Plan Stratégique National de Lutte Contre le Cancer 2022-2026

Objectives

The 2022–2026 National Strategic Plan for Cancer Control is the Republic of the Congo’s five-year reference framework for operationalising the National Cancer Control Programme, coordinating high-impact public-health interventions and reducing cancer-related morbidity and mortality. Cancer is identified as the country’s third leading cause of death and a major public-health concern.[1]Its vision is a resilient, high-performing health system that ensures universal access to quality services and improved population health.[2]

• Strengthen governance, leadership, coordination and partnerships for cancer control, including the legal and regulatory framework and operational capacity of implementing bodies.[3][4][5]
• Mobilise domestic and external resources, with a target to secure at least 80% of the funds required to implement strategy interventions.[6][7][8]
• Improve access to diagnosis, treatment, supportive care and palliative care, aiming for at least 80% of people with cancer to access diagnosis and care.[6][9]
• Increase the cancer-control workforce by 50% and ensure that at least half of referral and general hospitals have teams trained in cancer care.[6][10][11]
• Expand diagnostic infrastructure by equipping four facilities in Brazzaville and Pointe-Noire for cancer-related laboratory and imaging examinations, and establish radiotherapy and brachytherapy services in two general hospitals.[6][12][13]
• Improve access to anticancer and supportive medicines, with a target for at least 30% of patients to obtain anticancer medicines.[14][15]
• Reduce preventable cancer risks through health promotion, vaccination, screening and early detection, including a target to sensitise at least 50% of people aged over 12 years on risk factors, prevention and early screening.[6][16]
• Strengthen screening and management of precancerous lesions, aiming to screen at least 50% of people reached through awareness activities and provide care to all people identified as positive.[14][17]
• Increase vaccination against human papillomavirus and hepatitis B, although the supplied extracts present differing human papillomavirus coverage targets, including at least 25% and at least 45% of target populations.[14][17][18]
• Develop cancer information, surveillance and research through a national registry, tumour files, cancer mapping, risk-factor research and at least one recorded cancer study each year.[14][19][20][21]

Implementation

Implementation uses a health-system-wide and decentralised model, guided by leadership, accountability, results-based management, decentralisation, community participation, diversified partnerships and intersectoral action.[2]Central authorities retain strategic planning, coordination, resource mobilisation, monitoring and allocation functions, while health districts, facilities, communities and local authorities contribute to delivery.[22][23]The National Cancer Control Programme is the central coordinating mechanism, supported by the Ministry of Health and Population, departmental focal points, hospitals, civil society, technical and financial partners and private-sector actors.[24][25][8]

• Develop and promulgate legal and regulatory instruments, including application texts for Decree No. 2019-228, normative documents, a cancer-control steering committee and service guidance for integrating prevention, diagnosis and treatment across the health-system pyramid.[5][26][27][28]
• Prepare annual budgeted work plans, departmental quarterly plans and regular coordination meetings, including monthly steering-committee meetings, annual regulatory meetings and fortnightly programme staff meetings.[28][24]
• Establish 12 departmental cancer-control focal points and formalise collaboration with civil-society organisations through memoranda of understanding and quarterly monitoring meetings.[24][29]
• Engage technical and financial partners, national and international organisations, Roche, relevant businesses and departmental and municipal councils through round tables, working sessions and partnership agreements.[25][30]
• Mobilise financing through annual budget advocacy, applications to partners, corporate social-responsibility contributions, Universal Health Insurance advocacy, local-authority plans and annual LISALISI fundraising events in Brazzaville and Pointe-Noire.[8][31][30]
• Strengthen service delivery by training specialised personnel, creating multidisciplinary hospital teams, developing clinical training guides and decision algorithms, supervising their use, and developing a 2023–2026 palliative-care strategy.[9][10][11][32][15]
• Improve medicine availability by advocating institutionalised free provision, adding generic anticancer medicines to the national essential medicines list, procuring supplies and replenishing hospitals every six months through the Central Purchasing Agency for Essential Medicines and Supplies.[15][33]
• Expand prevention through knowledge, attitudes and practices surveys, prevention guides, a national communication plan, departmental training, annual district supervision and at least two mass awareness campaigns each year.[16][34][17]
• Introduce human papillomavirus vaccination through awareness activities, a submission to Gavi for procurement, vaccine-stock acquisition from 2024 and integration into the Expanded Programme on Immunisation.[17][18]
• Operate monitoring and evaluation through routine reports, health-facility and cross-sectoral data, patient-management records, national health accounts and integrated disease-surveillance tools.[23][35]
• Integrate cancer surveillance forms and trend indicators into District Health Information Software 2, establish a national cancer registry, and target registry completeness of at least 95% of factual data required for monitoring and evaluation.[14][19]
• Track implementation through indicators covering legal instruments, operational structures, work-plan delivery, financing, access to care, trained teams, medicine supply, screening, vaccination, registry reporting and cancer research.[4][35][36]

