National Cancer Strategy

Objectives

Establish a coordinated national framework for cancer control that reduces cancer incidence, morbidity and mortality while improving equitable access to prevention, early detection, diagnosis, treatment, rehabilitation, supportive care and palliation.[1][2][3]The vision is for Sudanese people to understand cancer risks, practise preventive behaviours and access the full continuum of cancer services.[2]The strategy responds to rising cancer incidence, fragmented activity, inequitable access, inconsistent care, high treatment costs and shortages of skilled personnel.[1]

• Reduce cancer incidence through primary prevention, including healthier lifestyles, tobacco control, healthy diets, physical activity, obesity prevention, action on cancer-causing infections, and assessment of environmental and occupational carcinogens.[4][5][6][7]
• Promote vaccination and infection control by supporting hepatitis B vaccination and screening in high-prevalence populations, raising awareness of intravenous drug use risks, and assessing the priority of human papillomavirus vaccination.[4][6][8]
• Ensure earlier presentation and detection through public awareness, self-examination, cancer education, primary care access, workforce training and prompt referral for suspected cancer.[9][10][11][7]
• Assess screening programmes before introduction using the Wilson and Jungner criteria, cost-effectiveness, practical feasibility, treatment capacity and the potential harms of false-positive results.[4][11]
• Provide effective diagnosis and treatment through standardised pathology, diagnostic quality assurance, national guidelines and protocols, multidisciplinary management, regional oncology capacity and timely access to treatment.[12][13][14][15]
• Improve quality of life for people with cancer and their families through rehabilitation, counselling, psychosocial support, communication training, pain relief, home-based support and palliative care in every region.[16][17][18]
• Strengthen service delivery through planning, coordination, education, monitoring and evaluation, efficient workforce skill mix, reduced out-of-pocket payments and improved health information systems.[16][19][20]
• Strengthen cancer control through research, surveillance, expanded cancer registration, improved pathological reporting and wider use of National Cancer Registry data.[2][21][22]

The strategic principles emphasise a population-health approach, reduction of inequalities, health promotion, prevention, timely and equitable care, evidence-based quality, patient and community involvement, dignity, multidisciplinary coordination and sustainable change.[2]Priority investment is directed towards diagnostics and early detection, alongside advocacy, resource mobilisation, workforce development, service-model development, research and cancer surveillance.[9][16]

Implementation

Implementation is led by the Federal Ministry of Health, particularly its Non-Communicable Diseases Department, working with State Ministries of Health and a multi-institutional taskforce.[1][2]Delivery is intended to combine government leadership with the participation of non-governmental organisations, communities, patients and carers, professional bodies, private providers, universities, insurers, international partners and relevant non-health sectors.[9][3][15]

• Coordinate implementation through the Directorate of Public Health and Emergency, Non-Communicable Diseases Department, Public Health Institute, Radiation and Isotopes Centre Khartoum, National Cancer Institute in Gezira, National Cancer Registry, laboratories and other partners.[1]
• Deliver services across primary, secondary and tertiary levels, with primary care responsible for awareness, early detection, referral and staff training; secondary care for diagnosis and initial management; and tertiary care for specialist oncology management.[22]
• Develop a cancer service model with diagnostic capacity, oncology-centre networks, referral and back-referral pathways, multidisciplinary teams, clinical guidelines and palliative care.[9][22]
• Expand diagnostic capacity by standardising pathology request forms and procedures, improving equipment calibration and maintenance, training laboratory and imaging staff, ensuring supplies and consumables, and making diagnostic mammography available.[4][13][15]
• Establish and expand regional oncology services, including a model hospital cancer unit with diagnostics and multidisciplinary care, functioning histopathology, haematology and radiology services in each State, and at least one local palliative-care service in every region.[16][3][14]
• Use remote and mobile technologies, telepathology, eHealth and task-shifting to support States where specialist capacity or local multidisciplinary teams are unavailable.[16][22][15]
• Build workforce capacity through undergraduate oncology education, primary-care training, specialist training, communication skills development, training in data recording and analysis, and strengthened roles for social workers in counselling and psychosocial support.[16][11][18]
• Establish multi-agency cancer-control groups at federal and State levels, create a non-governmental organisation forum, involve the private sector, and use the Sudan Medical Council and professional associations for professional regulation and multidisciplinary audit.[17][20]

Strategy development drew on document and literature review, situational and gap analysis, interviews, brainstorming, SWOT analysis, Federal Ministry of Health consultation, stakeholder workshops, breast cancer multidisciplinary workshops and specialist input on oral cancer.[23][24]Governance processes include endorsement through national health-sector planning arrangements and the Higher Coordinating Council, while high-level Ministry of Health advocacy is intended to secure partner engagement.[16][8]

Implementation is to be tracked against activities, timelines and indicators through the Non-Communicable Diseases Department.[2]Monitoring mechanisms include cancer incidence and outcome measurement through a National Cancer Registry covering all States; Cancer Registry, State Ministry of Health, oncology-centre and palliative-care reports; prevention-programme reporting; patient and carer satisfaction studies; multidisciplinary audits; and research on risk factors, screening, service quality, outcomes and cost-effectiveness.[3][25][16]The source does not specify a consolidated reporting timetable, complete indicator framework or formal accountability schedule beyond these arrangements.[25][15]

