Plan Nacional De Cuidados Integrales Del Cáncer

Objectives

Peru’s National Plan for Comprehensive Cancer Care 2020–2024 provides a national framework to reduce cancer morbidity and mortality and improve quality of life through equitable, evidence-based and life-course care spanning health promotion, prevention, early detection, diagnosis, treatment, rehabilitation and palliative care.[1][2][3]It aims to expand access to comprehensive care, including at least 40,000 people annually financed by the Seguro Integral de Salud, while reducing cancer mortality.[4]

• Reduce cancer risk factors through healthy lifestyles, action on social determinants, occupational carcinogen control, counselling, and vaccination against human papillomavirus and hepatitis B.[5][6]
• Increase screening and early detection for cervical, breast, colorectal, prostate and skin cancers, alongside prompt referral for suspected cancers not covered by screening programmes.[7][8]
• Improve timely diagnosis, staging, treatment and palliative care, including specialised pathways for prevalent adult cancers and integrated services for children and adolescents.[9][10]
• Strengthen service capacity, quality, medical supplies, technologies, workforce competencies and financial protection for comprehensive cancer care.[11][12]
• Develop decentralised and deconcentrated oncology services, cancer information systems, population and hospital registries, childhood cancer registration, clinical and public-health research, and a skilled health workforce.[2][13][14][15]
• Prioritise territorial vulnerability and unequal access, particularly in regions with high mortality or weak prevention and care capacity.[16][17]

Implementation

Implementation combines Ministry of Health stewardship, integrated health-service networks, primary-care-led prevention and referral, specialised oncology pathways, decentralised infrastructure investment, digital health, supply-chain management and continuous monitoring.[4][18][19]The Plan is mandatory for Ministry of Health, regional-government and local-government provider institutions, while serving as a reference for Social Health Insurance, Armed Forces, National Police and private providers.[20]

• Coordinate delivery through the Ministry of Health, National Institute of Neoplastic Diseases, National Institutes of Health, Seguro Integral de Salud and its Intangible Solidarity Health Fund, regional and local governments, health-service providers, oncology institutes and hospitals.[21][22]
• Deliver prevention and screening through first-level care, families, communities, local governments and multidisciplinary teams, supported by trained community leaders, health professionals, campaign communications and referral and counter-referral pathways.[23][24][25]
• Organise care through integrated networks and clinical pathways that link primary care, hospitals, specialised services and home-based palliative care according to patient condition, treatment complexity and life course.[7][10]
• Expand regional oncology capacity through multi-year investment programming, construction, equipment, commissioning, operation and maintenance of regional institutes, hospitals, radiotherapy, chemotherapy, pathology, blood-bank, intensive-care and paediatric oncology services.[19][26][27]
• Use telemedicine, teleconsultation, tele-interconsultation, telepathology, teleorientation, telemonitoring, tele-education and telegovernance to support early diagnosis, referral, imaging interpretation, professional education and management across facilities.[28][18]
• Manage oncology medicines and supplies through cost-effective selection, centralised corporate purchasing, availability and rational-use monitoring, strengthened regional storage, distribution and cold-chain continuity where required.[29][30]
• Develop explicit guarantees of timeliness and quality within the Essential Health Insurance Plan, including a compliance-verification tool and recognition of palliative care as essential for patients and families.[9]
• Strengthen surveillance through nominal screening records, population-based cancer registries, hospital-based surveillance and a national childhood cancer registry, with links to the Health Information System and E-QHALI electronic medical records.[13][31]
• Build workforce capacity by assessing staffing gaps, implementing progressive gap-closure plans, aligning undergraduate and residency training with service needs, and delivering continuing professional development through People Development Plans and the Strategic Educational Programme in Health.[15][32][33]
• Monitor implementation through supervision, evaluation and control activities, screening outputs, treatment and service-supply measures, registry coverage, workforce measures and cancer mortality per 100,000 inhabitants.[34][35][36]

Monitoring & Evaluation

The plan establishes a broad monitoring, evaluation and surveillance architecture for comprehensive cancer care, combining service-output targets, cancer registries, screening records, budget execution analysis, quality assurance and implementation follow-up.[37][2][13][31]

