National Action Plan for Cervical Cancer Prevention and Control 2019-2023

Objectives

The 2019–2023 national action plan seeks to reduce Cambodia’s cervical cancer burden through a comprehensive, population-based and life-course programme spanning primary prevention, screening and treatment of precancerous lesions, invasive-cancer management and palliative care.[1][2][3][4]Cervical cancer is identified as the most urgent cancer-control priority, with prevention and palliative care emphasised as cost-effective interventions.[5]

• Prevent human papillomavirus infection through vaccination, health education and condom promotion, with nationwide vaccination intended to exceed 90% coverage.[6][7]
• Expand screening and linked treatment for women aged 30–49 years, initially targeting screening of more than 60% of this age group at least once by 2020 and progressing towards universal coverage of the targeted population.[8][4]
• Establish national screening standards and incrementally extend population-based screening and precancer treatment over five years, supported by trained providers, equipment, supplies and referral arrangements.[9][10]
• Strengthen referral centres for complex precancerous lesions and invasive cancer, including diagnostic capacity, pathology, surgery, radiotherapy, chemotherapy, palliative care and support for patients and families.[6][11][10]
• Ensure accountable programme management through a multidisciplinary national management structure, a national coordinator, coverage and quality targets, and monitoring and evaluation.[12][11]

Implementation

Implementation is designed as a phased national scale-up integrated into routine health services and coordinated across prevention, reproductive health, immunisation, adolescent health and cancer-care functions.[8][3][4]The delivery model combines community mobilisation, vaccination, screening, timely treatment, referral and palliative care, with particular attention to equitable and sustainable access for rural populations.[3][4]

• Integrate cervical cancer screening guidance into the Minimum Package of Activities Operational Guidelines and Clinical Practice Guidelines, and integrate human papillomavirus vaccination into the National Immunisation Programme.[8]
• Build on the vaccination demonstration project in Svay Rieng Province and two operational districts in Siem Reap Province, using its positive evaluation and existing immunisation-system capacity to guide national expansion, guidelines, training materials and selection criteria.[3][7]
• Develop, adapt and field-test local-language information, education and communication materials; train providers in their use; and implement communication and community-mobilisation activities for vaccination, screening and precancer treatment.[13]
• Scale up screening and treatment through selected provinces, assess facility readiness, establish national training capacity, orient provider cadres, procure equipment and supplies, and provide supportive supervision.[9]
• Introduce human papillomavirus DNA testing as a primary screening method after piloting in selected operational districts, including assessment of self-collected samples’ acceptability and feasibility.[9][10]
• Strengthen national and provincial referral capacity, pathology and laboratory services, and centralised treatment for complex lesions and invasive cancer; planned Regional Cancer Centres in Siem Reap by 2020 and Kratie by 2025 are intended to serve as subnational training hubs.[2][11]
• Expand palliative care across service levels and develop community-based provision, noting that no such system was in place at the time and that Douleurs Sans Frontières was piloting home-based care in Phnom Penh.[2][14]
• Coordinate planning, implementation and evaluation through the Cervical Cancer Prevention Sub-Technical Working Group and the wider Sub-Technical Working Group for Breast and Cervical Cancers, working with the Non-communicable Diseases Task Force.[8][6]
• Engage the Ministry of Health and its departments and programmes, provincial health departments, operational districts, national hospitals, the Ministry of Education, Youth and Sport, the Ministry of Women’s Affairs, professional and academic groups, donors, non-governmental organisations and relevant clinical disciplines.[8][12][11]
• Use regular working-group meetings, defined terms of reference, participatory self-assessment involving providers and communities, supportive supervision, gap identification and corrective action to support governance and local problem-solving.[14][11]
• Strengthen information systems by making cervical cancer reportable, incorporating programme indicators into the Cambodia Health Information System, and establishing hospital-based cancer registration in 2021 and population-based registration in 2022.[11]
• Monitor vaccination coverage, screening uptake, screen-positive results, completion of precancer treatment, incidence and programme performance, recognising that apparent incidence may initially rise as previously undiagnosed cancers are detected and that reductions in invasive disease and mortality may take more than a decade to emerge.[8][3][12][15][4]
• Mobilise sustained financing through government and donor resources, possible National Social Security Fund coverage for screening and precancer treatment, and exploration of a dedicated share of tobacco or alcohol tax for long-term vaccine financing; the source does not specify an overall programme budget or funding gap.[7][11]