Monitoring & Evaluation

The strategy proposes a monitoring and evaluation system centred on implementation tracking, cancer registration, service-quality audit, research and surveillance. The Non-Communicable Diseases Department is expected to follow implementation against activities, timelines and indicators, while the National Cancer Registry is intended to provide nationwide information on incidence, outcomes and patterns of disease.[2][9][3]

• Measure cancer incidence and outcomes in every State through a sustained National Cancer Registry with coverage across all States.[3]
• Track prevention programmes, stage at diagnosis, functioning diagnostic services, oncology centres, palliative-care units, State multi-agency groups and Registry data collection.[3]
• Use Cancer Registry reports, State Ministry of Health reports, oncology-centre and palliative-service reports, programme reports, survey reports and non-governmental organisation forum reports as means of verification.[3][25][17]
• Produce an annual National Cancer Registry summary and publish annual reports, supported by improved information networking and data from non-governmental organisations on early detection and screening.[25][22]
• Strengthen registry completeness and quality by training doctors, statisticians, registry clerks and other staff in diagnosis recording, verification, analysis, medical statistics and cancer epidemiology.[16][17][21][26]
• Improve pathology reporting, standardise request forms and laboratory records, apply quality-control measures, and calibrate equipment to support diagnosis and more accurate registration.[10][27][13][28]
• Address deficiencies in mortality, survival and age-standardised incidence data, including incomplete cancer recording on death certificates, and assess the feasibility of mortality recording and a cancer-survival database.[16][29][27][30]
• Undertake quality audits, multidisciplinary audits and professional regulation to assess diagnostic access, treatment standards, guideline availability, palliative-care access, patient satisfaction and care outcomes.[4][16][25][15][20]
• Use research to investigate epidemiology, risk factors, occupational exposures, screening feasibility, diagnostic delays and misdiagnosis, service standards, models of care and cost-effectiveness.[16][29][6][13]
• Assess proposed screening programmes against the Wilson and Jungner criteria and evaluate feasibility, treatment capacity, false-positive referrals, harms and cost-effectiveness before introduction.[4][6][11]
• Establish accountability for breast and prostate cancer guideline implementation through the Federal Ministry of Health, professional associations and the Sudan Medical Council.[6][11][31]

A comprehensive consolidated indicator framework, reporting frequency, evaluation timetable and accountability matrix are not specified in the supplied text, although implementation is recognised as dependent on adequate funding, skilled staff and political commitment.[3][25][21][15][20]

Costing & Financing

Financing is characterised by constrained and poorly coordinated resources, high patient costs and an emphasis on mobilising support for diagnostics, early detection, treatment capacity, palliative care and cancer registration. The text does not provide a consolidated programme budget, annual financing envelope, costed workplan, quantified funding gap or economic assumptions.[2][18][19][15][20]

• Prioritise investment in diagnostics and early detection, including reduced diagnostic costs through non-governmental organisations and expanded insurance coverage.[4][16][15][20]
• Mobilise resources from government, non-governmental organisations, international collaborators, the private sector, the Ministry of Finance, the National Health Insurance Fund, civil organisations and telecommunication companies.[25][15][20]
• Address budget challenges, overspent budgets, high treatment costs, inadequate insurance coverage and the uncertain financial sustainability of the National Cancer Registry.[2][22]
• Review the free-of-charge policy and rebudgeting options so that support can cover investigations and earlier diagnosis as well as treatment.[19][28]
• Increase resources for palliative care, research, registry expansion, data collection, report production, diagnostic access, workforce capacity, radiotherapy maintenance and spare parts.[18][21][26]
• Recognise that chemotherapy is free for all cases, but targeted therapy, immunotherapy, supportive treatment, diagnosis and follow-up investigations are outside the free-treatment policy.[27][30]
• Address chemotherapy budget growth that has not kept pace with patient numbers or medicine costs, alongside maintenance and repair costs that reduce available resources.[30]
• Reduce catastrophic household spending, which is borne by families, health insurance and limited charitable support; a December 2010 study found that 42% of 231 patients received help from relatives or friends and 23% moved home because of treatment costs or proximity to hospital.[30]
• Investigate the costs of late detection, develop a business case for primary-care early detection based on potential future savings, and compare the cost-effectiveness of treatment abroad with treatment in Sudan.[16][12][17]
• Consider tobacco and other exposure-related taxation, corporate social responsibility and private sponsorship as possible sources of cancer-control funding, while recognising that taxation alone would not resolve prevention financing.[8][32]

Government, with World Health Organization and International Atomic Energy Agency support, funds cancer-control buildings, equipment, radiotherapy, supplies, medicines, continuing education and training, but resources are described as inadequate and concentrated on costly treatment.[30]Planned centres in Alobied and AlGadaref lack funding, and historical cancer-registry operations ended because sustaining funds were unavailable.[33][34]