Plan National de Prévention et de Contrôle du Cancer 2020–2029

Objectives

Morocco’s second National Plan for Prevention and Control of Cancer, covering 2020–2029, aims to reduce cancer morbidity and mortality and improve the quality of life of people with cancer and their relatives. It builds on the first national plan to consolidate gains, remedy shortcomings in governance and care quality, reduce inequalities in access, and provide comprehensive, innovative and patient-centred care adapted to national resources and socio-economic circumstances.[1][2][3][4]

• Prevent cancer by reducing exposure to tobacco, harmful alcohol use, unhealthy diets, physical inactivity, infectious agents, occupational hazards and environmental carcinogens.[5][6][7]
• Strengthen surveillance of cancer, its determinants and occupational and environmental exposures, supported by cancer registries, periodic risk-factor surveys and an occupational and environmental cancer observatory.[6][7][8]
• Prevent and control cervical cancer through human papillomavirus vaccination, hepatitis B vaccination, hepatitis C screening and care, screening, diagnosis and treatment of precancerous lesions.[6][9][10]
• Expand equitable early detection of breast and cervical cancers, particularly for eligible, vulnerable and high-risk women, while improving public knowledge, screening participation, diagnostic quality and referral pathways.[10][11][12]
• Ensure timely, safe and high-quality diagnostic and therapeutic care, including primary-care early diagnosis, pathology, specialised oncology services, nationally adapted protocols, medicines access and national referral centres for complex care.[4][13][14]
• Institutionalise supportive and palliative care, generalise pain management, and ensure palliative-care support for all cancer patients who require it.[15][16]
• Strengthen governance, quality assurance, health information systems, workforce development and research as cross-cutting enablers across prevention, early detection, treatment and palliative care.[5][17][18]

The plan adopts equity, solidarity, participation, quality and excellence as guiding values, with programmes intended to protect the rights of people affected by cancer. It sets measurable ambitions including 70% participation in cervical screening, 90% human papillomavirus vaccination coverage among 11-year-old girls, 100% hepatitis B vaccination coverage among newborns within 24 hours, and improved survival outcomes for breast cancer and childhood cancer.[3][10][15]

Implementation

The plan uses an integrated, multisectoral and participatory delivery model spanning prevention, screening, diagnosis, treatment, supportive care and palliative care. It was developed by the Ministry of Health and the Lalla Salma Foundation for Cancer Prevention and Treatment through an assessment of the first plan, epidemiological analysis, a dedicated review committee and thematic planning workshops involving public institutions, health professionals, academic experts, civil society and international partners.[2][19][20][21]

• Coordinate national and regional implementation by mapping stakeholders, defining their roles, creating information-sharing mechanisms, translating the national plan into regional strategic plans, and agreeing regional roadmaps with health directorates.[17][22]
• Deliver prevention through collaboration between government, civil society, education, workplaces, health services and other sectors, including tobacco-free schools, universities, hospitals, workplaces and public administrations; cessation support; taxation advocacy; and communication campaigns.[23][6][24]
• Reduce occupational risk through exposure substitution, pesticide controls, workplace guidance, labour inspection, exposure-traceability records and an “Enterprise without cancer risk” initiative.[7]
• Provide organised breast and cervical screening through public-sector services, reproductive-health reference centres, mobile teams and recruitment approaches adapted to geographically isolated, vulnerable and high-risk populations.[23][11][12]
• Use public-private partnerships to purchase anatomical pathology services from private laboratories for breast and cervical cancer programmes, while maintaining free specified diagnostic and precancerous-lesion management services within the public programme.[12][4][25][26]
• Strengthen care capacity through oncology-centre construction, equipment renewal, standardised diagnostic platforms, specialised referral services, harmonised protocols, pooled medicines purchasing, direct supply to oncology centres, and pharmacy audits to prevent stock-outs.[13][14][27]
• Extend palliative care into primary healthcare while retaining specialist teams for complex cases, establish referral networks and a National Palliative Care Programme, improve opioid availability, and involve families, volunteers, local authorities, associations and community actors.[15][16]
• Implement quality assurance through facility-based quality-management units, standards, certification and accreditation support, including national steering arrangements and assistance from certified centres or international accreditation bodies.[22][18]
• Develop a secure, interoperable electronic patient record across all health-system levels, using a unique patient identifier, national standards, dedicated information-system teams and a management dashboard for plan monitoring.[18]
• Build workforce and research capacity through revised curricula, postgraduate oncology and palliative-care training, e-learning, centres of excellence, cancer research networks, clinical-trial strategy development, biobanking and priority research on epidemiology, health economics, social science and clinical care.[18][8][28]

Monitoring is intended to combine computerised patient records, cancer registries, risk-factor surveillance, programme data, quality assurance and periodic evaluation of all plan measures. Reported targets include accreditation of all oncology centres, computerised hospital information systems and quality approaches in all reproductive-health reference and oncology structures, and a 50% increase in cancer-related publications in indexed journals.[7][18][28]

