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][2]Its mission is to deliver equitable, cost-effective, quality preventive, promotive, curative and palliative cancer services as close to families as possible.[1][2]The overarching goal is to reduce premature cancer mortality by one-third by 2030, contributing to a healthy and productive population.[1][3][2]

• Reduce cancer incidence, morbidity and mortality and improve quality of life through evidence-based health promotion, prevention, early detection, diagnosis, treatment and palliative care.[4][5][6]
• Achieve universal health coverage for cancer control through a primary health care approach.[4][7][6]
• Prioritise cervical, breast, prostate, colorectal and childhood cancers, including cervical cancer elimination.[4][3][7]
• Reduce premature adult cancer mortality by 30% and increase childhood cancer survival to more than 60% by 2030.[5][7][6]
• Strengthen decentralised leadership and governance, countrywide cancer workforce capacity, data availability, infrastructure, equipment, transport, communication and community engagement by 2026.[1][3][8]
• Increase cancer-service funding from less than 1% to 5% of the total health budget by 2026, while leveraging National Health Insurance Management Authority resources.[1][7][8]

The plan translates these system-wide ambitions into disease-specific targets, including a 15% reduction in cervical and prostate cancer mortality by 2026, a 12.5% reduction in breast and colorectal cancer mortality by 2026, and childhood cancer survival of 40% by 2026.[9][10][11][12][13][14]

• Expand human papillomavirus vaccination, cervical screening and treatment of precancerous lesions and invasive cervical cancer.[9]
• Improve awareness, early diagnosis, referral, diagnostic quality, timely treatment and multimodality care for breast and colorectal cancers.[15][16][11][12]
• Increase prostate-specific antigen testing, ultrasound-guided biopsy capacity, specialist training and access to treatment for prostate cancer.[10][17]
• Decentralise childhood cancer diagnosis and chemotherapy, improve treatment completion and safety, expand tumour-marker testing and develop paediatric oncology skills.[13][18][19][20]
• Integrate innovative technology and research into prevention and treatment, and include priority cancers in national health insurance packages.[4]

Implementation

Implementation is based on a decentralised, coordinated cancer-control system using existing health-sector organisational and management structures, with primary health care serving as the vehicle for nationwide prevention, screening and early detection and referral facilities delivering specialised care.[3][7][6][21]The approach builds on interventions from the 2016–2021 National Cancer Control Strategic Plan and is organised around leadership and governance, financing, service delivery, workforce, medicines and supplies, infrastructure and equipment, communication, and health information, information and communication technology and research.[22][4]

• Coordinate national governance and information-sharing through the Ministry of Health, including the Oncology Services Unit, Cancer Control Unit and National Cancer Control Technical Working Group.[4][7][23]
• Establish a Cancer Control Act and a Zambia National Cancer Institute to provide a legal mandate, national leadership, coordination and support for cancer-control implementation.[4][14][23]
• Deliver services through government, faith-based not-for-profit, mine-owned and private for-profit providers across primary, secondary and tertiary levels of care.[21]
• Expand comprehensive diagnosis, treatment and palliative care beyond Lusaka, initially strengthening Southern and Copperbelt provinces and developing capacity across all 10 provinces.[8][24][2]
• Use vaccination campaigns, mobile health interventions, health talks, print and electronic information materials, radio and television programming, and community leadership to improve prevention, awareness and care-seeking.[25][24][26]
• Strengthen training, retention packages and collaboration with local, regional and international institutions for cancer specialists and other health workers.[27][8][20]
• Improve access to chemotherapy, radiotherapy, surgery, imaging, pathology, blood-bank services, essential medicines and supplies, alongside equipment maintenance and local biomedical engineering capacity.[28][29][30][31][2]

Planning and implementation use a multidisciplinary consultative model involving Ministry of Health technical teams, hospitals, cooperating partners, civil society organisations, private-sector stakeholders and communities.[32][3][33]Partners are expected to support decentralisation, policy and legislative development, training, technical assistance, infrastructure, service delivery, advocacy and financing.[34][35][36][37]

• Strengthen referral and patient-navigation pathways, including electronic follow-up from diagnosis through treatment and subsequent care.[15][38][39]
• Establish multidisciplinary teams, or tumour boards, and coordinate referrals of patients and specimens across facilities and partners.[28][29]
• Integrate cancer services into health insurance, develop dedicated funding lines for priority cancers and prepare bankable resource-mobilisation documents.[27][8][40]
• Cost implementation using an ingredient input-based approach informed by previous-plan projections, economic conditions, cancer burden data, interventions, targets and stakeholder consultation.[7]
• Implement the five-year plan at an estimated total cost of 2,399,590,585 Zambian Kwacha.[7]

Operational monitoring relies on existing and new routine, periodic and ad hoc health-information systems, including the Zambia National Cancer Registry, Hospital Management Information System, Human Resource Information System, Electronic Logistics Management Information System and Healthcare Financing System.[7]Electronic patient records, registry expansion and linkage with the District Health Information Software 2 and Health Management Information System are intended to improve measurement of incidence, prevalence, mortality, survival, service coverage and performance.[8][24][40]

