Plan Stratégique National de Lutte contre le Cancer au Burundi

Objectives

Burundi’s 2023–2027 National Strategic Plan for Cancer Control provides a national framework to reduce cancer incidence, morbidity and mortality, improve the quality of life of people affected by cancer, and advance equitable access to prevention, diagnosis, treatment, palliative care, rehabilitation, information and research.[1][2][3]It supports universal health coverage and is aligned with national development and health-sector policy frameworks.[4][5]

• Strengthen leadership, governance, coordination, institutional frameworks and sustainable financing for cancer control.[2][6]
• Prevent cancer through health promotion, tobacco and alcohol control, hepatitis B and human papillomavirus vaccination, and reduced occupational and environmental exposure to carcinogens.[7][8][9]
• Expand screening and early detection, particularly for cervical and breast cancer, while improving referral, follow-up and access for vulnerable populations.[7][10][11]
• Improve diagnostic and treatment capacity through pathology, imaging, laboratory services, chemotherapy, multidisciplinary care, qualified personnel and a national cancer reference centre.[12][13][14]
• Establish nationwide palliative and supportive care, including pain management, psychosocial, nutritional and spiritual support, rehabilitation and continuous access to oral morphine and other essential medicines.[12][15][16]
• Develop cancer registration, epidemiological surveillance, information systems and research to produce reliable data for planning, performance measurement and policy development.[3][17][18]

The plan sets measurable ambitions in several areas. It aims to increase primary-prevention initiatives by at least 25% by 2027, reduce infection-related cancers by 20%, achieve annual screening coverage of at least 40% for breast cancer and 30% for cervical cancer, diagnose at least 40% of expected breast cancers among women aged 40 to 69, treat all detected cervical precancerous lesions, and ensure that at least 80% of people with positive screening results return for care.[7][10][8][19]

Service-development objectives include improving diagnostic and cancer-management capacity by at least 25% over five years, constructing a national cancer reference centre by December 2026, expanding public hospitals providing cancer care from one in 2023 to five by 2027, and increasing the number of health professionals qualified in palliative care by at least 30% by December 2027.[12][20][13][21]

Implementation

Implementation combines multisectoral governance, health-system strengthening, decentralised delivery, partnership mobilisation, activity-based planning and progressively strengthened monitoring. The Ministry of Public Health and the Fight against AIDS leads the plan through the National Integrated Programme for the Control of Non-Communicable Diseases, with participation from other ministries, public and private providers, civil society, universities, development partners and international agencies.[22][23][24]

• Coordinate national and regional steering structures, map stakeholders, define their roles and information-sharing arrangements, and establish public, private and civil-society consultation mechanisms.[2][25][26]
• Deliver services across central, intermediate, peripheral and community levels, supported by provincial health directorates, health districts, hospitals, health centres, community actors and private providers.[27][28]
• Develop national standards, clinical guidelines, referral tools, quality-assurance arrangements and good-practice manuals aligned with international guidance.[29][30][14]
• Decentralise cancer care through regional referral hubs, centres of excellence, day-chemotherapy units, mobile screening services and strengthened diagnostic capacity outside Bujumbura.[31][32][33][34]
• Build workforce capacity through specialist training, standardised oncology curricula, training of trainers, continuing education and partnerships for South-South and North-South exchange.[35][36][37]
• Implement palliative care through pilot facilities and community-linked services, minimum care packages, multidisciplinary teams, supervision tools, training manuals and an oral-morphine preparation and dispensing capacity.[15][38][39]

Prevention and early detection are intended to use public communication, school and community campaigns, vaccination, private-sector participation, screening protocols and integrated referral pathways. Cervical screening is to include screen-and-treat or screen, triage and treat approaches using visual inspection with acetic acid, human papillomavirus testing and cytology, with outreach and static-facility models adapted for disadvantaged communities.[7][11][40]

The diagnostic and treatment model includes a national cancer reference centre, regional chemotherapy services, multidisciplinary consultation, pathology and telepathology, imaging, endoscopy, equipment maintenance, national treatment guidance and coordinated management of anticancer medicines, supportive medicines, morphine, consumables and medical devices.[13][41][42][43]

Monitoring is intended to draw on cancer-registry and cancer-care-centre data, logical frameworks, dashboards, performance reviews, data-validation meetings and periodic plan evaluations.[3][30][44]The plan provides for surveillance directives, an agreed cancer-indicator manual, strengthened Bujumbura registry staffing and infrastructure, digitised data collection, annual data-presentation meetings and publication of a biennial national cancer report.[17][45][44]

