The National Cancer Control Strategy (2023–2027)

Objectives

Kenya’s National Cancer Control Strategic Plan 2023–2027 provides a roadmap for implementing the Kenya Cancer Policy 2019–2030. It seeks a nation free from the preventable burden of cancer through a coordinated, responsive and patient-centred framework that reduces cancer morbidity, mortality and premature deaths, while improving the experience and quality of life of people living with cancer.[1][2][3]Its overarching goal is to reduce premature cancer mortality in Kenya by one third by 2028.[2][4]

• Advance universal health coverage, equity, inclusivity, sustainability, survivor and community involvement, evidence-based innovation, and improved financial, geographic and social access to cancer care.[5][4]
• Prevent cancer and detect it early by reducing modifiable risk factors, promoting healthier environments, strengthening immunisation, screening and early diagnosis, and addressing social, environmental and occupational determinants of cancer.[1][2][6][7]
• Reduce tobacco use from 13.3% to 6.5% and alcohol use from 19% to 10% by 2028, alongside action on unhealthy diets, physical inactivity, overweight and obesity.[6][8][9][10]
• Provide equitable prevention and early-detection services, including cervical, breast, colorectal and prostate cancer screening and early diagnosis, while strengthening childhood-cancer detection and hereditary-cancer risk identification.[4][6][11][12]
• Improve diagnostic imaging, pathology and laboratory medicine so that diagnosis, staging, treatment planning, follow-up, research and planning are accurate, accessible and timely.[13][14]
• Ensure timely, comprehensive and sustainable treatment, palliative care, rehabilitation and survivorship services, delivered through multidisciplinary care and linked referral pathways.[15][16]
• Increase childhood-cancer survival to 60% by 2030 and improve quality of life for children affected by cancer.[17][16]
• Strengthen advocacy, communication, partnerships, coordination and sustainable financing to support an informed population, reduce stigma and mobilise resources for cancer control.[18][19][20]
• Develop strategic information, cancer registration, surveillance, research, monitoring, evaluation, accountability and learning to guide policy, practice and continuous quality improvement.[2][21][20]

Implementation

Implementation uses a people-centred, multisectoral and primary health care-oriented model spanning prevention, early detection, diagnosis, treatment, palliative care, survivorship and end-of-life care.[22][3][23]The Ministry of Health, through the National Cancer Control Programme, leads implementation, technical support and coordination with national and county actors across the cancer-control continuum.[2][24][25]

• Integrate cancer interventions into community health, primary care, county referral and national referral services, with sub-county hospitals serving as hubs for primary health care and cancer-specific interventions.[26][23]
• Strengthen primary-care providers’ capacity to deliver prevention information, screening, early diagnosis, referral, ongoing care and links between communities and secondary or tertiary services.[23][27]
• Organise delivery around five key result areas: prevention and early detection; imaging, pathology and laboratory medicine; treatment, palliative care and survivorship; advocacy, partnerships, coordination and financing; and strategic information, registration, surveillance and research.[2][21]
• Coordinate national technical teams through the Non-Communicable Diseases Intersectoral Coordinating Committee and the Cancer Technical Working Group, while strengthening a National Steering Committee on Cancer Prevention and Control, the National Advisory Committee and county cancer focal points.[2][19][24]
• Engage national and county governments, public, private and faith-based providers, professional bodies, civil society, patient groups, academia, hospitals, development partners, regulators, industry, communities and cancer survivors.[1][28]
• Support counties to incorporate cancer control into annual work plans and integrated development plans, establish cancer-control programmes, allocate resources, report data and share specialised workforce, infrastructure and commodities.[28][29][30]
• Expand service capacity through regional cancer centres, national referral hospitals, centres of excellence, diagnostic networks, telehealth, telepathology, teleradiology, electronic records, patient navigation and hub-and-spoke referral arrangements.[31][15][32][33][34]
• Develop and disseminate standards, policies, guidelines, directories, training packages, reporting templates and quality-assurance mechanisms for screening, diagnostics, treatment, palliative care, rehabilitation and survivorship.[14][16][35][36]
• Strengthen workforce planning through an Oncology Human Resource Development Plan, pre-service and in-service education, fellowships, mentorship, scholarships, professional recognition, accreditation, career development and county workforce-sharing mechanisms.[32][37][38]
• Strengthen access to essential oncology products through forecasting, pooled procurement, supply-chain planning, local manufacturing, regulatory oversight, post-market surveillance and dashboards tracking availability and use.[18][39][40][41]
• Mobilise financing through increased public investment, universal health coverage benefit packages, mixed public-private-people partnerships, county ring-fenced budget lines, health-related levies and taxes, improved insurance reimbursement and social protection for children with cancer and their families.[20][42][43]
• Operationalise monitoring, evaluation, accountability and learning through process, output and outcome indicators, annual monitoring, mid-term, end-term and impact evaluations, data-quality audits, service-quality audits, cancer surveillance reports and strengthened population-based and hospital-based cancer registries.[44][24][8][45][46]