• Monitor implementation through supervision, monitoring, evaluation and control of cancer prevention and control, including continuous implementation management during 2020 and 2021–2024.[21][38][36]
• Track service coverage and performance, including at least 40,000 people receiving Seguro Integral de Salud-financed cancer care annually, screening coverage, the proportion receiving treatment, supplied oncology services and production of normative documents.[4][35]
• Measure cancer mortality per 100,000 inhabitants under the Ministry of Health institutional objective for disease prevention, monitoring and control.[39][34]
• Monitor cervical screening, breast clinical examination, mammography, colorectal screening, prostate-specific antigen testing and skin-cancer screening; annual targets are specified for selected screening and treatment indicators.[40][24][41][35][42]
• Develop integrated information systems comprising a nominal screening registry, population-based cancer registries, hospital-based cancer surveillance and a national childhood cancer registry.[13][31][43]
• Link the Health Information System and E-QHALI electronic medical-record system with cancer registries to support surveillance, monitoring, referrals and decision-making.[31]
• Conduct quality controls, technical assistance, supervision and implementation reviews for cancer registries, while strengthening data quality, registrar capacity and operational capability.[31][44]
• Assess compliance with clinical pathways, process maps and explicit guarantees of timely, quality care under the Essential Health Insurance Plan, and implement continuous improvement plans.[9][10][45]
• Monitor rational use and availability of oncology medicines, supplies and medical devices procured centrally, alongside infrastructure and equipment maintenance.[30][19][27]
• Track workforce density, workforce-gap closure, training activities and staff performance through institutional People Development Plans and the Strategic Educational Programme in Health.[15][32][46]
• Use territorial vulnerability analysis, population- and hospital-based registries, mortality records and disease-burden evidence to prioritise interventions.[47][16][17][48]

Historical evidence highlights uneven performance: cervical screening and care utilisation increased during earlier periods, whereas mammography coverage remained low; service decentralisation expanded from 10 of 25 regions in 2017 to 17 in 2019.[49][50][51]Hospital-based surveillance operated through 61 notifying units, but the plan identifies insufficient timely, reliable nominal data and population-based registries that are not yet sufficiently representative for national estimates.[13][52]

Although multiple indicators, targets and monitoring mechanisms are identified, the supplied material does not provide a single consolidated indicator framework, standard reporting timetable, independent evaluation design or comprehensive formal accountability structure.[4][9][35]

Costing & Financing

Financing relies principally on Budgetary Programme 0024, Prevention and Control of Cancer, alongside Seguro Integral de Salud and Fondo Intangible Solidario de Salud support, ordinary resources, donations and transfers, directly collected resources, borrowing and other subsector resources.[49][21][53]

• Increase the Budgetary Programme 0024 budget from 30,239,303 Peruvian soles in 2011 to 985,519,326 Peruvian soles in 2018 according to the narrative, although a chart reports 982,519,326 Peruvian soles for 2018.[54][55]
• Record programme budget growth from 141.4 million Peruvian soles in 2012 to 792.6 million Peruvian soles in 2018 after excluding Seguro Integral de Salud financial transfers to avoid double counting at receiving executing units.[55][56]
• Allocate 50.2% of the 2018 programme budget to diagnosis and treatment, 10.7% to screening, and 5.8% to prevention and promotion.[56]
• Distribute programme products across diagnosis and treatment, screening, premalignant-lesion management, promotion, prevention, management and palliative care, with diagnosis and treatment the largest component.[57]
• Mobilise investment through multi-year programming, feasibility studies, technical files, investment projects, construction, equipment, commissioning, operation and maintenance for oncology capacity and decentralised services.[19][26][58][27]
• Fund infrastructure, equipment, telemedicine, pathology, radiotherapy, medicines, supplies, storage, distribution, workforce development and cancer information systems, although monetary valuations are generally not supplied.[18][30][22][15][31]
• Establish a protected, intangible fund for cancer research, without a stated monetary amount or funding source.[14]
• Address unequal regional funding, as higher cancer mortality was not consistently matched by higher allocations for prevention and control during 2016–2018.[59]

Fondo Intangible Solidario de Salud financial transfers for cancer care had reached nearly 500 million soles by the end of 2018.[49]The plan also identifies a budget gap of 1,037,224 and financing of 900,000 for specified Programme 024 activities, but neither the currency nor the costing methodology is specified in the supplied material.[36]

An estimated 2020–2024 budget across all funding sources is referenced, with no additional budget required for 2021 and investment projects excluded from that year’s estimate.[21]However, the supplied sections do not provide a consolidated plan cost, comprehensive funding-gap assessment, detailed resource-mobilisation strategy or explicit economic assumptions.[37][21]