Plan Nacional De Cuidados Integrales Del Cáncer

Objectives

Peru’s National Plan for Comprehensive Cancer Care 2020–2024 seeks to reduce cancer morbidity and mortality and improve quality of life through equitable, evidence-based and continuous care spanning health promotion, primary and secondary prevention, screening, early and definitive diagnosis, timely treatment, rehabilitation and palliative care. It applies a life-course, person-, family- and community-centred approach, incorporating equity, human rights, gender, interculturality and action on social determinants of health.[1][2][3][4]

• Reduce population exposure to cancer risks by promoting healthy lifestyles, preventive counselling, healthy public policies, action on social determinants, prevention of occupational carcinogen exposure, and vaccination against human papillomavirus and hepatitis B.[5][6][7]
• Increase early detection by expanding primary-care and territorial screening for cervical, breast, colorectal, prostate and skin cancers, alongside management of premalignant lesions and prompt referral of suspected cases.[8][9][10][11]
• Improve comprehensive care by developing integrated diagnostic, treatment and palliative-care pathways for children, adolescents and adults, with priority attention to breast, cervical, colorectal, lung, stomach, prostate, liver, haematological and skin cancers.[12][13][14][15]
• Strengthen decentralised and deconcentrated oncology services, including chemotherapy, radiotherapy, specialised surgery, diagnostic support, emergency care and palliative care, to reduce geographical inequities in access.[16][17][18]
• Develop integrated cancer information systems, comprising population-based and hospital-based registries, a National Paediatric Cancer Registry and a nominal screening register, to support surveillance, continuity of care and decision-making.[19][20][21]
• Build clinical and public-health research capacity, strengthen specialised and primary-care workforce competencies, and expand financial protection for people requiring cancer care.[22][23][24][25]

Implementation

Implementation is organised through Integrated Health Networks, linking primary care, hospitals, regional oncology institutes and the National Institute of Neoplastic Diseases in a national network of oncology services. The Ministry of Health provides sectoral stewardship, while the General Directorate of Strategic Interventions in Public Health leads cancer prevention and control and Budget Programme 0024, Prevention and Control of Cancer.[26][16][27][12]

• Deliver mandatory implementation through Ministry of Health providers and regional and local governments, while treating the plan as referential for Social Health Insurance, Armed Forces, National Police, private and other national providers.[28]
• Organise care by service complexity, population need, geographical access and facility capacity; establish differentiated service portfolios; and strengthen referral and counter-referral flows between district, provincial, regional and national levels.[17][18][29]
• Develop regional and macro-regional clinical pathways, with regional oncology institutes and the National Institute of Neoplastic Diseases providing high-complexity capacity, and map processes linking first-level services, hospital care and home-based palliative care.[12][13][30]
• Expand infrastructure and operational capacity through multi-year investment programming, technical studies, construction, equipment, commissioning, maintenance and service development at regional institutes, hospitals and primary-care facilities.[17][18][31]
• Use telemedicine, teleconsultation, tele-interconsultation, teleorientation, telemonitoring and digital information tools to support early diagnosis, referrals, pathology, imaging, virtual management and professional education.[32][33][34]
• Manage oncology medicines and supplies through evidence-based selection, high-cost medicine thresholds, updated specifications, rational-use monitoring, availability tracking, distribution and storage systems.[34][35]
• Coordinate multisectoral prevention action with local governments, education authorities, employers, workers, training institutions and communities, including CAREX-based identification and control of occupational carcinogens and vaccine cold-chain oversight.[6][36][7][37]
• Develop workforce capacity through gap assessments, regional planning, recruitment and retention measures, undergraduate and residency competency alignment, institutional People Development Plans and a Strategic Health Education Programme.[23][38][39][24]
• Monitor implementation through supervision, process-map and clinical-pathway compliance reviews, cancer registries, screening records, surveillance systems and cancer mortality indicators; detailed reporting schedules and a unified accountability framework are not specified in the supplied material.[12][19][20][40]
• Support financial protection through the Comprehensive Health Insurance scheme, including an access target of at least 40,000 people annually, while seeking increased insurance funding, investment projects and potential private or international cooperation; the supplied material does not provide a consolidated, quantified plan budget.[41][25][42][43]

Monitoring & Evaluation

The Plan combines programme monitoring with cancer surveillance, service-capacity assessment, screening registers, care-process review and research oversight. It identifies substantial information-system and monitoring activities, but many excerpts do not define a unified reporting timetable, full indicator metadata, evaluation methodology or formal accountability framework.[44][19][40][45]

