Plan Nacional Para El Control Del Cáncer 2024-2030

Objectives

Costa Rica’s National Cancer Control Plan 2024–2030 is a results-based planning instrument within the National Strategy for the Comprehensive Approach to Non-communicable Diseases and Obesity 2022–2030. It seeks to reduce cancer mortality and improve survival through effective, timely and comprehensive interventions, aligned with universal health coverage, reduced premature mortality and increased healthy life expectancy.[1][2][3]

• Implement comprehensive cancer care as the overarching area of work, structured around cancer prevention and health promotion, and timely access to specialised health services.[2][3]
• Improve knowledge management for prevention and health promotion through multisectoral and interinstitutional interventions that strengthen population knowledge, attitudes and practices.[3][4]
• Strengthen detection, timely diagnosis and equitable access to specialised comprehensive care, including laboratory, imaging, molecular, genetic, biopsy, surgery, radiotherapy and chemotherapy services.[3][5][6]
• Reduce modifiable risks by addressing tobacco and alcohol use, unhealthy diets, physical inactivity, overweight, obesity, pesticide exposure and cancer-associated infections.[7][8][9][10]
• Support cervical cancer elimination through vaccination, screening and treatment, including a target of 90% complete human papillomavirus vaccination coverage among girls and boys by 2030.[3][11][12][13]
• Increase cervical screening coverage to 53% by 2030 and mammography coverage to 54% by 2030, while developing a national cancer-screening registry.[14][15][16][17]
• Strengthen paediatric and adolescent cancer care, including the global ambition of at least 60% childhood cancer survival by 2030 and targeted action on treatment, training, early detection, palliative care and information systems.[18][3][19][20][21]
• Maintain five-year overall survival targets of 80% for childhood acute lymphoblastic leukaemia, 93.5% for childhood lymphoma and 69.8% for childhood brain neoplasms.[22][23][24]
• Standardise cancer care through national standards and protocols spanning prevention, early detection, treatment, rehabilitation and palliative care, including seven developed or updated standards by 2028.[25][26]

The Plan is informed by epidemiological evidence showing cancer as a major cause of mortality and by recognised gaps in staging data at diagnosis, which limit assessment of timely diagnosis and health-system impact.[27][28]Its outcome framework includes reducing premature mortality from cervical, breast, stomach and colorectal cancers among people aged 30–69 from 38.38 per 100,000 in 2018–2022 to 37.33 per 100,000 in 2025–2029.[29][30]

Implementation

Implementation combines Ministry of Health stewardship, coordinated action across the national health system and wider social production of health system, and results-based management. The Ministry of Health exercises rector leadership, while the National Cancer Council acts as an advisory body for organising, coordinating and planning comprehensive cancer care across public and private institutions.[31][32][33]

• Coordinate delivery through the Ministry of Health’s Directorate of Health Services, with strategic leadership from the Ministerial Office and technical support from the Directorate of Planning and its Monitoring and Evaluation Unit.[33]
• Engage the Costa Rican Social Security Fund, National Children’s Hospital, public and private providers, universities, professional colleges, civil-society organisations, international agencies and other social actors through strategic alliances and intersectoral collaboration.[2][34][35][36][37]
• Deliver prevention through communication campaigns, risk-factor interventions, vaccination, continuing education, research on agricultural pesticides and community-based health-promotion initiatives.[4][11][38][39][40]
• Provide screening, diagnostic confirmation and treatment across the Costa Rican Social Security Fund’s three-level care network, with preventive and early-detection activities delivered throughout the network and complex treatment concentrated mainly in national hospitals.[41][42]
• Maintain continuity of care through referral and counter-referral arrangements, and integrate community-based palliative care early with regular cancer treatment.[43][2]
• Modernise the National Tumour Registry Information System and establish a paediatric cancer staging registry, supported by the Ministry of Health, the Costa Rican Social Security Fund and the National Children’s Hospital.[44][45][46]
• Develop the Costa Rican Social Security Fund’s Institutional Cancer Care Plan for 2025–2030 through formulation, implementation and evaluation phases.[47][48]
• Use international cooperation, including the International Atomic Energy Agency INT6066 project, to support cancer-control assessments, plan follow-up, resource-mobilisation alliances and radiation-related cancer services.[49][50]

Monitoring is based on an automated dashboard that tracks action indicators and targets using planning templates, indicator sheets and progress reports submitted by responsible actors. Indicator sheets specify definitions, formulae, units, interpretation, disaggregation, baselines, annual targets, measurement frequency, information sources and statistical classifications.[51][52]

The Directorate of Health Services coordinates annual indicator monitoring, with progress records submitted in Microsoft Excel and including achievement against targets, comments, risks and evidence.[53]Monitoring is scheduled annually in February 2026–2029, with additional monitoring possible at the governing authority’s discretion.[53]A final evaluation is planned from 2030 to the first half of 2031 through a closure report assessing links between actions and outcome indicators and documenting lessons for future planning.[54]

Risk management uses measures from the 2023 Specific Risk Assessment System, including regulatory reform, contingency planning, alliances, information-security training and protocols.[54][55]Identified operational risks include cybersecurity vulnerabilities, limited technological and human capacity, staff turnover, and weak alignment between budgeting and planning; mitigation actions include backups, infrastructure maintenance, resource advocacy, staff knowledge management and remedial planning.[56][57]

Costing remains incomplete: several actions lack estimates because no institutional costing methodology exists, although the Plan includes activity-level resource estimates for selected standards, training, communication and research actions.[11][38][58][59][19][20]

