory medicine and cancer-service capacity.[2][8][9]
• Advance advocacy, partnerships, coordination and financing, including improved financial protection and alignment of stakeholder resources.[2][5][10]
• Strengthen strategic information, cancer registration, surveillance, operational research and dissemination of locally generated evidence for policy and clinical guidance.[2][11][12]

The Common Results and Accountability Framework supports this strategy by linking stakeholder-selected input, process, output, outcome and impact indicators with targets at national and county levels.[13][3]Priority 2030 ambitions include reducing cancer mortality from 103.2 to 92.9 deaths per 100,000 population, increasing human papillomavirus vaccination coverage from 58% to 90%, and reducing advanced-stage diagnosis from 69% to 40%.[14]

Implementation

Implementation follows a multisectoral, decentralised model spanning community, primary, secondary and tertiary care, with coordinated monitoring at national, county, sub-county and facility levels.[1][7]Cancer treatment is organised through a hub-and-spoke model in which Kenyatta National Hospital, Moi Teaching and Referral Hospital and Kenyatta University Teaching, Referral and Research Hospital serve as hubs linked to regional cancer centres.[7]Diagnosis is intended to be available from level 4 facilities upwards, supported by the national cancer reference laboratory and imaging equipment under the Managed Equipment Scheme.[7]

• Coordinate oversight through the monitoring and evaluation subcommittee of the Strategic Information, Registration, Surveillance and Research Technical Working Group, reporting through the Cancer Technical Working Group to the Non-Communicable Diseases Interagency Coordinating Committee.[2]
• Engage the Ministry of Health, National Cancer Institute of Kenya, Kenya Medical Research Institute, county governments, health facilities, development and implementing partners, academia, civil society, patient associations and private-sector institutions.[2][15][16]
• Use national, county, sub-county and facility Quality Improvement Teams to review performance, supervise implementation, validate data, coordinate partners and take corrective action.[17][18]
• Collect and report service data using standard screening and treatment tools, registers and Ministry of Health forms, with aggregation through the Kenya Health Information System and National Oncology Dashboard.[4][19]
• Deploy the National Oncology Electronic Medical Records Module to enable longitudinal patient tracking across the care continuum once implemented.[4]

Monitoring combines routine tracking of resources, activities and results with periodic evaluations of relevance, effectiveness, efficiency and sustainability.[13]Reporting is intended to occur monthly, quarterly and annually according to the results framework, with annual multisectoral strategy reviews, quarterly reviews of routine data, and mid-term and end-term evaluations.[20][21]Data sources include the Kenya Health Information System, cancer registries, population surveys, surveillance systems, facility assessments, clinical audits and research.[20][22]

Data quality assurance addresses accuracy, reliability, precision, completeness, timeliness, integrity and confidentiality.[23]Health records and information officers are expected to validate data during entry and processing, including checks for duplicates, outliers and missing values, while facility, county and sub-county assessments provide feedback and quality-improvement follow-up.[24]Data handling must comply with the Data Protection Act 2019 and 2021 data protection regulations because health information is sensitive personal data.[19]

Learning and accountability mechanisms include performance reviews, scorecards, bulletins, policy briefs, stakeholder feedback, data-use forums, operational research and dissemination of accessible evidence products.[21][25][16]The framework requires cancer monitoring and evaluation activities to be incorporated into county annual work plans and budgets and facility annual work plans and quarterly budgets.[18]It further requires projects to allocate 5–10% of total financial resources to specified MEAL activities, covering tools, training, hardware, data transmission, analysis, dissemination, supportive supervision and learning forums.[24][23]Although the framework identifies financing through national and county cancer-control allocations, integration with existing public-health financing and external development-partner support, it does not specify an overall monetary budget or funding gap.[24][23]

