المخطط الوطني للوقاية ومراقبة السرطان

Objectives

The National Plan for Cancer Prevention and Control 2020–2029 is Morocco’s long-term, patient-centred framework for reducing cancer morbidity and mortality, improving quality of life for people with cancer and their families, and reducing inequalities in access to prevention, diagnosis, treatment and palliative care.[1][2][3]It builds on the first national plan and seeks to address weaknesses in governance, planning and quality of care through innovative, sustainable and adaptable action suited to Morocco’s socio-economic and cultural context.[4][3]

• Consolidate achievements of the previous plan while strengthening quality, equity, governance, training, research and national cancer-control capacity.[5][2][6]
• Organise action across prevention, early detection, diagnosis and treatment, medicines, supportive and palliative care, quality assurance, information systems, communication, training and research.[7][6]
• Reduce exposure to modifiable risk factors, including tobacco, unhealthy diet, physical inactivity, obesity, harmful alcohol use, infectious diseases, environmental pollution and occupational carcinogens.[8][9][10][11]
• Prevent cervical cancer through human papillomavirus vaccination, screening, diagnosis and treatment of pre-cancerous lesions, in line with the global elimination initiative.[12][9][13]
• Strengthen early detection of breast and cervical cancers, improve screening knowledge and behaviours, introduce quality assurance, and ensure equitable access for vulnerable groups.[14][15][16]
• Provide comprehensive, safe and effective cancer care through qualified professionals, innovative treatment and facilities meeting international standards.[17][18]
• Ensure that all patients requiring palliative care receive appropriate support, while institutionalising supportive care, pain management, psychological support, nutrition, rehabilitation and child-focused services.[19][20]
• Achieve quantified prevention targets, including reductions in smoking and obesity prevalence, 90% human papillomavirus vaccination coverage among 11-year-old girls, and 100% hepatitis B vaccination coverage among newborns within 24 hours of birth.[21][22]
• Meet service targets including at least 40% annual breast-cancer screening coverage, 30% cervical-cancer screening coverage, treatment of all detected cervical pre-cancerous lesions and full palliative-care coverage for people in need.[23][20]

Implementation

Implementation combines multisectoral coordination, integrated patient- and family-centred care, decentralised regional delivery, public-private collaboration, strengthened information systems and continuous quality improvement.[2][24][25]The Ministry of Health and the Lalla Salma Foundation for Cancer Prevention and Treatment developed the plan through a dedicated review committee and planning workshops involving experts, government departments, organisations and other stakeholders.[26][27]

• Translate the national framework into regional projects and contractual roadmaps with the Ministry of Health’s regional directorates, supported by defined stakeholder roles, coordination arrangements and information sharing.[28][29]
• Deliver prevention through legislation, education, public communication, civil-society partnerships, school and workplace initiatives, and national and interministerial consultation on tobacco control.[30][31][32][33]
• Expand smoke-free schools, higher-education institutions, hospitals, businesses and public administration, while improving cessation support and considering reimbursement for cessation medicines and nicotine-replacement products through compulsory health insurance.[31][32]
• Integrate breast and cervical screening into the health system through national reference frameworks, reproductive-health referral centres, mobile services, free public-sector screening and early diagnosis, and targeted mechanisms for underserved populations.[34][15][35]
• Strengthen diagnostic and treatment pathways across primary healthcare centres, provincial and regional hospitals, university hospital centres, private clinics and oncology centres through staffing standards, equipment, protocols, training and follow-up.[18][36][37]
• Expand oncology infrastructure by constructing, equipping and maintaining regional oncology centres, centres of excellence and specialist referral services, including planned facilities in Drâa-Tafilalet and Safi Province.[37][38][39]
• Strengthen public-private partnerships, including the purchase of diagnostic pathology services from private laboratories for breast and cervical cancer programmes.[25][40]
• Develop a tiered palliative-care network of units, beds, health centres, mobile specialist teams, hospital and home-based services, supported by community associations, volunteers, local authorities and support groups.[20][41][42]
• Establish quality-management mechanisms, a national quality-assurance committee, care standards, institutional quality units and accreditation support for cancer-care structures.[29][43]
• Deploy secure, interoperable electronic patient health records, a unique national patient identifier and information-system teams, with a national committee involving health authorities, university hospitals, insurance bodies, data-protection authorities, the Digital Development Agency, the Lalla Salma Foundation and private-sector representatives.[44][45]
• Use dashboards, patient records, cancer registries and risk-factor surveillance to monitor implementation, data quality, service pathways, cancer incidence, mortality and priority outcomes.[46][47][44][48]
• Strengthen workforce capacity through specialist education, continuing professional development, oncology and palliative-care curricula, e-learning, quality-assurance training and professional support.[49][50][51]
• Advance research through a priority-based strategy, an occupational and environmental cancer observatory attached to the Cancer Research Institute in Fez, clinical-trial reform, biobanks, research networks and periodic evaluation of plan measures.[52][53][54]

