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

Objectives

Kenya’s National Cancer Control Monitoring, Evaluation, Accountability and Learning (MEAL) Framework 2023–2027 provides the results and performance framework for implementing the National Cancer Control Strategy 2023–2027. It seeks to establish a comprehensive, integrated and coordinated system for performance tracking, accountability, learning and evidence-informed adaptation across cancer stakeholders.[1][2]Its wider vision is a nation free from the preventable burden of cancer, with a goal to reduce premature cancer mortality by one third by 2028 while improving survival, down-staging, quality of life and people’s experience of care.[3]

• Reduce cancer incidence, morbidity, mortality and late-stage diagnosis through coordinated prevention, early detection, diagnosis, treatment, palliative care, survivorship and strategic information interventions.[1][4]
• Harmonise cancer data collection, reporting and information use across national, county, sub-county, facility and community levels.[2][5]
• Track structural, process, outcome and impact indicators, linking results to targets, corrective action, accountability and learning.[6][2]
• Strengthen cancer information systems, surveillance, registration, operational research and monitoring and evaluation capacity.[7][2]
• Advance prevention through tobacco control, healthy lifestyles, environmental protection, safer living and working environments, hepatitis B virus vaccination, human papillomavirus vaccination and social and behaviour change communication.[4]
• Expand screening and early diagnosis for cervical, breast, colorectal, prostate and oral cancers across community, primary, secondary and tertiary healthcare levels.[4]
• Promote equity, inclusivity, patient-centred care, community and survivor participation, sustainability, innovation and improved financial, social and geographical access to cancer services.[3][8]

The Common Results and Accountability Framework aligns national cancer-control results with global cervical cancer elimination, non-communicable disease and childhood cancer initiatives, as well as Kenyan national plans.[9]Key 2030 targets include reducing cancer mortality from 103.2 to 92.9 per 100,000 population, increasing human papillomavirus vaccination from 58% to 90%, increasing cervical screening from 31% to 70%, and reducing advanced-stage diagnosis from 69% to 40%.[9]The framework also measures cancer prevention and control expenditure as a proportion of the total health budget, from a 2021 baseline of 0.8% towards a 2030 target of 10%.[9]

Implementation

Implementation uses a harmonised, multisectoral and decentralised model that combines national stewardship, county delivery, facility reporting, community information systems, quality improvement, research and routine performance review.[7][5]The MEAL Framework is implemented 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 disease intersectoral coordination mechanism.[7]

• Coordinate national implementation through the Ministry of Health National Cancer Control Programme, monitoring and evaluation and health informatics functions, the National Cancer Institute of Kenya, research organisations, government agencies, counties, facilities, partners and civil society.[5][10]
• Deliver treatment through a hub-and-spoke model in which national referral hospitals act as hubs and regional cancer centres as spokes, while diagnostic pathology and imaging services are provided at level 4 facilities and above.[4]
• Use county Cancer Quality Improvement Teams and corresponding sub-county and facility structures to review data, supervise services, address performance gaps, coordinate partners and oversee continuous quality improvement.[5][11]
• Integrate cancer reporting into the Kenya Health Information System, cancer screening and treatment registers, facility forms, cancer registries, community information systems and the Oncology Electronic Medical Records Module.[4][3][12]
• Roll out digital information systems alongside training, mentorship, technical support, supervision, infrastructure and adequate staffing for personnel managing cancer data.[5]
• Conduct operational research through the Strategic Information, Registration, Surveillance and Research Technical Working Group, using secondary-data analysis and primary exploratory, intervention, evaluative and cost-effectiveness studies.[13]

Monitoring covers implementation inputs and activities, results, cancer-control conditions and population outcomes.[14]Routine monitoring uses standardised tools for data collection, collation, analysis, interpretation, dissemination and action, with monthly, quarterly and annual reporting according to the indicator.[14]Data sources include the Kenya Health Information System, electronic medical records, facility and laboratory registers, cancer registries, health-facility assessments, population surveys, vital statistics, community referrals and surveillance systems.[14][15]

National and county teams are expected to review data quality, performance and system capacity; produce reports, bulletins, scorecards and actionable information products; convene review meetings; and provide feedback to lower levels.[5][11]Data quality assurance assesses accuracy, reliability, precision, completeness, timeliness, integrity and confidentiality, using audits, verification checks, feedback and improvement plans.[16][17]Findings are validated through county and national quality improvement structures and the relevant cancer information technical working group before dissemination.[18][15]

Evaluation includes mid-term and end-term assessment of the cancer strategy and MEAL Framework, annual multisectoral reviews, quarterly routine-data reviews, programme evaluations, surveys and reviews of cancer registries, field visits and implementation reports.[18][19]Evaluation findings are intended to guide corrective action, resource reallocation, scale-up or adaptation of activities, technical-capacity strengthening, policy dialogue and subsequent strategy development.[18]