Monitoring & Evaluation

The framework combines routine programme monitoring, cancer surveillance and accountability mechanisms to track coverage, service quality, treatment completion and longer-term impact. Core measures include cervical cancer incidence, screening coverage among women aged 30–49 years, HPV vaccination coverage, screen-positive results and completion of treatment for precancerous lesions.[8][15][4]It recognises that screening may initially increase recorded cancer incidence by identifying previously undiagnosed cases, whereas reductions in invasive disease and mortality may take more than a decade to emerge.[3][12]

• Monitor the target for more than 60% of women aged 30–49 years to have been screened at least once by 2020, alongside clear coverage and quality targets for the wider programme.[8][11]
• Measure the proportion of eligible girls receiving two recommended HPV vaccine doses each semester and annually, using registration books and census data.[15]
• Measure annually the proportion of women aged 30–49 years screened at least once, the proportion screened for the first time in a 12-month period, the proportion with a positive screening result, and the proportion of screen-positive women completing appropriate precancer treatment.[15][4]
• Integrate vaccination, screening and cervical cancer performance indicators into the Cambodia Health Information System, supported by accurate data collection, reliable storage, user-friendly retrieval and regular reporting.[12][7][11]
• Establish hospital-based cancer registration in 2021 and population-based registration in 2022, addressing the absence of both registry types and the reliance on estimated incidence and mortality data.[2][11]
• Conduct periodic knowledge, attitudes and practices studies to assess information, education and communication activities, and use supportive supervision and periodic evaluation to review vaccine and programme performance.[7]
• Assign oversight to a national multidisciplinary management team, supported by a national coordinator, the Cervical Cancer Prevention Sub-Technical Working Group and a programme monitoring and evaluation function.[6][12]
• Use participatory self-assessment involving providers and community representatives to identify technical or programme gaps and implement timely corrective action.[11][14]

The available material does not specify a single reporting timetable, evaluation design, data-quality assurance protocol or enforcement process beyond the supervision, self-assessment, registry and corrective-action arrangements described.[8][14]

Costing & Financing

Financing priorities centre on sustained funding for prevention, screening, diagnosis, treatment, palliative care, programme governance and monitoring. Prevention and palliative care are characterised as cost-effective cancer interventions; visual inspection with acetic acid screening and treatment of precancerous lesions are identified as feasible and cost-effective in low-resource settings, while HPV vaccination is also considered cost-effective when resources permit.[5][8]The plan calls for medium- and long-term financing policies, a dedicated cervical cancer budget line and advocacy tools on cost benefits and deaths averted.[8][13]

• Mobilise government resources for governance, planning, implementation and evaluation, alongside pooled donor funding for government-priority services and non-pooled donor support for capacity-building and monitoring.[11]
• Explore inclusion of cervical screening and precancer treatment within the National Social Security Fund insurance package.[11]
• Explore long-term HPV vaccine financing, including a potential dedicated share of tobacco or alcohol tax.[7]
• Secure sustained resources through engagement with relevant ministries for the expansion of screening and primary prevention.[2]
• Use technical and financial support from the World Health Organization and the United Nations Population Fund for development of the national action plan.[1]
• Allocate activity-level funding to national screening procedures, a centralised cancer treatment centre, invasive-cancer treatment capacity, pathology and laboratory services, palliative care, governance, target-setting, local self-assessment and corrective-action processes.[10][14]

Private-sector prices, excluding provider charges, are US$39.82 per dose for bivalent HPV vaccine and US$52.50 per dose for quadrivalent HPV vaccine.[6]Several planned activities have no stated monetary value, including referral-centre strengthening, support for patients and caregivers, cancer reporting requirements, health-information-system indicator inclusion and cancer registry establishment.[10][14]The material does not provide an overall programme budget, comprehensive financing plan, quantified funding gap, unit costs beyond vaccine prices, or broader economic assumptions.[2][13]