Monitoring & Evaluation

The National Strategic Plan for Cancer Control 2022–2026 establishes monitoring, evaluation and accountability as core functions of cancer control, supported by a planned national cancer registry, integration of cancer data into District Health Information Software 2, routine reporting and a 2022–2026 monitoring and evaluation plan.[19][37][23]The framework nevertheless leaves some operational detail unspecified, including consolidated reporting schedules, data-quality procedures, evaluation frequency and an independent accountability mechanism.[23][35]

• Establish a national cancer registry within the National Cancer Control Programme, with a target for the registry to contain at least 95% of factual data required for monitoring and evaluation.[14][19]
• Integrate cancer trend indicators and case-surveillance forms into District Health Information Software 2, and ensure that reports from intermediate and peripheral levels reach the National Cancer Control Programme within required deadlines.[38][19]
• Monitor service-access outcomes, including at least 80% access to diagnosis and care, anticancer-treatment access for at least 30% of patients according to cancer type, and cancer-risk-factor and early-detection awareness among at least 50% of people aged over 12 years.[6][14]
• Track prevention outcomes, including screening of precancerous lesions among at least 50% of people reached through awareness activities, care for all people identified as positive, human papillomavirus vaccination coverage, and hepatitis B vaccination coverage above 95%.[6][14][17][18]
• Measure governance performance through the availability of legal and regulatory instruments, closure of identified legal gaps, operational status of implementing structures, implementation of annual work plans, regulatory resolutions, supervision and stakeholder participation.[5][26][27][28][35]
• Monitor financing through the State share of cancer-control expenditure, funds secured from technical and financial partners and companies, innovative financing, Universal Health Insurance coverage, and amounts raised through fundraising activities.[8][31][35]
• Strengthen surveillance and research by tracking trained cancer registrars, tumour-file contributions, cancer mapping, research studies, compiled dissertations, scientific meetings and recommendations submitted to the National Cancer Control Programme.[20][21][37]
• Use routine statistical reports, health and non-health-sector reports, national health accounts, patient-management records and integrated disease-surveillance tools as information sources.[35]

Costing & Financing

The plan combines State financing, technical and financial partner support, company contributions, Universal Health Insurance, local-authority funding and innovative financing to mobilise resources for cancer control.[25][30][8][31]Its financing objective is to secure at least 80% of funds required for implementation, but the source does not provide a reliable consolidated budget or quantified financing gap.[6][7][8]Some extracted aggregate figures are internally inconsistent and should therefore be interpreted cautiously.[37]

• Mobilise resources through annual budget advocacy, funding applications to technical and financial partners, corporate social-responsibility contributions, Universal Health Insurance advocacy and annual LISALISI fundraising events.[8][31]
• Incorporate cancer-control financing into departmental and municipal plans, supported by engagement with local councils, businesses, non-governmental organisations and associations.[25][30]
• Use proposed taxes on tobacco industries and mast installations as potential innovative financing mechanisms.[26][27]
• Address financial barriers including high medicine costs, limited population purchasing power, inadequate cancer-care coverage in Universal Health Insurance packages, low disbursement of programme operating funds and insufficient financing for cancer-control interventions and research.[39][40][41][42]
• Cost major investments for medicines, diagnostic and radiotherapy equipment, patient accommodation, prevention, vaccination, cancer registration, research and monitoring and evaluation in Central African CFA francs.[32][15][33][12][13][43][16][17][37]
• Recognise risks to sustainability from insufficient resources, non-disbursement of the State counterpart contribution, inadequate research financing and weak management of essential medicines and cancer products.[36][44]