National Cancer Control Strategic Plan

Objectives

The National Cancer Control Strategic Plan 2022–2026 seeks to build a Zambian health system that is equipped, staffed, trained and empowered to provide comprehensive cancer prevention, screening, diagnosis, treatment and care.[1]Its mission is to deliver equitable, cost-effective and quality preventive, promotive, curative and palliative cancer services as close to families as possible.[1]The overall goal is to reduce premature cancer mortality by one-third by 2030, contributing to a healthy and productive population.[2]The programme further aims to reduce premature adult cancer mortality by 30% and increase childhood cancer survival to more than 60% by 2030.[3]

• Prioritise cervical, breast, prostate, colorectal and childhood cancers across health promotion, prevention, early detection, diagnosis, treatment and palliative care.[4]
• Eliminate cervical cancer through the World Health Organisation 90-70-90 strategy, expand human papillomavirus vaccination and screening, and reduce cervical cancer mortality by 15% by 2026.[5][6]
• Increase the proportion of breast, childhood and colorectal cancers diagnosed at stages I or II to 60%, improve breast cancer early detection and management, and reduce breast cancer mortality by 12.5% by 2026.[5][7]
• Improve childhood cancer survival to 40% by 2026 through earlier diagnosis, treatment completion, decentralised chemotherapy, strengthened diagnostic capacity and safer standardised care.[8][9][10]
• Strengthen decentralised leadership and governance, the cancer workforce, cancer information and research, infrastructure, equipment, medicines, supplies and community engagement, while increasing cancer-service financing from less than 1% to 5% of the total health budget by 2026.[1]

Implementation

Implementation is designed around decentralised, coordinated cancer services delivered through existing health-sector organisational and management structures, with primary health care serving as a route towards universal health coverage.[5][3]The Ministry of Health is responsible for coordinated governance and information sharing to support evidence-based management.[5]Delivery involves public and private institutions, civil-society and non-governmental organisations, health facilities, communities, patients and survivors, professional groups and international partners.[5][11]Comprehensive treatment remains concentrated at Cancer Diseases Hospital, while surgery, chemotherapy and palliative care are also provided through public, private, mission, district, provincial and tertiary facilities.[12]

• Develop and enact a Cancer Control Act, then establish and operationalise the Zambia National Cancer Institute to coordinate national cancer-control governance, subject to the legal framework.[13][14]
• Decentralise comprehensive treatment, including surgery, systemic therapy, radiotherapy, nuclear medicine and palliative care, across provinces, beginning with Southern and Copperbelt provinces.[13]
• Expand prevention and early detection through primary health care, community communication, mobile health, human papillomavirus and hepatitis B vaccination, cervical screening, and priority-cancer screening and referral services.[15][16][17]
• Build workforce capacity through specialist and general health-worker training, skills-upgrading courses, retention measures and collaboration with universities, training institutions and international partners.[18][15]
• Strengthen service readiness by upgrading facilities, procuring and maintaining diagnostic and treatment equipment, improving radiotherapy capacity, strengthening supply chains and pooled procurement, and ensuring essential cancer medicines and supplies at all service-delivery levels.[18][19][16]
• Integrate cancer data into electronic health records and routine information systems, expand population-based registry coverage, link electronic patient records to the Zambia National Cancer Registry, and improve data on incidence, prevalence, mortality and survival for planning and evaluation.[13][5]
• Mobilise resources through increased government funding, dedicated budget lines, National Health Insurance Management Authority benefit-package inclusion, research proposals, internally generated revenue and bankable infrastructure and equipment proposals.[20]The five-year plan is estimated to cost 2,399,590,585 Zambian kwacha, using an input-based costing approach informed by previous-plan projections, economic conditions, cancer burden data and planned interventions.[5]

