राष्ट्रिय क्यान्सर नियन्त्रण रणनीति

Objectives

Nepal’s National Cancer Control Strategy for 2024–2030 provides a comprehensive national framework to progressively reduce cancer burden and mortality, improve quality of life for people living with cancer, support universal health coverage, and uphold the principle of leaving no one behind.[1][2]Its goal is to strengthen an effective and equitable cancer-control programme across prevention, early detection, diagnosis, treatment capacity, palliative care, supportive care and rehabilitation.[2][3]

• Reduce cancer incidence, morbidity and mortality while improving life expectancy and quality of life for people affected by cancer.[1]
• Address major modifiable risks through health promotion, healthy diets, physical activity, tobacco and alcohol control, infection prevention, vaccination, reduced exposure to radiation and occupational hazards, and supportive environments.[4][5]
• Expand evidence-based, feasible and cost-effective early identification and screening, particularly for cervical, breast, oral, throat, childhood and lung cancers, with integrated diagnosis, treatment, referral and follow-up.[6][7][8]
• Strengthen timely and equitable diagnosis, pathology, laboratory testing, imaging, nuclear medicine, radiotherapy, surgery, chemotherapy, hormone therapy and multidisciplinary treatment services.[9][10][11][12]
• Ensure supportive, rehabilitative and palliative care throughout the cancer pathway, including pain relief and access to opioid medicines.[13][14][15]
• Develop infrastructure and the specialist, allied-health, administrative and support workforce required for high-quality essential cancer services.[3][16][17]
• Strengthen cancer surveillance, registries, data systems, research, governance, resource mobilisation, multisectoral partnerships and financial protection for patients.[3][18][19]

The strategy recognises a substantial and growing cancer burden, linked partly to changing diets, lifestyles and reduced physical activity.[20]In 2022, Nepal recorded approximately 22,000 new cancer cases and more than 14,000 cancer deaths, with lung, breast and cervical cancer among the common cancers.[20]Childhood cancer is estimated at approximately 1,500 new cases each year, of which only about one third are detected, making early recognition, diagnosis and treatment particularly important.[9]

The nine action areas are health promotion and prevention; early identification; diagnosis, treatment and palliative care; infrastructure development; workforce development; multisectoral collaboration; monitoring, surveillance and research; governance and financial management; and supportive and rehabilitative services.[5]

Implementation

Implementation combines integrated, institutionalised and multisectoral action aligned with national health policy, health-sector strategies, periodic plans and the multisectoral action plan for prevention and control of non-communicable diseases.[1]Delivery is intended to connect prevention, awareness, screening, diagnosis, treatment, palliative care, rehabilitation, financial protection, surveillance and research across federal, provincial and local levels.[21][2]

• Implement cancer-risk awareness programmes through mass media, social media, national campaigns and community activities, while strengthening school health programmes and cancer-prevention education.[22][23]
• Enforce tobacco-control measures, including smoke-free public places, advertising restrictions, packaging and labelling controls, taxation and population surveillance, and strengthen alcohol licensing, sales, age-limit and drink-driving controls.[24][25][26][27]
• Sustain human papillomavirus vaccination for eligible girls and hepatitis B vaccination through routine immunisation, while monitoring coverage and seeking support to maintain vaccination delivery.[28][29]
• Develop and distribute screening and early-detection guidelines and technical protocols; train personnel; establish cervical screening services; provide clinical breast examination through primary health-care centres; use mobile mammography; and link people identified through screening to treatment through health insurance.[8][30][31]
• Upgrade laboratories, pathology, biomarker testing, imaging and referral systems, including digital pathology links, to reduce diagnostic delays and geographic inequity.[32][33][34]
• Expand specialised treatment centres, radiotherapy, nuclear medicine, oncology departments, paediatric oncology, blood services, cancer medicines and affordable accommodation near advanced cancer centres.[12][35][36]
• Update cancer treatment protocols every two years, establish multidisciplinary tumour boards at cancer centres, develop district hospice and palliative-care centres, and coordinate opioid procurement and distribution.[37][15]
• Increase specialist posts, training programmes, fellowships, clinical rotations and deployment of oncology, pathology, radiology, nursing, medical physics and support personnel.[16][17]

The Ministry of Health and Population leads implementation with the Department of Health Services, relevant ministry divisions, provincial and local governments, public and private hospitals, medical colleges, the National Public Health Laboratory, the Nepal Health Research Council, the Department of Drug Administration, professional organisations, civil society, communities and private-sector providers.[22][38][35][39]The Cancer Prevention and Control Division is intended to guide implementation at all levels, coordinate stakeholders and reduce duplication.[40]

A multisectoral National Cancer Control Committee, including civil society and people with direct experience of cancer, is to meet at least twice yearly to guide implementation and monitor progress.[40]Stakeholders and partner organisations are to be held accountable, supported by procedures and workplans developed as needed.[40]

Monitoring relies on service, workforce, screening, treatment, financial-protection, campaign and registry indicators.[22][8][12][16][19]Cancer surveillance is to be strengthened through population-based and hospital registries, standardised cancer-death reporting, health information systems, electronic medical records and collaboration with private hospitals and laboratories.[18][39][41]An annual implementation report is to be consolidated and published by the Cancer Prevention and Control Division, alongside a monitoring and evaluation framework, a mid-term review in 2026 and a full-period review in 2029–2030.[42]

