Plan National de Lutte Contre le Cancer (PNLCC) 2018–2022

Objectives

Mauritania’s National Cancer Control Plan frames cancer control as a multisectoral, multidisciplinary national response intended to reduce cancer-related morbidity and mortality, improve quality of life for patients and families, reduce exposure to risk factors, and ensure prevention, early detection, diagnosis, treatment and palliative care appropriate to the national context. The 2018–2022 plan is structured around primary prevention, screening and early diagnosis, treatment including palliative care, training and research with epidemiological surveillance, and programme coordination, advocacy and management.[1][2]The source also describes a 2015–2019 results framework within the integrated non-communicable disease strategy.[3][4]

• Reduce cancer mortality and the wider burden of cancer, while improving patient and family quality of life.[2][3][4]

• Prevent cancer by reducing tobacco use, unhealthy diets, obesity, physical inactivity, environmental and occupational exposures, carcinogenic consumer products, and chronic infections including human papillomavirus and hepatitis B.[5][6][7][8]

• Expand screening and early diagnosis, particularly for cervical and breast cancer, and organise earlier detection of prostate, colorectal, childhood and other relevant cancers.[9][8][10]

• Strengthen diagnosis, surgery, systemic treatment, radiotherapy, quality care, referral pathways and access to affordable quality medicines.[11][12][13]

• Develop integrated palliative, pain-relief, psychosocial, family and home-based support for people with advanced cancer.[14][13][15]

• Build workforce capacity, research and cancer surveillance, including population-based and hospital cancer registries.[15][16]

• Achieve stated 2015–2019 targets including a 15% reduction in cancer mortality, a 30% reduction in tobacco prevalence, prompt detection and treatment of more than half of precancerous lesions and early cervical and breast cancers, and training for 50% of doctors, midwives and other health personnel.[4]

• Increase breast self-examination awareness among more than 80% of women over 20, mammography awareness among more than 80% of women over 40, and at-least-once cervical screening among more than 50% of women over 40.[4]

Implementation

Implementation combines a national referral model centred on the National Oncology Centre with decentralised prevention, screening, diagnosis, referral and palliative-care services across the three-tier health system. The plan is to operate within the integrated national strategy for non-communicable diseases, under the Directorate for Disease Control, through political commitment, international cooperation, community participation and coordinated action by government, providers, civil society and partners.[17][18][3][6][19]

• Deliver prevention through tobacco-control legislation and cessation support, health communication, nutrition and physical-activity promotion, infection prevention and vaccination measures, occupational protection, food safety and consumer protection.[6][7][8]

• Use organised and mobile screening, active case-finding, visual inspection with acetic acid or Lugol’s iodine, treatment of suspicious cervical lesions by cryotherapy or thermocoagulation, and referral to appropriate facilities.[9][10]

• Strengthen regional diagnostic capacity through pathology laboratories, imaging, biopsies, trained staff, integrated diagnostic algorithms and coordination between care structures.[11][10][12]

• Develop specialised oncology services, day hospitals, chemotherapy preparation, inpatient capacity, radiotherapy equipment, multidisciplinary clinical meetings, communication and referral and counter-referral networks.[12][13]

• Expand palliative care beyond Nouakchott through professional training, dedicated care and psychological-support units, home care, accompaniment committees and improved opioid access.[14][20][15]

• Coordinate implementation through a Ministry of Health technical steering committee and thematic groups for prevention, early detection, diagnostic and therapeutic care, and palliative care.[21][22]

• Engage Ministry of Health directorates, the National Oncology Centre, hospitals, training and research institutions, non-governmental organisations, civil society, local authorities, community and religious leaders, and international partners including the World Health Organization, the United Nations Population Fund and UNICEF.[19][21][22]

• Institutionalise a national population-based cancer registry, establish hospital registries, analyse and disseminate registry data annually, and use surveillance to assess incidence, trends, survival, geographical distribution, prevention needs and care needs.[16]

• Monitor delivery through regularly completed forms at all levels, regular meetings and action plans, with indicators covering risk factors, legislation, screening, vaccination, trained staff, protocols, medicine availability, radiotherapy, palliative care, registry function, research, financing and coordination.[23][21]

• Address major implementation constraints, including late presentation, limited screening centres and pathology capacity, inadequate equipment and specialised staff, interruptions in medicines and consumables, weak documentation of awareness activity, limited registry resources and uneven geographical distribution of services.[24][25][26][27][11]