Monitoring & Evaluation

The Monitoring, Evaluation, Accountability and Learning framework provides an integrated results and performance system for the National Cancer Control Strategy 2023-2027, intended to standardise data collection, reporting, feedback, learning and accountability across national, county, sub-county, facility and community levels.[2][3]It uses a Common Results and Accountability Framework to track inputs, processes, outputs, outcomes and longer-term population impacts, supporting evidence-informed decisions and implementation adaptation.[13][3][14]

• Monitor cancer-control performance through routine collection, collation, analysis, interpretation and dissemination of data using standardised tools and procedures, with monthly, quarterly and annual reporting where specified.[20]
• Track indicators for prevention, vaccination, screening, diagnosis, treatment, palliative care, survivorship, financing, workforce, service readiness, research, registration and surveillance.[14][26][27][11]
• Measure progress towards selected 2030 targets, including reducing cancer mortality from 103.2 to 92.9 deaths per 100,000 population, increasing human papillomavirus vaccination coverage from 58% to 90%, and reducing advanced-stage diagnosis from 69% to 40%.[14]
• Use data sources including the Kenya Health Information System, population-based surveys, surveillance systems, cancer registries, facility assessments, laboratory registers, electronic medical records and routine programme reports.[20][22][28]
• Strengthen surveillance through population-based cancer registries in Nairobi and Eldoret, which collect incidence, mortality and survival data using CanREG with support from the International Agency for Research on Cancer through the African Cancer Registry Network.[22]
• Establish accountability through national and county monitoring and evaluation teams, quality improvement teams, technical working groups, performance reviews, scorecards, feedback mechanisms, supportive supervision and corrective action.[15][18][25]
• Conduct annual multisectoral cancer-strategy reviews, quarterly routine-data reviews, and mid-term and end-term evaluations using agreed terms of reference and review tools.[21]
• Undertake annual national data-quality assessments in selected counties, semi-annual county and sub-county assessments, and quarterly facility data reviews.[16]Data-quality assurance addresses accuracy, precision, reliability, timeliness, relevance, completeness, integrity and confidentiality.[16][23]
• Protect sensitive health information in accordance with the Data Protection Act 2019 and the 2021 data protection regulations, including arrangements for data access, storage, confidentiality and security.[19]
• Address identified system weaknesses, including incomplete indicator capture, limited routine information on screening infrastructure and workforce, fragmented registries, poor data quality, under-reporting, over-reporting, misreporting, data-entry errors and limited local analytical capacity.[4]

Costing & Financing

Financing is treated as a cross-cutting cancer-control priority, with resource mobilisation, public and private financing, county and facility budget integration, and partner support intended to sustain monitoring, evaluation, accountability and learning activities.[4][15][24]The framework does not specify an overall cancer-control budget, detailed costed activity plan, monetary funding gap, currency-denominated allocation or economic assumptions.[20][23]

• Allocate 5-10% of total project financial resources to specified monitoring, evaluation, accountability and learning activities as a condition in agreements with partners.[24]
• Finance data-collection tools, training, computer hardware and network maintenance, cancer database software, data transmission, data cleaning and analysis, dissemination, accountability and learning forums, communication, and supportive supervision.[23]
• Capture implementation costs for the framework within the costing of the National Cancer Control Strategic Plan 2023-2027 and subsequent strategic plans.[23]
• Incorporate cancer monitoring and evaluation activities into county annual work plans and budgets, and into facility annual work plans and quarterly budgets.[18]
• Mobilise resources through national and county cancer-control structures, development partners, the Ministry of Health, the National Cancer Institute-Kenya and other stakeholders.[18][29][25]
• Monitor cancer prevention and control expenditure as a proportion of the total health budget, with a baseline of 0.8% in 2021 and a target of 10% by 2030.[14]
• Track financing accountability through the proportion of health expenditure allocated to non-communicable diseases including cancer, funded resource-mobilisation proposals, costed action plans and the absorption rate of allocated cancer-control funds.[30][10]
• Establish a dedicated cancer research budget line and advocate for Ministry of Health and partner funding, while monitoring the proportion of the national research budget allocated to cancer research.[31][32]