Stratégie Nationale de Lutte Contre les Cancers du Col Utérin et du Sein en République Démocratique du Congo

Objectives

The strategy provides a national framework to reduce morbidity, mortality and avoidable suffering from cervical and breast cancers in the Democratic Republic of the Congo, integrating prevention, early detection, diagnosis, treatment, palliative care, surveillance and programme follow-up within the health system and reproductive-health services.[1][2]Its vision is that these cancers cease to be perceived as a calamity, through human papillomavirus immunisation before sexual debut, screening and early diagnosis, appropriate treatment of lesions, and minimal cancer-related mortality.[3]

• Strengthen a functional national cancer-control programme, with national standards, guidelines, coordination mechanisms and equitable access to quality services.[4][5]
• Improve knowledge, attitudes and practices through behaviour-change communication on cancer risks, responsible sexuality, healthy lifestyles, screening and timely care-seeking.[3][6]
• Prevent cervical cancer through education, risk reduction, human papillomavirus vaccination for girls aged 9 to 13 years, screening for cervical abnormalities and treatment of precancerous lesions.[7][8]
• Expand cervical screening among women aged 25 to 65 years, aiming for organised coverage of 80% of the target population and using visual inspection, cytology or, in specialised settings, human papillomavirus DNA testing.[9][10]
• Promote breast-cancer prevention and early detection by addressing modifiable risks, raising awareness, supporting breast self-examination and clinical examination, and targeting imaging surveillance towards women at higher risk.[11][12]
• Strengthen institutional and workforce capacity, health-information management, operational research, stakeholder partnerships and resource mobilisation for prevention and care.[3][13]
• Provide stage-appropriate diagnosis and treatment, including surgery, radiotherapy, chemotherapy, hormone therapy, targeted treatment and supportive care where clinically appropriate and available.[14][15][16]
• Deliver active, individualised palliative care that addresses physical symptoms and psychological, social and spiritual needs, involves families and respects patient dignity.[17]

Implementation

Implementation is designed as an integrated, multi-level model coordinated by the Ministry of Public Health through the National Reproductive Health Programme, under the Directorate of Family Health and Specific Groups.[18][19]It combines community mobilisation, integration into routine sexual and reproductive health contacts, tiered clinical services and referral, capacity-building, routine reporting, cancer registration, supervision and annual evaluation.[6][13][20]

• Coordinate national action through the National Reproductive Health Programme, which disseminates policies and standards, coordinates, supervises and evaluates activities, obtains regular stakeholder reports and analyses implementation quality.[19]
• Engage government bodies, health providers, universities, hospitals, civil-society organisations, communities, bilateral and multilateral partners, and professional and cancer-focused associations.[21][4][19]
• Deliver education, counselling and screening promotion through communities, schools, churches, media, social networks, women’s associations and non-governmental organisations, including during antenatal, postnatal, child-health and family-planning contacts.[22][23][7]
• Organise services across community structures, health centres, general referral hospitals, provincial hospitals, specialised hospitals and central health-zone offices, with defined roles in prevention, screening, diagnosis, treatment, palliative care, referral, supervision and data management.[24][23][25][26]
• Equip health centres for visual screening and data management, strengthen referral hospitals for screening, laboratory investigations, colposcopy, biopsy, imaging and treatment of precancerous lesions, and provide specialised hospitals with advanced diagnostics, cancer surgery, radiotherapy, pathology, molecular testing, registration and palliative-care capacity.[23][25][26]
• Develop workforce capacity from community health workers and volunteers to primary-care personnel, general practitioners, specialists and multidisciplinary oncology teams, covering communication, screening, counselling, diagnosis, nursing, referral, treatment, psychosocial care and palliative care.[27][28]
• Integrate opportunistic cervical screening into routine facility attendance while establishing organised screening arrangements that define target populations, intervals, testing methods, notification of positive results, referral, treatment recommendations and monitoring indicators.[10][29]
• Strengthen patient pathways by defining tasks at each service point and enabling rapid referral between public facilities, private providers and specialised cancer services.[13]
• Collect routine cancer information through tools adapted to central, intermediate and peripheral levels, including suspected-case notifications, case declarations, confirmed-case registration and compiled cancer registers.[30][31][32]
• Establish a national cancer registry and consolidate information from routine reports, surveys and operational research under the Division of Disease Control, while ensuring research findings inform the Ministry of Public Health.[30][33]
• Monitor completeness and timeliness of reports, cancer incidence, prevalence and mortality, screening and vaccination coverage, detection and treatment of precancerous lesions, communication outcomes and quality of care.[30]
• Conduct formative supervision semi-annually at central level, quarterly at intermediate level and monthly at peripheral and community levels, using approved checklists, documented feedback and follow-up.[34]
• Evaluate activities annually against process and outcome indicators, using a team including the national programme, disease-control directorate and partners, and undertake an external evaluation two years after implementation.[20]
• Mobilise domestic and external resources, require central and provincial cancer-control budget lines in the annual financial law, and develop a five-year national strategic plan with annual operational action plans.[33]The available material does not provide budget amounts, funding shares, implementation costs or quantified funding gaps.[33]