Financing measures include budgeting and costing the plan, advocating for increased public financing, establishing annual dedicated budget lines for cancer medicines and palliative care, creating a special subsidy fund for diagnosis and anticancer treatment, and mobilising government, private-sector and international-partner resources.[31][35][46]Proposed innovative mechanisms include directing 15% of alcohol and tobacco tax revenue to cancer control, telecommunications-linked contributions, an annual Government-led telethon and tax deductions for private-company donations.[47][48]

Monitoring & Evaluation

The plan establishes a performance-oriented approach combining cancer registration, epidemiological surveillance, routine health information, activity monitoring, supervision and periodic review. It recognises that historically weak cancer data, the absence or interruption of registry operations, limited digitisation and insufficient surveillance financing have constrained evidence-based planning.[49][50][51]

• Establish and operationalise an epidemiological cancer-surveillance system through validated directives and a consensual cancer-indicator manual.[17][45]
• Strengthen the Bujumbura cancer registry by appointing hospital data focal points, recruiting registry staff, providing internet access and transport, and conducting regular data collection.[45]
• Digitise cancer-data collection across referral facilities, equip focal-point facilities with information technology, and use the District Health Information Software 2 system for cancer and screening data.[52][53]
• Validate cancer data quarterly, convene annual data-presentation meetings, publish a biennial national cancer report in 2026, and conduct six-monthly formative supervision of digitised data collection.[44][52]
• Develop a dashboard of management indicators, conduct quarterly cancer-control performance reviews and produce periodic evaluation reports on implementation of the national plan.[30][53]
• Use cancer-registry and cancer-care-centre data to monitor early diagnosis and treatment, five-year survival, palliative-care uptake and service delivery.[54]
• Track governance through budget-execution rates, with targets increasing from 5% in 2023 to 100% in 2027.[20]
• Monitor screening coverage, targeted to rise from 5% in 2023 to 80% in 2027, alongside targets for early diagnosis, early treatment, survival and compliance with quality standards.[20]
• Monitor prevention and early detection through targets including a 25% increase in primary-prevention initiatives, 40% annual breast-cancer screening coverage, 30% cervical-cancer screening coverage, treatment of all detected cervical precancerous lesions and an 80% return rate after a positive screening result by 2027.[7][10]
• Supervise palliative-care services through validated tools, a six-monthly calendar and standardised records, registers, home-visit forms and activity-summary forms that support reporting and follow-up.[38]
• Evaluate research and surveillance through studies of prevention cost-effectiveness, cancer incidence and mortality, programme impact, and feasibility of human papillomavirus testing.[18][55]

Many implementation matrices provide expected results, dates, priorities and responsible structures, but several extracts do not specify complete indicator definitions, reporting formats, data-quality protocols, evaluation methods or formal accountability procedures.[25][36][17]

Costing & Financing

The plan combines budgeted programme mechanisms, targeted subsidy proposals, government financing, partner mobilisation and innovative revenue options, but most extracts do not provide a complete programme budget, financing gap or costed annual expenditure plan.[31][47][56]

• Budget the cancer plan, rationalise available resources, allocate funds for palliative medicines at central and decentralised levels, and introduce innovative financing mechanisms.[31]
• Establish annual dedicated budget lines for anticancer medicines, supportive medicines, morphine, consumables and medical devices.[31][43]
• Create and replenish annually a special fund to subsidise cancer diagnosis and anticancer treatment, reflecting the high cost of care relative to household purchasing power.[35]
• Mobilise resources for a national cancer reference centre through annual meetings during 2023–2027 and government-led donor engagement intended to reduce treatment abroad.[13][57]
• Allocate specific financing for cervical-cancer screening, early breast-cancer diagnosis and screening or early diagnosis of common cancers in Burundi’s regions.[58]
• Purchase diagnostic services from private anatomical pathology laboratories where households cannot afford private-sector services.[33]
• Advocate for the allocation of 15% of alcohol and tobacco tax revenue to cancer control and for dedicated financing of surveillance, screening, diagnosis and treatment infrastructure.[47]
• Develop innovative resource mobilisation through telecommunications contributions, an annual government-led telethon and tax incentives for private-company donations.[48]
• Establish continuous financing for cancer-registry activities and cancer research, supported by national and international research partnerships.[55][24]
• Subsidise and publish prices for anticancer medicines, morphine and other essential palliative-care commodities, and include oral morphine and related medicines in mutual-health-insurance coverage.[12][59]

Direct patient costs demonstrate substantial affordability barriers: public pathological examinations were reported at 50,000 FBU compared with an average of 200,000 FBU privately, while computed tomography ranged from 150,000 to 200,000 FBU publicly and from 200,000 to 1,000,000 FBU privately.[60][61]Immunohistochemistry and human papillomavirus testing sent to France cost between 50 and 200 US dollars.[60]Wider constraints include poverty, declining gross domestic product per capita, inflation, insufficient registry operating funds and high costs of diagnostic investigations.[27][50]