Monitoring & Evaluation

The Plan establishes an implementation-focused monitoring and evaluation system led by the Ministry of Health’s Directorate of Health Services, combining annual indicator tracking, administrative data, cancer surveillance, progress reporting, risk management and a final evaluation in 2030–2031.[33][51][53][54]

• Operate an automated dashboard to track action indicators and targets, using planning templates, indicator sheets and progress reports submitted by responsible social actors.[51]
• Use indicator sheets that define the calculation formula, unit of measurement, interpretation, disaggregation, baseline, annual targets, measurement frequency, data source and statistical classification.[52]
• Collect annual progress records through Microsoft Excel, including results achieved against targets, implementation comments, risks and supporting evidence.[53]
• Measure indicators annually in February 2026, 2027, 2028 and 2029, with additional monitoring permitted when required by the health-sector governing authority.[53]
• Compare baselines with implementation results, identify delays, apply corrective support or advocacy, and share national cancer-response progress reports with participating institutions and organisations.[51][53]
• Conduct a final evaluation from 2030 through the first half of 2031, using a closure report to assess relationships between strategic actions and outcome indicators and to document lessons for future planning.[54]
• Submit strategic decisions to the National Cancer Council, chaired by the Minister of Health or a delegate, before endorsement by the Ministry of Health’s Ministerial Office.[54]

The indicator framework includes mortality, survival, prevention, vaccination, screening, registry, service-standard, workforce, training, research and institutional-planning measures.[4][58][59][19][20][21]Key outcome measures include reducing premature mortality from cervical, breast, stomach and colorectal cancers among people aged 30–69 from 38.38 per 100,000 in 2018–2022 to 37.33 per 100,000 in 2025–2029, measured quinquennially.[29][30]The Plan also targets a reduction in overall mortality for these cancers from 73.03 to 72.94 per 100,000 over the same periods.[60]

• Maintain five-year survival at 80% for childhood acute lymphoblastic leukaemia, 93.5% for childhood lymphoma and 69.8% for childhood brain neoplasms, with relevant survival measures assessed in 2030 through CONCORD-4.[22][23][24]
• Increase complete human papillomavirus vaccination to 90% by 2030 for girls and boys, monitored annually through administrative records; the baseline for girls was 68.7% in 2022, whereas the boys’ baseline was not estimated.[12][61][13]
• Reach 53% cervical-screening coverage and 54% mammography coverage by 2030, alongside completion of the National Cancer Screening Registry.[59][14][15][17]
• Modernise the National Tumour Registry Information System by 2029, establish a paediatric cancer staging registry by 2030, and improve tumour-stage recording to address current limitations in assessing diagnostic timeliness and metastatic disease.[58][44][45][62]
• Use National Tumour Registry incidence data and National Institute of Statistics and Census mortality data, while recognising that the mortality registry is considered highly reliable and has approximately 2% unidentified or misclassified causes of death.[63][64]

Risk management follows the 2023 Specific Risk Assessment System, with measures addressing regulatory, institutional, capacity, workforce, information-security and planning risks.[54][55]Selected mitigation actions require permanent implementation or completion within 12 months of risk detection.[56][57]Independent evaluation, accountability sanctions and a detailed reporting calendar are not specified.[33][51][52]

Costing & Financing

The Plan contains selected activity-level resource estimates, but does not provide a consolidated budget, financing strategy, funding-gap analysis, financing sources or broader economic assumptions.[4][19][20][21]Many activities cannot be costed because no institutional costing methodology has been defined.[58][65][66][46]

• Allocate 31,920,000 for interinstitutional coordination of communication and education campaigns on cancer prevention and early detection during 2025–2029; the source does not clearly identify the currency.[11]
• Allocate 5,775,000 each for continuing education provided by health professional colleges and academic health units during 2025–2030; the source does not clearly identify the currency.[38]
• Allocate 13,491,533 for promoting research on the human-health and environmental effects of agricultural pesticides during 2024–2030; the source does not clearly identify the currency.[38]
• Provide 9,055,000 euros for developing or updating cancer-care standards during 2024–2028 and 4,900,000 euros for evaluating two standards during 2026–2027.[59]
• Provide 5,600,000 euros for standardising paediatric and adolescent cancer care in 2025 and 26,400,000 euros for measuring cancer-care expenditure and identifying financing sources during 2025–2030.[19]
• Record 89,309,685 for incorporating cancer into the 2025–2030 National Agenda of Health Research and Technological Development, although the currency is not identified.[21]

Existing expenditure evidence is limited. Curative inpatient and outpatient care represented 84.8% of estimated public health expenditure in 2019, while childhood cancer care at Hospital Nacional de Niños Dr Carlos Sáenz Herrera represented an estimated 16.03% of expenditure on the other pathologies listed in that hospital’s Disease Distribution list.[67]Cancer care was predominantly concentrated in national or specialised hospitals in the 2019 and 2020 health expenditure reports.[67]

• Assess cancer-care expenditure and identify financing sources through health accounts based on the System of Health Accounts 2011 framework, with assessments scheduled for 2027 and 2029.[68]
• Base several planning-matrix estimates on staff time, including work to coordinate communications, develop or evaluate standards, prepare care norms, and obtain, analyse and promote education reports.[69][70][26][71][72]
• Recognise that HPV vaccination, screening registries, paediatric registries, therapies, palliative-care improvements and several training targets lack budget estimates because no institutional costing methodology is available.[66][16][73][74]
• Identify limited economic and human resources as constraints on information-technology prioritisation and delivery, including modernisation of cancer information systems.[45]

International cooperation may support resource-mobilisation alliances through the International Atomic Energy Agency technical cooperation project INT6066, but no associated financing amount is specified.[49]