Monitoring & Evaluation

The strategy establishes a multi-level monitoring, evaluation and surveillance framework for cervical and breast cancer control, centred on routine data collection, cancer notification and registries, supervisory oversight, periodic indicator review and formal evaluations.[30][34][20]

• Integrate cancer data collection into the National Health Information System and its reproductive-health subsystem, using tools adapted for central, intermediate and peripheral levels of the health system.[28][30]
• Establish a national cancer registry and centralise information from routine reports, surveys and operational research, under coordination of the Division of Disease Control.[30]
• Address weaknesses in existing information systems, as morbidity and mortality data were scarce, largely hospital-based or estimated, while population-based registries were rare or incomplete.[2]
• Use case-declaration, notification, registration and compiled-registry forms to document suspected, declared and confirmed cases across community, facility, health-zone, provincial and national levels.[35][31][32]
• Record patient demographics, residence, vaccination history, laboratory results, diagnosis, tumour site and extent, pathology, treatment, outcome, death, and survival information in cancer records.[20][31]
• Classify final case status as confirmed, probable, compatible or rejected, and record outcomes including alive, deceased, transferred, lost to follow-up or unknown.[31]
• Monitor report completeness and timeliness; cancer incidence and prevalence by type and province; cancer-specific mortality; screening coverage; detection and treatment of precancerous lesions; human papillomavirus vaccination coverage; communication and behaviour-change measures; and quality-of-care indicators.[30]
• Review programme indicators periodically to assess performance, although the supplied text does not define indicator denominators, targets or reporting frequency.[28]
• Collect and manage data through health centres, general referral hospitals, provincial and specialised hospitals, and health-zone offices using registers, consultation and referral forms, supervision tools and information-technology equipment.[23][25][36][26]
• Coordinate, monitor, supervise and evaluate reproductive-health activities nationally through the National Reproductive Health Programme, which is expected to obtain and analyse regular activity reports from stakeholders and assess implementation quality.[19]
• Conduct formative supervision using a standard checklist, with central supervision scheduled semi-annually, intermediate-level supervision quarterly, and peripheral and community supervision monthly; document results, identify success and failure factors, disseminate reports and provide feedback to facilities.[34]
• Evaluate cervical and breast cancer activities annually against assigned objectives using process and outcome indicators, through a mixed team of the national programme, disease-control directorate and partners.[20]
• Conduct an external evaluation two years after implementation to assess delivery and recommend corrective measures.[20]
• Use defined screening-programme parameters, including the target population, screening intervals, tests, positive-result notification, referral arrangements, therapeutic recommendations and monitoring indicators; organised cervical screening targets 80% coverage of the target population.[10]
• Maintain clinical follow-up records, including annual review status and review points at years 1, 2, 3, 4, 5, 7, 10 and 15.[37]

Costing & Financing

Financing provisions focus on domestic and external resource mobilisation, incorporation of cancer-control budget lines into public financial planning, and investment in equipment, medicines, workforce capacity, information systems and service delivery. No quantified implementation budget, funding-gap estimate, allocation, currency value or costing methodology is provided in the supplied extracts.[33][36][26]

• Mobilise resources through national, provincial and designated coordination bodies, including technical and financial partners.[33]
• Include a central- and provincial-government budget line for cancer control, including cervical and breast cancers, in the annual financial law.[33]
• Develop a five-year national strategic plan and annual operational action plans through the National Reproductive Health Programme and collaborating structures.[33]
• Address reported constraints, including insufficient financial resources, limited government and development-partner contributions, low financial access to appropriate care, and shortages of equipment, materials and trained personnel.[4][5]
• Prioritise provision of equipment, essential medicines, staff training, research, laboratory capacity, imaging, radiotherapy, surgery, data-management equipment, communication materials and palliative-care medicines.[18][36][26]
• Promote prevention, health promotion, early detection and integrated cervical and breast cancer programmes as comparatively favourable economic approaches, since prevention is described as less costly than management of advanced disease and integrated programmes as potentially cost-effective and affordable in many low- and middle-income countries.[2][6][24]
• Recognise that organised cervical screening is generally more cost-effective than opportunistic screening because it can use available resources more efficiently and reach more women.[29]
• Note qualitative cost considerations: visual inspection screening is characterised as inexpensive; magnetic resonance imaging is described as costly; and improving patient pathways through organisation and training is expected to require relatively limited expenditure.[9][12][13]
• Record that the strategy’s development, finalisation and validation received technical and financial support from the World Health Organization country office in Kinshasa.[21]