• Monitor implementation through supervision, monitoring, evaluation and control activities within the cancer-prevention and control programme, including an annual report as an operational output.[46][47][48]
• Track headline access and service-delivery measures, including comprehensive care for at least 40,000 people annually financed by the Comprehensive Health Insurance scheme, screening coverage, treatment access, supplied oncology services and cancer mortality.[41][49][40]
• Use cervical-screening targets of 415,340 women by 2020 and 432,205 by 2024; reported 2018 coverage was 238,345 of 402,484 scheduled women, or 59.2%.[50]
• Track breast-screening activity: clinical breast examination reached 323,008 of 543,753 scheduled women in 2018, or 59.4%, with targets of 1,500,000 women by 2020 and 3,456,000 by 2024.[9]
• Monitor human papillomavirus vaccination through the nominal register, vaccine-storage equipment and cold-chain arrangements; the stated goal is to protect all girls aged 9 to 13 and extend vaccination to fifth-grade boys.[36][37]
• Strengthen population-based registries, hospital-based surveillance, a national paediatric cancer registry and a nominal screening registry to identify people at risk, follow premalignant lesions, assess screening outcomes and support timely treatment.[5][19][21]
• Extend population-based registry coverage from Lima Metropolitan Area, Arequipa and Trujillo to Cajamarca, Iquitos and Junín, supported by technical guidance, trained staff, information technology, quality control and technical assistance.[20][51]
• Link hospital registry data with the Health Information System and E-QHALI electronic health records to improve data quality, implementation monitoring and decision-making.[51][21]
• Use surveillance data, mortality records and territorial vulnerability analysis to monitor cancer burden and service response; the vulnerability assessment applies 18 indicators on determinants, risk factors, mortality and health-service response.[52][53]
• Assess oncology capacity through censuses and administrative systems covering workforce, equipment and services, including specialist density, regional distribution, radiotherapy availability and operational status.[54][55][56]
• Evaluate compliance with integrated care-process maps, clinical pathways and explicit guarantees for timeliness and quality, using findings for continuous improvement.[12][13][57]
• Monitor rational use and availability of oncology medicines, supplies and medical devices at healthcare-provider and implementing-unit level.[34]
• Oversee research through research-project and researcher registries, research and ethics committees, project monitoring through publication, and dissemination of research priorities.[58][59][60]
• Apply indicators for diagnosis and staging of new cervical and breast cancer patients, normative documents, quality certifications, trained professionals, indexed research publications, insurance affiliation, benefit coverage, financial coverage and service control.[61][62][46]

Reported earlier implementation results included an increase in people receiving cancer care from 25,359 in 2012 to 78,284 in 2015, while cervical cytology coverage among women aged 30 to 49 increased from 6.93% to 12.5% and visual inspection with acetic acid increased from 0.49% to 3%.[63]Formal reporting cycles, indicator baselines and targets, sanctions and named accountability bodies are not consistently specified in the supplied material.[44][12][20][45]

Costing & Financing

Financing is principally associated with Budget Programme 0024, Prevention and Control of Cancer, the Comprehensive Health Insurance scheme, the Intangible Solidarity Health Fund and multi-year public investment programming. The extracts identify financing needs and some tabled allocations, but do not provide a complete costed budget for the 2020–2024 Plan, a quantified funding gap or economic assumptions.[64][27][17][65]

• Continue financing cancer-control activities through Functional Programme Structure 0024 beyond the activities originally scheduled through 2015.[64]
• Record approximately 500 million Peruvian soles transferred by the Intangible Solidarity Health Fund by the end of 2018; the programme had supported 97,415 people and nearly 1.5 million care contacts.[64]
• Finance access to comprehensive cancer care for at least 40,000 people annually through the Comprehensive Health Insurance scheme.[41]
• Strengthen financial protection by expanding universal health-insurance coverage, enabling automatic affiliation for uninsured oncology patients, maintaining continuity of care and increasing the Comprehensive Health Insurance budget.[24][25][42]
• Use investment projects and multi-year investment programming for oncology infrastructure, equipment, radiotherapy, paediatric services, hospital capacity, commissioning, operation and maintenance.[17][18][31]
• Allocate an additional budget line for medical supplies for integrated cancer care under budget classification 2.3.18, although no amount or funding source is specified.[35]
• Incorporate workforce-gap closure, recruitment, remuneration, training and educational activities into institutional operational plans and associated budgets.[23][66][38]
• Mobilise potential external support through private initiatives, non-governmental organisations, international cooperation, and instruments involving the National Competitiveness Council, the Inter-American Development Bank and the World Bank.[42][43]
• Address documented constraints including inadequate financing for treatment and insufficient resources for prevention, diagnosis and treatment, particularly in low- and middle-income settings.[4]

Some implementation tables show allocations for 2021–2023 and further programme allocations, with sources labelled ordinary resources, RO and DyT; the extracts do not define all source abbreviations, identify the currency, reliably link every figure to a specific activity, or provide totals.[47][67][14][48]