Financing is expected through national and county cancer-control allocations, integration with other public-health programmes, programme budgets, existing data platforms and external development assistance.[16]Projects are expected to allocate 5–10% of total financial resources to specified MEAL activities, incorporated into partner agreements.[16]The extracted material does not provide a standalone MEAL budget or monetary cost estimates.[17]

Monitoring & Evaluation

The Monitoring, Evaluation, Accountability and Learning (MEAL) framework provides the results and performance architecture for implementation of Kenya’s National Cancer Control Strategy 2023-2027. It is intended to harmonise cancer data collection and reporting, track performance against targets, strengthen information systems and operational research, connect national and county indicators, and promote stakeholder accountability and learning.[1][2]The Common Results and Accountability Framework organises results at impact, outcome and output levels and supports evidence-based decisions, efficiency, transparency and accountability across national and county levels.[2][9]

• Monitor structural or input, process, outcome and impact indicators, covering resources and service capacity, implementation activities, intermediate results and longer-term population-health effects.[6]Track cancer incidence, morbidity, mortality, down-staging and survival, alongside service-specific indicators across prevention, screening, diagnosis, treatment, palliative care, survivorship, research, communication and financing.[1][20][21]
• Use routine monitoring to follow programme resources, activities and results, and undertake periodic evaluation of effectiveness, efficiency, relevance and sustainability.[6]Conduct quarterly routine-data reviews, annual multisectoral strategy reviews, and mid-term and end-term evaluations of the cancer programme and MEAL framework.[18][19]
• Collect and manage data through the Kenya Health Information System, cancer screening and treatment registers, facility records, laboratory registers, cancer registries, surveys, electronic medical records and the National Oncology Dashboard.[4][3][14]Strengthen linkages between hospital-based and population-based cancer registries and use registry information for research, policy, planning and action.[12]
• Apply reporting frequencies that vary by indicator, including monthly, quarterly, annual, biennial, five-year and longer-cycle reporting.[14][22][23]Produce annual programme-review reports, quarterly cancer prevention and control bulletins, policy briefs, county health bulletins, periodic situation reports, scorecards and research outputs.[15][5][10]
• Assign national technical structures responsibility for validating indicators, tools, targets and findings; tracking framework performance; generating actionable information products; and initiating corrective action.[5]Assign county, sub-county and facility teams responsibility for data review, report submission, supervision, mentorship, quality improvement, feedback and local corrective action.[11][24]
• Conduct data-quality assessments against accuracy, reliability, precision, completeness, timeliness, integrity and confidentiality standards.[17]Undertake annual national assessments in selected counties and twice-yearly county and sub-county assessments at data-generation points, supported by standardised tools, audit reports, on-site feedback and quality-improvement plans.[25][16]
• Address identified weaknesses in incomplete continuum data capture, inadequate population coverage and registry integration, weak facility-level analysis, limited data-use capacity, inconsistent information-sharing platforms, and under-reporting, over-reporting, misreporting and data-entry errors.[3]Strengthen workforce capability through training and mentorship for community health personnel, clinical teams, health records and information officers, cancer registrars and programme managers.[5]
• Use monitoring, research and evaluation findings to identify unintended consequences, good practice, implementation problems and resource needs; inform policy, planning, service improvement and advocacy; and support corrective measures such as adapting activities, reallocating resources and strengthening technical capacity.[9][18][26]

Costing & Financing

Financing is treated as a core cancer-control priority and as an enabler of sustainable, equitable and quality care.[1][3][27]The MEAL framework is to be financed through national and county cancer-control allocations, integration with other disease-control and public-health programme financing, cancer-programming budgets, existing data platforms, and external development assistance or other stakeholder support.[16]The extracted material does not provide a standalone MEAL budget, total programme cost, currency-denominated allocation, quantified funding gap, expenditure amount or economic assumption.[17]

• Allocate resources for MEAL functions including data-collection tools, training, computer hardware and networks, cancer-database software, data transmission and analysis, dissemination, accountability and learning forums, communication, and supportive supervision.[17]
• Incorporate cancer monitoring and evaluation activities into national, county and facility annual work plans and annual or quarterly budgets, while requiring relevant structures to mobilise resources.[11][12]
• Allocate 5-10% of total project financial resources to specified MEAL activities and incorporate this requirement into partner agreements.[16]
• Track cancer prevention and control expenditure as a proportion of the total health budget, with a baseline of 0.8% in 2021 and a 2030 target of 10%.[9]Monitor the wider target of allocating 17% of total health expenditure to non-communicable diseases, including cancer control, at national and county levels.[28]
• Support resource mobilisation through advocacy, partnerships, public-private partnerships, investment cases, funded proposals, costed action plans, budget reporting and expenditure tracking.[20][28][29]
• Establish a dedicated cancer research budget line and advocate for research funding from the Ministry of Health and partners.[13]Development of the MEAL framework received financial support from the Centers for Disease Control and Prevention, although no amount is specified.[1]
• Address inadequate investment in priority cancer information systems and use data to inform budget allocation for awareness creation, screening, human resources and commodities.[3][24]