Plan Nacional Para El Control Del Cáncer 2024-2030

Objectives

Costa Rica’s National Cancer Control Plan 2024–2030 provides a strategic and tactical framework to reduce cancer mortality and improve survival through integrated, effective and timely interventions. It responds to cancer as the country’s second leading cause of death and aligns with the National Strategy for the Comprehensive Approach to Non-Communicable Diseases and Obesity 2022–2030, national health and development priorities, and regional and international commitments.[1][2][3][4]The Plan has one strategic axis, Integrated cancer care, and addresses the general population through cancer prevention and timely access to specialised services, with additional measures for children and adolescents affected by cancer.[4][5]

• Improve knowledge, attitudes and practices on cancer prevention and health promotion among the public and health workforce through multisectoral and interinstitutional action.[5][6]
• Reduce exposure to modifiable risks, including tobacco and alcohol use, unhealthy diets, physical inactivity, overweight and obesity, carcinogenic exposures and cancer-associated infections.[7][8][9][10][11]
• Promote human papillomavirus vaccination, cervical screening and treatment, and other evidence-based prevention measures, including attention to agricultural pesticide risks.[12][11][6][13]
• Strengthen early detection, timely diagnosis and access to comprehensive specialised care, spanning prevention, early detection, diagnosis and treatment, rehabilitation, pain control, palliative care and survivorship-related support.[14][15][16][17][5]
• Improve cancer information, surveillance and knowledge management through modernisation of the National Tumour Registry Information System, tumour-stage recording, paediatric staging records and a national screening registry.[18][13][19][20]
• Standardise care through evidence-based norms and protocols for adult, paediatric and adolescent cancers across public and private services.[21][22][23][24]
• Strengthen childhood cancer care and survival, supporting the World Health Organization objective of at least 60% survival among children and adolescents with cancer by 2030.[12][25][26]

The Plan’s outcome framework seeks to reduce premature mortality from cervical, breast, stomach and colorectal cancers among people aged 30–69 years from 38.38 deaths per 100,000 population in 2018–2022 to 37.33 in 2025–2029.[27][28]It also seeks to reduce the overall mortality rate for these cancers from 73.03 to 72.94 per 100,000 population over the same periods.[29][30]Childhood survival indicators cover acute lymphoblastic leukaemia, lymphoma and brain neoplasms, with specified baselines and survival-maintenance or improvement targets.[6][31][32][33]

Implementation

Implementation uses Results-Based Management for Development, organising expected effects, strategic actions, indicators, targets and responsibilities to support coordinated public value, accountability and health-system resilience.[34][5]The Ministry of Health is the public-health governing authority, directing and coordinating implementation with social actors across Costa Rica’s Social Health Production System.[2][35]The National Cancer Council advises the Ministry on organisation, coordination and planning of comprehensive cancer care across relevant public and private institutions.[35]

• Coordinate strategic management through the Ministerial Office, with technical-strategic management by the Ministry of Health Directorate of Health Services and planning support from the Directorate of Planning.[35]
• Deliver services through the Costa Rican Social Security Fund network, which links primary care, health areas and regional hospitals with national referral and specialised hospitals; preventive and early-detection activities operate across the network, while diagnostic confirmation and treatment are concentrated mainly in national hospitals.[36]
• Strengthen referral and counter-referral arrangements, multidisciplinary tumour teams, diagnostic equipment, radiotherapy capacity, specialised workforce development and access to public, private and public-private screening services.[37][38][16][17]
• Provide paediatric cancer care through the National Children’s Hospital, including specialised haematology-oncology services, treatment protocols, training, innovative-therapy review and paediatric palliative-care improvement.[39][22][40][41][42]
• Engage public institutions, hospitals, academic units, professional colleges, civil-society organisations, communities, private providers and international partners in education, research, prevention, care and implementation activities.[4][43][22][44][45]
• Use international and regional cooperation, including World Health Organization and Pan American Health Organization approaches, the International Agency for Research on Cancer, and International Atomic Energy Agency technical cooperation, to support assessment, technical assistance and potential resource-mobilisation alliances.[46][25][44][47]

Each strategic action is associated with an indicator, baseline, target and implementation responsibility.[48]The monitoring system, led by the Directorate of Health Services with technical support from the Monitoring and Evaluation Unit of the Directorate of Planning, uses data collection, processing, analysis, dashboards, indicator sheets and progress reports submitted by responsible actors.[35][49][48]Indicator sheets cover definitions, formulas, units, disaggregation, baselines, annual targets, frequency, sources and international linkages.[48]

Annual monitoring is scheduled for February 2026–2029, with additional monitoring possible where required by the governing authority.[50]Progress reports record achievement against annual targets, comments, risks and supporting evidence; results inform corrective actions, national cancer-control reports and strategic decision-making by the National Cancer Council, subject to endorsement by the Ministerial Office.[49][50][51]Final evaluation begins in 2030 and is due to conclude in the first half of 2031, examining relationships between actions and outcome indicators and identifying lessons for subsequent planning.[50][51]

