National Strategy for Cancer Control in Ghana

Objectives

Ghana’s National Strategy for Cancer Control, covering 2012 to 2016, provides a comprehensive national framework to reduce cancer incidence, mortality and impact, improve survival and quality of life, and integrate cancer control into health planning and service delivery.[1][2]It follows a comprehensive continuum of prevention, early detection, diagnosis, treatment, rehabilitation, palliative care, surveillance and research.[3][4]

• Reduce cancer incidence and mortality by 30% through primary prevention, screening and early detection.[2][5]
• Improve diagnosis and treatment by 30% through evidence-based and cost-effective interventions.[2][5]
• Improve quality of life for people with cancer and their families by 40% through support, rehabilitation and palliative care.[2][5]
• Document 50% of cancer cases and establish a functional population-based cancer registry to support surveillance, planning, research and evaluation.[2][5][6]
• Strengthen service delivery through planning, coordination, decentralisation, workforce development, infrastructure and improved resourcing across all levels of care.[2][7][8]

Priority action spans healthy diets and physical activity; tobacco, alcohol, occupational and environmental risk control; infection-related cancer prevention; public awareness; screening and early diagnosis; referral and treatment; palliative care; cancer registration; research; and partnerships inside and beyond the health sector.[2][9][10]Key priority cancers include breast, cervical, prostate, head and neck, childhood, haematopoietic and gastrointestinal cancers, including liver cancer.[5]

The strategy seeks to replace fragmented and limited-coverage activities with systematic countrywide action, while promoting public awareness that cancers can be prevented, detected early and, in some cases, cured.[11]Expected results include stronger awareness, systematic national screening, improved treatment outcomes and survival, functional palliative care, a functioning cancer registry and improved human-resource capacity.[12]

Implementation

Implementation is intended to use an integrated, decentralised health-system model that combines population prevention with accessible screening, referral, diagnosis, treatment, palliative care, data systems and research.[7][13]National treatment centres at teaching hospitals provide specialised services including radiotherapy, regional hospitals provide treatment and referral, district and sub-district facilities support screening, and communities focus on education, health promotion and home-based support.[8][13]

• Establish programme leadership by elevating cancer control to programme status, appointing a Programme Manager and using a National Cancer Control Steering Committee or advisory structure to advise on planning, coordination, implementation, resource mobilisation, monitoring and evaluation.[1][13]
• Engage the Ministry of Health, Ghana Health Service, National Health Insurance Scheme, hospitals, training institutions, regulatory agencies, civil society, patient representatives, research bodies, non-governmental organisations, development partners and relevant sectors around a shared cancer-control agenda.[14][5][13]
• Implement prevention through public education, school health programmes, healthy-food promotion, physical-activity opportunities, tobacco and alcohol controls, taxation, advertising restrictions, workplace safety measures and regulation of carcinogenic exposures.[9][15]
• Prevent infection-related cancers through hepatitis B vaccination, blood-safety measures, hepatitis testing and prevention of hepatitis C transmission, alongside human papillomavirus vaccination delivered through the national immunisation programme using school, community and outreach channels.[10][16]
• Expand organised and opportunistic screening, early diagnosis and referral through reproductive health, family planning, sexually transmitted infection and other routine health services.[17]
• Deliver multidisciplinary cancer care using clinical, surgical, radiation and medical oncology, pathology, radiology, nursing, psychology, social work, dietetic and rehabilitation expertise.[18]
• Develop treatment protocols, referral guidance, pharmacovigilance arrangements and Cancer Management Boards at cancer centres and regional hospitals.[19]

Palliative care is to be decentralised to sub-national, community and household levels, with specialised core teams, trained community providers and family involvement.[19][20]Health centres and district hospitals are intended to supervise lower-level teams, maintain supplies, provide follow-up and referral, while specialist centres manage advanced procedures, training and complex care.[20]Essential medicines, including oral morphine, are to be available at all levels, and the plan sets a target of providing palliative care to 25% of eligible patients by 2020.[21][19]

Workforce and infrastructure actions include postgraduate cancer-specialty fellowships, revised training curricula, continuing professional development, pathology and imaging capacity, radiotherapy and surgical equipment, laboratory accreditation and maintenance arrangements.[4]The registry approach includes appointing leadership, training data officers, establishing technical and advisory committees, adopting nationally consistent minimum data sets, integrating data from Accra and Kumasi, and producing annual reports on incidence, prevalence, treatment and survival.[6]

Monitoring is intended to use surveys, records reviews, facility reporting and registry data across prevention, screening, treatment, palliative care and registration.[22][23]Most indicators are reviewed annually, while selected screening referral and screening-centre indicators are reviewed bi-annually.[22]Financing mechanisms include increased government allocation, tobacco and alcohol tax proceeds, National Health Insurance Scheme coverage for cancer medicines, endowment funds, childhood-cancer support funds and partnerships; no overall budget or detailed costed financing plan is specified in the supplied material.[15][24]