Monitoring & Evaluation

The strategy establishes a comprehensive Monitoring, Evaluation, Accountability and Learning framework across the cancer-control continuum, combining process, output and outcome indicators, defined responsibilities, data use and knowledge management.[8]Annual monitoring is coordinated by the National Cancer Control Programme with the Non-Communicable Diseases Intersectoral Coordinating Committee and National Steering Committee on Non-Communicable Diseases.[24]

• Track key results through a Common Results and Accountability Framework, with one principal indicator per key result area, baselines and targets incorporated into Ministry of Health monitoring.[8]
• Monitor prevention and service targets, including 70% cervical screening coverage, 30% breast and colorectal screening coverage, 90% human papillomavirus vaccination coverage, 90% treatment for cervical precancerous lesions or invasive disease, 60% childhood-cancer survival, 50% palliative-care access and 20% high-quality population-based registry coverage.[8]
• Review implementation through annual, mid-term, end-term and impact evaluations, implementation review forums and dissemination of findings to stakeholders.[44][46]
• Strengthen surveillance by linking population-based and hospital-based registries with screening records, death registration, health-management information systems and interoperable oncology electronic medical records.[24][44]
• Expand population-based registry coverage from approximately 11% towards at least 20% of the national population, strengthen registries in Nairobi, Eldoret and Kisumu, and establish additional registries in Nakuru and Mombasa.[20][44]
• Publish annual cancer-burden and surveillance reports, incorporate priority cancer indicators into national and county surveys, and improve use of surveillance data for planning.[47][45]
• Conduct Service Quality Audits, Data Quality Audits, supportive supervision, registry-compliance audits and continuous quality-improvement activities.[44][45][47]
• Use operational monitoring mechanisms including service audits, quarterly technical-working-group meetings, multidisciplinary-team reports submitted monthly through the National Oncology Dashboard, and oncology product dashboard reporting.[33][36][41]
• Strengthen accountability through county focal points, annual work plans, coordination meetings, supportive supervision and quarterly reporting to the non-communicable disease inter-agency coordinating committee.[19][29]

Earlier implementation monitoring found that, of 215 interventions under the 2017–2022 strategy, 28% had been fully implemented, 65% were under implementation and 7% had not commenced.[48]Planned surveillance activities, including the STEPS survey and public-health surveillance frameworks, were not completed because of inadequate financial resources.[48]

Costing & Financing

The strategy seeks sustainable and innovative financing for cancer prevention and control, with public investment, mixed financing models, county budget planning, insurance coverage and health-related taxes identified as principal mechanisms.[20][42]Cancer financing is monitored through the cancer budget share of the total health budget, with a baseline of 0.8% and a target of 10%.[8]

• Increase public financing through the Universal Health Coverage benefit package and chronic-disease funding to reduce catastrophic expenditure and impoverishment.[20]
• Adopt mixed public, private and people’s partnership models, access programmes and strengthened National Health Insurance Fund reimbursement for essential cancer services.[20][42]
• Support counties to prepare annual cancer-control work plans and ring-fence protected cancer-control budget lines.[20][42]
• Mobilise revenue through consolidated levies and health-related taxes, including tobacco excise taxation targeted at 70% of retail price and proposed taxation of alcohol, sugar-sweetened beverages, trans fats and unhealthy foods and drinks.[9][10]
• Finance comprehensive childhood-cancer care through differentiated coverage, procurement of essential products and social protection for children and their families.[20][43]
• Support affordable access to medicines and technologies through pooled or regional procurement, local manufacturing, tax exemptions for priority oncology products and strengthened supply-chain planning.[40][41]

Kenya’s financing context includes scarce health resources, public health expenditure estimated at 2.2% of gross domestic product and out-of-pocket payments accounting for one third of total health expenditure.[19]The strategy identifies inadequate and unsustainable financing as a constraint on prevention, screening and surveillance, but the supplied material does not provide a total costed implementation plan, activity-level allocations, quantified funding gap, unit costs or detailed economic assumptions.[48][49]