The supplied material identifies programme budgets for some actions, including early detection, prevention, medicines and specialised services, but financing sources, funding gaps and a fully consolidated plan budget are not consistently specified.[25][14][27]

Monitoring & Evaluation

The plan embeds monitoring and evaluation within governance, quality assurance, health information systems, surveillance and periodic assessment. It builds on internal and external evaluation of the 2010–2019 plan, which identified governance and care quality as areas requiring improvement.[2]Strengthening governance and monitoring is an explicit objective, supported by cross-cutting quality-assurance and information-system axes.[5]

• Establish a national cancer-control monitoring and evaluation system, including a dashboard of management indicators to track actions and activities.[18]
• Extend the computerised patient record, already implemented in Regional Oncology Centres in Rabat, Casablanca, Tangier and Beni Mellal, to other centres in order to improve data processing, use and availability of monitoring indicators.[29][3]
• Develop a secure, interoperable digital patient record with national standards, a unique patient identifier and governance involving health, insurance, digital-development, data-protection, civil-society and private-sector bodies.[18]
• Measure cancer incidence, mortality and related epidemiological parameters by consolidating the Casablanca Cancer Registry, publishing its report every two years, establishing a national childhood-cancer registry and extending hospital registries to all Regional Oncology Centres.[7]
• Conduct national non-communicable-disease risk-factor surveys every five years, including Stepwise surveys, the Global Youth Tobacco Survey and the Global School-based Student Health Survey.[10]
• Strengthen surveillance of tobacco use, carcinogens in food, air and soil, pesticide exposure, and occupational and environmental cancers, including through a proposed national observatory within the Cancer Research Institute.[8][28]
• Monitor prevention targets, including a 20% reduction in smoking prevalence among children aged 13–15 years and adults, a 25% reduction in obesity, 90% human papillomavirus vaccination coverage among 11-year-old girls, 100% hepatitis B vaccination coverage among newborns within 24 hours, and 70% cervical-screening participation.[10]
• Track service-delivery targets, including annual screening coverage of at least 40% for breast cancer and 30% for cervical cancer, an 80% return rate for both programmes, treatment of all screen-detected cervical precancerous lesions, and specified diagnosis, treatment and survival outcomes.[4][15]
• Implement continuous monitoring, evaluation and data analysis for breast- and cervical-cancer early-detection programmes, supported by participant-tracing information systems and quality-assurance arrangements.[11][12]
• Evaluate implementation of all plan measures periodically and monitor expected results including computerised information systems and quality approaches in all reproductive-health reference and oncology structures, accreditation of all oncology centres, and a 50% increase in cancer publications in indexed journals.[28]

Regional implementation is intended to include roadmaps with regional health directorates, regional strategic plans, and follow-up evaluation.[22]The supplied material does not specify a consolidated indicator dictionary, standard reporting timetable, evaluation methodology, data-publication arrangements or a fully defined accountability framework.[5][18]

Costing & Financing

The plan includes a multi-year action and budget programme for 2020–2029 covering prevention, screening, diagnosis, treatment, palliative care, information systems, workforce development, research and infrastructure.[30][31][32]Available tables provide selected action-level allocations, but several programme sections have no populated amounts, and financing sources, funding gaps and wider economic assumptions are generally not specified.[31][32]

• Allocate reported amounts, with an unspecified currency and unit, to healthy-lifestyle promotion, harmful-alcohol measures, cervical-cancer prevention, viral-hepatitis risk management, occupational-cancer surveillance and cancer-risk-factor surveillance.[33][34][35]
• Cost early-detection actions for 2020–2029 in units of 1,000 Moroccan dirhams, including 324,400 for the reported programme section, 113,300 for reducing inequalities and cervical-cancer incidence, 1,600 for public-private pathology partnerships, and 1,800 for primary-level screening and diagnosis.[25][26][36]
• Fund service inputs including free mammography, ultrasound and biopsy procedures, free cervical early-diagnosis and precancerous-lesion management, human papillomavirus screening pilots, and purchased pathology services from private laboratories.[11][12][25][26]
• Provide stated table amounts in Moroccan dirhams for specialist referral centres, medicines acquisition and distribution, workforce support, supportive care and pharmacy audits; the supplied extract does not identify the budget year or funding source for these amounts.[14][27][37]
• Consider tobacco taxation as a public-health instrument and advocate dedicating part of tobacco-tax revenue to cancer research, prevention and care, while seeking lower prices and insurance reimbursement for smoking-cessation medicines and nicotine substitutes.[24]
• Maintain sustained financing for quality-assurance implementation and resource requirements for medicines, palliative care, digital systems, training, research, equipment and specialist staff.[17][22][18][8]

A global estimate cited for the annual cost of cancer is 1,160 billion US dollars in 2010.[2]Beyond this estimate and the listed table allocations, the supplied material does not specify an overall plan budget, financing envelope, resource-mobilisation strategy, donor or domestic funding shares, affordability analysis, or quantified funding gap.[2][25][14]