Financial protection includes existing subsidies, insurance arrangements and plans to increase support for poor patients, consider travel assistance and expand treatment access.[43][44]The strategy also proposes a costing framework, but the supplied text does not specify a quantified overall budget, funding gap or financing allocation.[42]

Monitoring & Evaluation

The strategy establishes a national monitoring, evaluation, surveillance and accountability agenda for cancer control, linking routine data systems, cancer registries, implementation indicators, research and periodic review to improvements in prevention, diagnosis, treatment, palliative care and equitable access.[14][3][18][42]

• Strengthen cancer surveillance through population-based cancer registries, hospital-based registries, standardised cancer-death reporting and health information systems. Nepal has three population-based registries covering approximately 20% of the population, while the hospital-based registry network has expanded to 12 hospitals.[45][18][39]
• Collect routine, continuous data on cancer incidence, prevalence, mortality, diagnostic methods, stage, survival prospects and treatment services, supported by legal arrangements and collaboration among service providers.[14]
• Improve data completeness and quality by using hospital data for population-based registration, engaging private hospitals and laboratories, and monitoring cancer-data reporting through the health management information system.[39]
• Develop electronic medical records, unique patient identification numbers or identity cards, and administrative service units to retain patient information and support service monitoring.[46]
• Track prevention performance through indicators such as the number of mass-communication and community campaigns; harmful-substance-use prevalence; smoke-free areas; tobacco taxation; school health programmes; and human papillomavirus and hepatitis B vaccination coverage.[22][23][29]
• Monitor screening and early-detection implementation through the availability of guidelines, cervical-screening facility coverage, proportions of women screened, numbers of personnel trained in visual inspection with acetic acid and human papillomavirus deoxyribonucleic acid testing, training events, screening activities, equipment availability and people identified through health insurance.[8][30][31]
• Use service-capacity indicators to track diagnostic, treatment and workforce expansion, including hospitals with upgraded services, imaging units, specialised cancer centres, radiotherapy patients and waiting times, trained personnel, referral systems, medicine availability and blood-bank capacity.[12][47][35][48][16][17]
• Strengthen quality assurance by introducing histopathology quality-assurance practices, standardised histopathology reporting formats and measures to improve diagnostic-reporting timeliness.[32][49]
• Review treatment quality through monitoring use of standard treatment protocols, multidisciplinary tumour-board meetings, palliative-care and hospice coverage, and opioid availability and access barriers.[37][15]
• Use research, including laboratory, epidemiological, clinical, psychosocial, behavioural, health-system and policy research, to support continuous improvement in cancer control.[2]
• Assign the National Cancer Control Committee responsibility for overseeing implementation progress, meet at least twice annually, and hold stakeholders and partners accountable across implementation levels.[40]
• Prepare, consolidate and publish annual implementation reports through the Cancer Prevention and Control Division in the Ministry of Health and Population; conduct a mid-term review in 2026 and a full-period review in 2029–2030; and develop an implementation monitoring and evaluation framework.[42]

Many operational extracts identify indicators and implementation periods but do not provide complete indicator definitions, baselines, targets, reporting frequencies, evaluation methodologies or accountability procedures.[50][38][12][18]

Costing & Financing

The strategy recognises that cancer prevention, diagnosis and treatment require sustained investment, while financial protection is essential because cancer treatment is costly, prolonged and frequently unaffordable for households.[1][51]

• Allocate resources and strengthen financial management and governance as core strategic areas, alongside infrastructure and workforce development.[52][3]
• Use cost-effective prevention and control approaches, particularly health promotion and prevention, which are identified as the most cost-effective and sustainable cancer-control approach.[1][5]
• Support treatment through financial plans at federal, provincial and local levels, public subsidies, the impoverished citizen medicine programme and health insurance arrangements, while recognising that these measures remain insufficient for comprehensive long-term cancer management.[43]
• Provide or consider free comprehensive treatment through national funding, include cancer treatment in insurance packages, and strengthen financial protection for poor patients, including increased support through the poor citizens’ medicine-treatment programme and possible travel assistance.[44][51]
• Prepare a costing framework for implementation of the National Cancer Control Strategy and estimate and manage the budget needed for cancer research.[39][42]
• Mobilise resources for equipment, infrastructure, specialised services, workforce development, medicines, blood services, palliative care, patient accommodation, rehabilitation and information systems; specific funding sources and allocations for these requirements are not specified.[35][36][53][54]

Available expenditure evidence indicates that healthcare for non-communicable diseases totals 64.4 billion Nepalese rupees, or 31.8% of current health expenditure; out-of-pocket payments comprise 40.3% of non-communicable disease care expenditure, and cancer care accounts for 4.2% of current non-communicable disease health expenditure, equivalent to 8.5 billion Nepalese rupees.[20]

Financial barriers include patients bearing diagnostic-test costs, expensive advanced radiotherapy in private hospitals, and higher costs linked to overseas engineering support and testing abroad.[55][32][56][57]The supplied material does not specify a consolidated national cancer-control budget, quantified funding gap, financing allocation, resource-mobilisation target or economic assumptions.[2][3][42]