National Program Against Oncological Diseases in the Republic of Moldova for the Years 2008–2012

Objectives

The National Programme seeks to improve health outcomes through prevention, earlier detection, diagnosis, treatment, rehabilitation and palliative care for oncological diseases. Its central aims are to reduce late diagnosis, disability and cancer mortality, improve survival, and strengthen the organisation of cancer control across health services and wider public institutions.[1][2]

• Establish systems for research and for primary and secondary cancer prevention, integrating cancer control into medical assistance and coordinating it with other national programmes.[2]
• Reduce exposure to behavioural, environmental, occupational and social risk factors, including smoking, alcohol consumption, poor nutrition, stress, chemical, physical, biological and radioactive hazards.[3]
• Promote healthy lifestyles and cancer awareness through sustained public communication, including television, radio, newspapers and magazines.[3]
• Detect and treat pre-cancerous conditions and cancers earlier through annual detection activities, screening, diagnosis and complex treatment.[1][2]
• Standardise cancer treatment, introduce clinical protocols, expand rehabilitation and palliative care, and develop hospice services.[4]
• Protect pregnant women and prevent congenital malformations through risk-based medico-genetic and ultrasonographic examinations.[5]
• Strengthen oncology human resources, scientific research and the monitoring of prevention and cancer-control effectiveness.[2]

The Programme sets outcome ambitions of approximately a 2–3% reduction in cancer mortality, a 0.2% reduction in infant mortality, an 8–10% reduction in one-year case fatality, a 5–10% increase in recorded morbidity, a 5–8% increase in annual detection, a 15–20% increase in cured patients, and a 10% reduction in population risk factors.[1]

Its preventive strategy combines primary prevention, aimed at controlling causes and risk factors, with secondary prophylaxis, aimed at identifying and managing pre-cancerous conditions and malignancies through screening, diagnosis, treatment, rehabilitation, disability assessment and palliative care.[2][5][6]

Implementation

Implementation relies on a multi-level delivery model linking family doctors, district and regional oncologists, other medical specialists, oncology consulting rooms, the Republican Specialised Oncological Policlinic, and the Oncological Institute. Family doctors and specialists are expected to undertake active and passive detection of cancer and pre-cancerous conditions, while specialised oncology institutions concentrate definitive diagnosis and treatment of malignant tumours.[2][6]

• Coordinate implementation through the Ministry of Health, Oncological Institute, National Health Insurance Company, Academy of Sciences of Moldova, relevant environmental, education, agriculture and other ministries, local public administration, professional bodies, civil-society organisations, international public organisations, the Cancer Society, public broadcasting and other mass media.[3][5][6][4]
• Develop annual cancer-control plans for 2008–2012, drawing on recommendations of the International Union Against Cancer, and develop satellite programmes for the most frequent cancers in the Republic of Moldova.[3]
• Implement population screening through family doctors, including risk assessment and follow-up based on hereditary, age and social factors.[3]
• Strengthen regional oncologists’ and specialists’ role in maintaining registers of people at oncological risk, and prepare annual detection guides and clinical protocols for common lung, breast, skin, gastric, cervical and colorectal cancers.[3]
• Organise district consultative teams to support annual detection using morbidity and mortality rates, and hold annual conferences, seminars and thematic symposia for oncology and primary-care professionals.[5]
• Improve oncology consulting rooms by increasing oncologist staffing and providing equipment, including computers and portable ultrasound devices.[6]
• Modernise cervical cytological screening and introduce immunohistochemical and electron-microscopic methods for pathological detection.[6]
• Upgrade diagnostic equipment, radiotherapy infrastructure and treatment capacity, including a new radiotherapy building and modern apparatus such as a linear accelerator.[6][4]
• Develop a bone-marrow transplantation department, rehabilitation services, palliative treatment, pain management and hospice services in Balti and Cahul.[4]
• Prepare ministerial regulations, standardise treatment with oncology medicines, organise centralised procurement, and introduce clinical treatment protocols.[5][6][4]

Information and public-engagement mechanisms include a republican information system within the Cancer Register to improve preventive examinations and patient records, annual Week against Cancer campaigns under the motto “Early detection saves life”, and telemarathons and radiomarathons every three years.[5][4]