Monitoring & Evaluation

The plan establishes a cancer monitoring and evaluation direction centred on complete, accurate, timely and accessible data for measuring incidence, prevalence, mortality and survival, and for supporting planning, coordination and service improvement by 2026.[1]It combines routine health information systems, cancer registries, facility records, surveys and disease-specific reporting, although parts of the supplied text note that the overall indicator matrix, evaluation design, reporting timetable and accountability framework are incomplete or unspecified.[7][8][23]

• Strengthen routine information systems by integrating cancer data with the Health Management Information System and District Health Information Software 2, improving electronic patient records, and linking records to the population-based Zambia National Cancer Registry.[27][8][24]
• Expand cancer surveillance through the Zambia National Cancer Registry, including population-based registries in Lusaka, Ndola and Livingstone, and improve facility-level reporting that remains substantially paper-based.[41][42][23]
• Use routine, periodic and ad hoc data collection 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.[7]
• Draw on supplementary evidence sources including the Global Cancer Observatory, World Health Organisation STEP Survey, Zambia Demographic and Health Survey, vital-statistics systems and hospital data.[7][43][44]
• Monitor cervical cancer vaccination, screening, treatment completion, workforce training and service availability using defined indicators, verification sources, baselines and annual targets for 2022 to 2026.[9][45][46]
• Track cervical cancer targets including full human papillomavirus vaccination rising from 40% in 2021 to 80% in 2026, screening from 10% to 60%, and completion of precancer treatment from 66% to 90%.[9][45][46]
• Measure prostate cancer progress through facility coverage, specialist training, treatment-guideline availability, stage at diagnosis and treatment coverage, including improvement in the early-to-late diagnosis ratio from 20:80 towards 70:30 by 2026.[10][17]
• Track breast and colorectal cancer mortality, diagnostic capacity, training, equipment, service availability and early-stage diagnosis, with colorectal targets of 50 districts providing integrated screening, 30 facilities providing colonoscopy and 40% of cancers diagnosed at stages I and II by 2026.[47][48][49][12]
• Monitor childhood cancer early diagnosis, treatment completion and five-year survival, targeting 70%, 80% and 40% respectively by 2026, alongside provincial service expansion, diagnostic turnaround time, reporting quality and workforce development.[13][18][19][20]
• Assign specified reporting roles for selected indicators to the Ministry of Health Oncology Services Unit and the cancer control health promotions officer, using physical verification, reports, registers, surveys, audits and databases.[50][26][51]
• Use the Sector Advisory Group, Joint Annual Review and Mid-Term Review as health-sector coordination and review mechanisms, while addressing weaknesses in stakeholder engagement with these processes.[52]
• Address the absence of monitoring and evaluation and performance review in the previous National Cancer Control Strategic Plan, which prevented determination of cancer-control performance.[2]

Costing & Financing

The National Cancer Control Strategic Plan for 2022 to 2026 was costed at an estimated ZMW 2,399,590,585.00, approximately ZMW 2.4 billion, using an ingredient input-based approach informed by projections from the previous plan, the prevailing economic context, cancer morbidity and mortality data, and planned objectives, strategies and interventions.[7]Financing policy seeks to increase cancer-service funding from less than 1% to 5% of the total health budget by 2026 while leveraging National Health Insurance Management Authority resources.[7][8]

• Increase government funding for cancer prevention, diagnosis, treatment, training and research, establish dedicated central-government funding lines for priority cancers, and include cancer services in budgets at all health-care levels.[8][24]
• Leverage national health insurance to reduce household out-of-pocket costs, while extending cover because the scheme currently covers breast, cervical, colorectal and prostate cancers but excludes childhood cancers.[27]
• Develop bankable resource-mobilisation documents, mobilise local resources, pursue cooperating-partner and international collaboration, and support research funding through the National Health Research Authority.[8][40]
• Undertake economic modelling and costing for adult and childhood cancer management, and map cancer-care resources.[8][24]
• Address inadequate and inconsistent government financing, low resource allocation, unfunded staffing posts, high equipment-maintenance costs, medicine and supply shortages, costly databases and insufficient research funding.[36][30][31][53]
• Recognise financing risks from partner fatigue, shifting partner priorities, terminated collaborative agreements, unpaid equipment-service contracts and unfunded training programmes.[28][29][54]
• Use a medium-term expenditure framework and estimate financing inflows by year, strategic area and output; the costing approach also calls for specifying activities, determining frequency, costing each activity and avoiding duplicate costing.[23][37]
• Note that several programme sections provide no activity-level budget, funding source, quantified funding gap or economic assumption despite identifying substantial resource needs for workforce, infrastructure, equipment, medicines, diagnostics and service delivery.[41][42][50][51]