• Mobilise human, financial and material resources through advocacy, partnerships, international cooperation and a proposed cancer-research support fund; the supplied material does not specify an overall programme budget, financing allocations or funding gap.[6][19][23]

Monitoring & Evaluation

The plan provides a broad monitoring and evaluation framework centred on cancer surveillance, programme implementation monitoring, annual assessment against performance indicators, and the use of cancer information to guide prevention and care.[2][3][23]It places epidemiological surveillance, training and research among its five intervention areas.[1][6]

• Establish and institutionalise a population-based national cancer registry and hospital registries to measure incidence, trends, survival, geographical distribution, presentation patterns, prevention needs and care needs.[16]
• Analyse and disseminate registry data annually, while using systematic information systems to improve data collection, archiving and analysis and align cancer information with the non-communicable disease monitoring system.[16][15]
• Monitor cancer distribution over time and by location, including medium-term impacts over 10 years and long-term impacts over 10 to 20 years.[23]
• Use observational studies, including case-control and cohort studies, together with knowledge, attitudes and practices surveys, to assess strategy effectiveness and behavioural risk factors.[23][16]
• Track indicators covering risk-factor prevalence; prevention legislation; screening, awareness and vaccination campaigns; trained staff and strengthened services; precancerous-lesion management; protocols; medicine and radiotherapy availability; palliative-care capacity; registry functionality; research; resource mobilisation; and coordination.[23][21]
• Monitor diagnostic and therapeutic care and establish quality assurance across cancer-treatment modalities.[13]
• Use a technical steering committee, thematic groups, regular meetings, action plans and monitoring forms completed at all levels to support implementation oversight.[23][21][22]

Quantified outcome targets include reducing cancer mortality by 15%, reducing tobacco prevalence by 30%, detecting and promptly treating more than 50% of precancerous lesions and early cervical and breast cancers, training 50% of relevant health personnel, and curing 50% of patients receiving care.[4]Earlier National Oncology Centre targets included reducing cancer mortality by 30% and overseas cancer evacuations by 80%.[17]The source also reports baseline risk-factor findings from the 2008 STEPS-WISE survey, including tobacco use of 32.7%, obesity of 20% and insufficient moderate-intensity physical activity of 96% among people aged 16–64.[5]

Important surveillance constraints include the registry’s lack of institutionalisation, dedicated data-collection and data-entry personnel, premises, logistics and operational finance.[28]Reporting and accountability remain incompletely specified: apart from annual dissemination of registry data and regular monitoring arrangements, the material does not define indicator methodologies, baselines, responsible reporting bodies, a comprehensive reporting calendar, evaluation methods or formal accountability procedures.[16][23]

Costing & Financing

The supplied material identifies substantial resource needs for cancer prevention, early detection, diagnosis, treatment, palliative care, information systems, training and research, but provides very limited quantified financing information.[12][13][15]The plan includes a budget section, yet the extracts do not provide its total value, activity-level costs, domestic allocations, funding commitments, financing gaps or economic assumptions.[1]

• Mobilise human, financial and material resources through government commitment, advocacy, national and international partnerships, and international cooperation involving financial assistance alongside technology and knowledge transfer.[19][6]
• Establish a support fund for cancer research and develop partnerships to support research activities.[19]
• Provide a dedicated budget line, premises, equipment and operating resources for the national cancer registry, which currently has no own resources or dedicated budget.[29]
• Support cancer-focused non-governmental organisations financially and consider engagement of the National Health Insurance Fund.[27]
• Improve availability and affordability of anticancer, supportive and palliative-care medicines, while addressing high morphine and consumables prices, stock-outs and the illicit medicines market.[20][13]
• Consider public-private purchasing partnerships, local medicine production and bioequivalence rules as measures relevant to access to quality medicines at affordable prices.[15]

In 2008, overseas oncology evacuations were estimated to cost 1.5 billion Ouguiyas, equivalent at the time to 4 million Euros.[30]This cost was associated with 441 cancer patients among 1,366 patients evacuated abroad, with cancer accounting for 42% of evacuations in that account.[30]The National Oncology Centre was established partly in response to the high volume and cost of overseas cancer evacuations.[30]

Resource constraints include shortages of specialised facilities, technical equipment, pathology services, medicines, single-use supplies, qualified personnel, palliative-care structures and decentralised services.[24][25][26]Proposed infrastructure, including specialised diagnostic capacity, regional oncology services, radiotherapy equipment, multidisciplinary care, home-based palliative care and workforce training, is resource-intensive, but no associated cost estimates are specified.[12][13][15]