Financing is to be provided by the State in accordance with legislation in force for annual detection, treatment, and training and professional development of oncology staff. The Ministry of Finance, National Health Insurance Company, international public organisations and non-governmental organisations are also identified among bodies involved in financing or supporting delivery.[1][6][4]

Monitoring & Evaluation

The Programme combines outcome monitoring with operational surveillance, using cancer morbidity, mortality, annual detection, one-year case fatality, cure and survival measures, infant mortality, and population exposure to cancer risk factors to assess prevention and cancer-control performance.[1][2]It also seeks to monitor and evaluate the overall effectiveness of prevention and cancer-control activities.[2]

• Track annual detection, recorded morbidity and cancer mortality, including targets for higher detection and recorded morbidity alongside reduced mortality and one-year case fatality.[1]
• Monitor treatment outcomes through cured-patient levels, survival and rehabilitation-related cancer-care activities.[1][2]
• Assess changes in behavioural, environmental and social cancer risks, including smoking, alcohol consumption, diet, harmful exposures and other adverse living conditions.[2][3]
• Maintain registers of people at oncological risk through regional oncologists and specialists, supporting identification, follow-up and management of risk groups.[3]
• Use family doctors, district oncologists and other specialists for active and passive detection of cancer and precancerous conditions.[6]
• Organise district consultative teams to support annual cancer detection and use morbidity and mortality rates in this work.[5]
• Develop annual cancer-control plans for 2008–2012, annual detection guides and clinical protocols for common cancers, creating recurring mechanisms for implementation review and clinical standardisation.[3]
• Establish a republican information system within the Cancer Register to improve preventive examinations and record-keeping for oncology patients.[4]

Professional learning and public communication form additional monitoring-support mechanisms. Annual conferences, seminars and thematic symposia are intended to strengthen oncologists’, family doctors’ and other specialists’ use of contemporary detection and treatment guidance and their monitoring of oncological risk.[5]Public awareness is supported through permanent healthy-lifestyle communication in television, radio, newspapers and magazines, as well as an annual Week against Cancer and telemarathons and radiomarathons every three years.[3][5]

Accountability is primarily assigned through named implementing bodies rather than through a detailed performance-management system. The Ministry of Health, Oncological Institute, Academy of Sciences of Moldova, National Health Insurance Company, relevant ministries, local public administration authorities, professional and civil-society organisations, mass media and other partners have implementation roles across the Programme.[3][5][6][4]The available material does not specify a separate reporting template, data-quality protocol, formal evaluation methodology, sanctions for non-performance, or named accountability procedures.[3][5][6][4]

Costing & Financing

Financing is framed principally as State-supported implementation under legislation in force, covering annual cancer detection, treatment, and the training and professional development of oncology personnel.[1]The financing and support landscape also includes the Ministry of Finance, National Health Insurance Company, international public organisations and non-governmental organisations.[6][4]

• Fund annual detection and treatment activities and strengthen oncology workforce training and continuing professional development.[1]
• Resource oncology consulting rooms with additional oncologists and equipment, including computers and portable ultrasound devices.[6]
• Upgrade diagnostic capacity through modernised cervical cytological screening and pathological diagnostic methods, including immunohistochemical and electron-microscopic techniques.[6]
• Invest in specialised diagnosis and treatment capacity, including diagnostic equipment, radiotherapy infrastructure, a new radiotherapy building and modern radiotherapy apparatus such as a linear accelerator.[6]
• Develop a bone-marrow transplantation department, rehabilitation and palliative-care services, pain management, and hospice infrastructure in Balti and Cahul.[4]
• Establish a Cancer Register information system to support preventive examination and oncology-patient record-keeping.[4]
• Procure specified oncology medicines centrally from sources provided for that purpose and support standardised treatment through ministerial regulations and clinical protocols.[6][4]

The Programme therefore identifies substantial capital, equipment, medicines, workforce and service-development requirements, but the available material does not provide a total programme budget, activity-level allocations, unit costs, expenditure ceilings, financing shares, partner contribution amounts, resource-mobilisation plan, funding-gap estimate or economic assumptions.[1][6][4]It also does not specify the monetary value, currency, date or duration of financing for the listed infrastructure, equipment, medicines, information-system or hospice investments.[6][4]