Monitoring & Evaluation

The plan establishes a monitoring and evaluation architecture centred on governance, quality assurance, information systems, patient records, cancer registries, surveillance and periodic assessment of implementation.[7][47][44][54]It aims to improve data quality, support decision-making and track progress across prevention, screening, diagnosis, treatment, palliative care, training and research.[47][44]

• Develop an information system and dashboard with indicators, guidance and follow-up on the status, development and progress of planned actions and activities.[44]
• Deploy secure, interoperable electronic patient health records, based on a standardised web model and a unique national patient identifier, to support care-pathway follow-up, data sharing and data quality.[47][43][44][45]
• Establish dedicated information-system teams and a national patient-record committee involving the Ministry of Health, university hospitals, health-insurance bodies, data-protection and digital-development institutions, the Lalla Salma Foundation for Cancer Prevention and Treatment, and private-sector representatives.[44][45]
• Translate the national plan into regional projects and contractual roadmaps with Ministry of Health regional directorates, while maintaining follow-up and evaluation of regional implementation.[28][29]
• Apply quality-assurance mechanisms across strategic areas and care structures, including quality-management units, national standards, documentation and assessment of existing practices, and support from accredited centres or international accreditation bodies.[29][43]
• Strengthen cancer surveillance through the Greater Casablanca population-based cancer registry, with publication every two years; establish a national childhood cancer registry; and extend hospital-based registries to all regional oncology centres.[46]
• Create a national observatory for occupational and environmental cancers at the Cancer Research Institute in Fez to investigate environmental and occupational exposures, support cohort studies and develop occupation- and sector-specific morbidity and mortality indicators.[53]

Quantified prevention targets include reducing smoking prevalence by 20% among children aged 13 to 15 and adults aged 18 and over, reducing general-population obesity prevalence by 25%, achieving 90% human papillomavirus vaccination among 11-year-old girls, and achieving 100% hepatitis B vaccination among newborns within 24 hours of birth.[21][22]Screening and early-detection targets include at least 40% annual breast-cancer coverage, 30% cervical-cancer coverage, 80% repeat screening among previously screened people, diagnosis of at least 40% of anticipated breast cancers among people aged 40 to 69, and treatment of all programme-detected cervical pre-cancerous lesions.[23]

Other outcome measures include 100% coverage by mobile palliative-care teams, palliative care for all patients who need it, doubled annual morphine consumption, at least 90% cervical-cancer treatment coverage, a five-year increase in life expectancy for breast-cancer patients, and 80% five-year survival among children with cancer.[55][49]The plan also targets hospital information-system and quality-procedure coverage across all relevant referral reproductive-health and regional oncology centres, full accreditation of regional oncology centres, and a 50% increase in oncology publications in indexed journals.[48]

Monitoring is intended to cover cancer incidence, mortality, cervical-cancer mortality, annual diagnosis and treatment rates, risk factors, screening participation, vaccination coverage, patient pathways and service quality.[30][34][13][46][48]The available text does not specify a consolidated reporting timetable, a complete indicator dictionary, independent evaluation procedures, or clearly assigned formal accountability responsibilities beyond the committees, regional directorates, information systems and quality structures described.[28][44][45][48]

Costing & Financing

The plan includes work programmes and estimated-budget sections for 2020 to 2029, covering infrastructure, oncology centres, diagnostic platforms, tumour-treatment equipment, information systems, prevention, early detection, cancer care and palliative care.[7]It also lists investment programmes for constructing referral reproductive-health centres and constructing, expanding and equipping regional oncology centres.[48][38][39]

• Maintain financing for quality-assurance measures across cancer prevention, early detection, treatment and palliative-care structures.[29]
• Provide resources required to implement and sustain screening programmes, with public-sector screening and early-diagnosis services provided free of charge.[34]
• Provide free mammography, ultrasound and biopsy-related interventions within the breast-cancer screening programme, and maintain free early diagnosis and initial management of cervical pre-cancerous lesions.[35][40]
• Support equipment procurement, renewal and maintenance, oncology-centre development, and the purchase of diagnostic pathology services from private laboratories through public-private partnership.[40][37]
• Assess the economic and epidemiological effects of cigarette consumption, use tobacco pricing as a public-health measure, and propose allocating part of tobacco-tax revenue to a dedicated fund for cancer research, prevention and improved patient care.[32]
• Reduce prices for smoking-cessation medicines and nicotine-replacement products and consider reimbursement through compulsory health insurance, involving the National Health Insurance Agency.[32]

The only explicit monetary estimate in the available text is an estimated annual global cost of cancer of approximately 1,160 US dollars billion in 2010.[56]This is a global estimate rather than a Morocco-specific National Cancer Prevention and Control Plan budget.[56]

No monetary amounts are provided for the plan’s estimated budgets, infrastructure investments, screening programmes, information systems, palliative-care expansion, quality assurance, research or workforce development.[7][48]The available text also does not specify total financing allocations, funding gaps, donor contributions, a detailed resource-mobilisation strategy, unit costs, cost-effectiveness assumptions or broader economic projections.[29][44][48]