Monitoring & Evaluation

The plan proposes a strengthened cancer monitoring, evaluation and information system to generate accurate, timely and accessible data on incidence, prevalence, mortality and survival, supporting service planning, coordination and performance assessment by 2026.[21][5][13]It recognises that cancer information remains incomplete, with inadequate coverage in routine information tools, incomplete cancer variables and indicators, limited integration with SmartCare and the District Health Information Software 2, and continuing reliance on paper-based records at Cancer Diseases Hospital.[22][23][1]

• Use routine, periodic and ad hoc health-information collection and reporting through Ministry of Health systems, including the Zambia National Cancer Registry, Hospital Management Information System, Human Resource Information System, Electronic Logistics Management Information System and Healthcare Financing System.[5]
• Expand population-based registry coverage and link electronic patient records with the Zambia National Cancer Registry, including registries in Copperbelt and Southern Provinces.[13]Population-based registries operate in Lusaka, Ndola and Livingstone, although earlier assessments identified only Lusaka as fully functional and questioned the standards of the Ndola and Livingstone registries.[22][1][24]
• Establish electronic health records, standardise cancer-related data elements, strengthen facility registries, and connect cancer-service key performance indicators to the District Health Information System 2 and the Health Management Information System.[22][15][25]
• Monitor implementation using physical checks, service and annual reports, web-based searches, contract checks and verification of records, with reporting frequencies ranging from biannual to annual for specified activities.[25][26][27]
• Track disease-specific measures, including human papillomavirus vaccination and screening coverage, treatment completion, diagnostic stage, service availability, workforce training, timely reporting, breast-cancer diagnostic access, colorectal screening and colonoscopy capacity, and childhood-cancer survival.[28][29][7][30][9]
• Review governance interventions during 2022 to 2026, including enactment of the Cancer Control Act and establishment of the Zambia National Cancer Institute.[14]
• Strengthen cancer research and locally relevant evidence generation, with targets to establish three fully functional population-based registries and publish 35 cancer-control research studies by 2026.[1][25]

The previous strategy lacked a monitoring and evaluation component, limiting assessment of cancer-control performance.[1]Although the plan contains a Performance Indicators Framework and numerous indicator tables, the supplied material does not provide one consolidated indicator framework, a complete evaluation design, a universal reporting timetable or clearly assigned accountability arrangements.[31][13][24]

Costing & Financing

The five-year National Cancer Control Strategic Plan for 2022 to 2026 is estimated to cost 2,399,590,585 Zambian Kwacha.[5]Costing used projections from the 2016 to 2021 plan, the prevailing economic situation, cancer morbidity and mortality data, and the plan’s objectives, strategies and interventions.[5]An ingredient input-based approach identified the resources required for interventions and planned outputs through stakeholder consultation.[5]

• Increase cancer-service financing from less than 1% to 5% of the total health budget by 2026, including funding for prevention, diagnosis, treatment, training and research.[21][5][20]
• Leverage National Health Insurance Management Authority resources, include cancer services in benefit packages, establish dedicated central-government funding lines, and budget for cancer services at all levels of care.[5][15][20]
• Extend insurance coverage to childhood cancer, as the current scheme covers breast, cervical, colorectal and prostate cancers but excludes childhood cancers, contributing to out-of-pocket expenditure, late presentation and treatment abandonment.[23][15]
• Mobilise resources through internally generated revenue, medical tourism, National Health Research Authority proposals, development-partner assistance, private insurance, public-private partnerships and bankable infrastructure and equipment proposals.[32][33][18][20]
• Undertake economic modelling for adult and childhood cancer management and develop a medium-term expenditure framework to support implementation.[15][24]

The plan identifies inadequate and inconsistent funding, high treatment costs, incomplete insurance coverage, limited funding for early diagnosis and treatment, unfunded specialist posts, costly equipment maintenance and uncertain partner support as major financing constraints.[2][33][18][23]Risks include donor withdrawal, changing partner priorities and the sustainability of externally supported vaccination and information systems.[32][33][22]The cost summary contains annual strategic-area figures, but some extracted rows are inconsistently formatted; the supplied text does not provide a reliable disbursement schedule, complete financing inflows or quantified funding gap.[34]