Monitoring & Evaluation

The strategy’s monitoring and evaluation approach centres on establishing a functional, population-based national cancer registry, improving routine data collection, conducting operational and baseline research, and using evidence to plan, supervise and assess cancer-control activities.[2][4][6][24]The framework recognises that Ghana’s cancer data have been incomplete, often deriving from institutional reports, sentinel mortality sites or modelled estimates, with limited geographical and disease coverage.[1][12][25]

• Establish and maintain a population-based cancer registry, alongside hospital-based registries, to document 50% of cancer cases, generate complete and timely information, and support surveillance, research, service planning and evaluation.[2][5][4][6]
• Develop a nationally consistent minimum cancer-registration data set; maintain accurate, confidential records; recruit and train data officers; procure renewable software; integrate data from Accra and Kumasi; and establish technical and advisory committees for registry oversight.[6]
• Produce and disseminate annual reports on cancer incidence, prevalence, treatment and survival to the Ministry of Health, Ghana Health Service, hospitals, clinicians and other stakeholders.[6]The proposed population-based registry is also expected to produce annual national cancer-statistics reports.[26][24]
• Undertake regular operational research and baseline research to inform decisions and assess indicators, including collaborative social, behavioural, environmental, psychological and health-services research.[2][6][13][24]
• Monitor prevention through annual records reviews of information, education and communication materials, mass-media outputs and advocacy activities, alongside annual surveys of cancer knowledge and population exposure to cancer risk factors.[27][22]
• Assess screening and early detection through training records, equipment procurement, referrals of suspected cases, screening-centre establishment, public-awareness coverage, stage distribution reported by facilities and screening among populations at risk.[22]Most measures are reviewed annually, while referrals and screening-centre establishment are reviewed bi-annually.[22]
• Track treatment through annual records reviews of trained professionals, treatment guidelines and protocols, cancer medicines, continuing professional development, cancer centres, cure rates and survival.[22]The monitoring framework gives a baseline of two national cancer centres.[22]
• Track palliative care through professional training, facility availability and use of oral morphine, morphine guidelines, integration into service delivery, hospice establishment and access among eligible patients.[23]The plan sets a target of providing palliative care to 25% of eligible patients by 2020.[19]
• Use technical supervision and monitoring at national, regional and district levels, supported by Cancer Management Boards at cancer centres and regional hospitals and registry technical and advisory committees.[19][4][6][26]
• Improve data quality through laboratory accreditation to reduce false-positive and false-negative results, and through improved reporting of occupational cancers and structured monitoring of radon activity and medical or industrial radiation exposure.[10][4]

Quantified strategic targets include documenting 50% of cancer cases, reducing cancer incidence and mortality by 30%, improving diagnosis and treatment by 30%, and improving quality of life for people with cancer and their families by 40%.[2][5]Although the annex supplies process and outcome measures across prevention, screening, treatment, palliative care and registration, the supplied material does not provide all indicator definitions, baseline values, reporting formats, evaluation designs or a comprehensive accountability procedure.[14][27][22][23]

Costing & Financing

The strategy identifies substantial resource needs for cancer prevention, screening, diagnosis, treatment, palliative care, workforce development, information systems and infrastructure, but the supplied material does not provide a total budget, detailed costings, monetary allocations, unit costs, quantified funding gap or economic assumptions.[11][4][6][24]It characterises current cancer-care expenditure as negligible in relation to the growing cancer burden and calls for greater government resource allocation.[24]

• Mobilise financial support through government allocation, collaborators and development partners, with the National Cancer Control Steering Committee assigned an advisory role in resource mobilisation.[1][11][24]
• Increase tobacco and alcohol taxation and use the proceeds to support cancer control and other non-communicable disease activities; no tax rate or projected revenue is specified.[2][15]
• Include chemotherapeutic agents and other cancer-treatment medicines on the National Health Insurance Scheme list and make them available through registered pharmacies.[24]
• Encourage higher insurance premiums for people seeking more comprehensive cancer management, establish national, regional and district endowment funds for patients, and create a childhood-cancer treatment fund.[24]
• Address financing and access barriers, including the high cost of curative prostate-cancer treatment, expensive cervical-cancer treatment requiring long-term follow-up, and unaffordable or irregular chemotherapy supplies for childhood cancers.[28][29][30]
• Fund routine human papillomavirus immunisation for pre-adolescent girls through the health-care system; the source describes routine use of approved vaccines in pre-adolescent girls, adolescent girls and young women as highly cost-effective.[16]
• Resource fellowships, workforce training, specialised facilities, diagnostic and treatment equipment, equipment maintenance contracts, laboratory accreditation, registry staffing, software, essential palliative-care medicines, hospices and community-level services.[21][20][8][4][6]
• Recognise that some proposed gastrointestinal screening tools are not feasible in the short to medium term and do not appear cost-effective, while no population-based cost-effective screening method is identified for stomach cancer.[31][32]

Household expenditure data cited for 2005 show spending shares of 2.6% on alcoholic beverages, 1.6% on tobacco and 3.5% on health-related expenses.[15]These figures describe household expenditure patterns rather than programme financing or budget allocations.[15]