Risk management follows the 2023 Specific Risk Assessment System and includes measures to address regulatory barriers, continuity risks, institutional coordination, information security, information infrastructure, staffing, installed capacity and disconnects between budgeting and planning.[51][52][53][54]The Plan contains selected resource estimates, but many activities lack cost estimates because institutional costing methodologies are unavailable; it does not provide a consolidated plan budget, financing envelope or quantified funding gap.[6][18][22][50]

Monitoring & Evaluation

The National Cancer Control Plan 2024–2030 uses a results-based monitoring system to track implementation, assess progress against indicators and targets, identify corrective actions, support accountability, and inform national cancer-control reporting.[5][35][49]The Directorate of Health Services of the Ministry of Health leads annual monitoring, with technical support from the Monitoring and Evaluation Unit within the Directorate of Planning; the National Cancer Council reviews the closing report for strategic decision-making, with decisions endorsed by the Ministerial Office.[35][50][51]

• Measure each strategic action through an associated indicator, baseline, target and responsible implementing body. Indicator sheets cover definitions, formulas, units, interpretation, geographical and thematic disaggregation, sources, frequency, annual targets and international linkages.[48]
• Collect, process and analyse data through planning templates, indicator sheets and progress reports from participating social actors, using a database and automated dashboard to present progress in tables, charts and summary reports.[49][48]
• Report annual progress against targets, including achievement percentages or numbers, implementation comments, risks and supporting evidence. Annual indicator measurement is scheduled for February 2026, 2027, 2028 and 2029, with additional monitoring possible where required by the governing authority.[50]
• Undertake final evaluation from 2030, concluding in the first half of 2031 through a closing report assessing relationships between strategic actions and outcome indicators and identifying lessons for future planning.[50][51]
• Manage implementation risks through the 2023 Specific Risk Assessment System, using regulatory reform, contingency and remedial plans, inter-institutional alliances, information-security capacity-building, infrastructure maintenance and staffing measures where needed.[51][52][53][54]
• Strengthen surveillance through the National Tumour Registry, including modernisation of the National Tumour Registry Information System, timely case closure and coding, tumour-stage recording, and a paediatric cancer staging registry.[18][13][19][55]
• Track outcome indicators for premature mortality from cervical, breast, stomach and colorectal cancers among people aged 30–69, with a baseline of 38.38 deaths per 100,000 population for 2018–2022 and a target of 37.33 for 2025–2029.[27][28]
• Monitor overall mortality from the same four cancers, targeted to decline from 73.03 per 100,000 population in 2018–2022 to 72.94 in 2025–2029.[29][30]
• Monitor key service and prevention indicators, including complete human papillomavirus vaccination, cervical and breast screening coverage, cancer-care standards, training, research promotion, multidisciplinary care and childhood cancer survival.[6][18][21][56][57]
• Target 90% complete human papillomavirus vaccination coverage by 2030 for girls and boys; the girls’ baseline was 68.7% in 2022, while the boys’ baseline was not available.[43][56][57]
• Target 53% cervical screening coverage and 54% mammography coverage by 2030. The cervical screening baseline was 31% in 2022 and the breast-screening baseline was 36% in 2021.[21][58][59]
• Monitor childhood cancer survival through CONCORD studies and registry data, including maintenance of five-year survival at 80% for acute lymphoblastic leukaemia, 93.5% for lymphoma and 69.8% for brain neoplasms.[31][32][33]

Costing & Financing

The Plan includes selected resource estimates but does not provide a consolidated implementation budget, comprehensive financing framework, confirmed funding sources, quantified funding gap, resource-mobilisation target or economic assumptions.[6][22][35][50]Several actions are recorded as not costed because no institutional costing methodology has been defined, including vaccination, screening, registries, training, new therapies and several information-system initiatives.[43][18][56][60][19]

• Allocate estimated resources to communication and education campaigns, continuing education, pesticide-related research, cancer-care standards, paediatric cancer standards, expenditure measurement and the health research agenda.[43][61][21][22][62][63]
• Use Health Accounts to measure cancer expenditure and identify financing sources for prevention, treatment, research and paediatric cancer services, with two evaluations planned by 2030.[64]
• Recognise service-resource pressures, including concentration of cancer care in national and specialised hospitals and the need to invest in diagnostic equipment, radiotherapy capacity and the workforce required to operate it.[15][38][16]
• Note that general and specialised curative inpatient and outpatient care represented 84.8% of public health expenditure in 2019, while estimated childhood cancer care at the National Children’s Hospital represented 16.03% of expenditure on other listed conditions.[15]
• Mobilise potential support through international cooperation, including the International Atomic Energy Agency project INT6066, which may facilitate comprehensive assessment, plan follow-up and resource-mobilisation alliances without specifying financial amounts.[44][47]