Plan Cancer Togo 2022-2025

Objectives

Togo’s National Cancer Control Plan, titled Plan Cancer Togo 2022-2025, is intended to reduce cancer-related mortality through coordinated prevention and comprehensive cancer care, aligned with the national non-communicable disease strategy and National Health Development Plan.[1][2][3]It responds to a rising cancer burden, estimated at 5,208 new cases and 3,468 deaths in 2020, with breast and cervical cancers prominent among women and prostate cancer among men.[4][5]

• Increase community awareness of cancer risk factors, primary prevention and the importance of early diagnosis.[3][6]
• Promote early detection of breast, cervical, colorectal and prostate cancers, including screening campaigns and improved clinical and self-examination skills.[3][7]
• Expand vaccination against hepatitis B and human papillomavirus, and strengthen screening and treatment for hepatitis B, C and D to prevent liver cancer.[3][7][8]
• Strengthen cancer diagnosis and comprehensive curative and palliative care, including medicines, technical infrastructure, referral arrangements and specialised human resources.[3][9][10]
• Develop cancer surveillance, registration, operational and clinical research, monitoring and evaluation.[3][11]
• Reduce modifiable risks through legislative, regulatory and intersectoral action on tobacco, alcohol, unhealthy diets, physical inactivity, carcinogenic exposures and ionising radiation.[3][12][13]
• Reinforce leadership, partnerships and domestic and external resource mobilisation for cancer control.[3][11][14]

The strategy is organised around five interlinked areas: prevention and early detection; quality of care; surveillance, research, monitoring and evaluation; leadership, governance and intersectoral action; and partnerships and resource mobilisation.[3][11]The wider situation analysis identifies prevention and early detection, human resources, care, financial mobilisation, surveillance and research, and governance as core intervention domains.[15]

Implementation

Implementation combines health-system strengthening, decentralised delivery, multisectoral action and international collaboration. The plan builds on a national cancer-control programme established in 2009, a National Cancer Institute created in 2015, cancer-registration activities initiated in 2017, and recommendations from the International Atomic Energy Agency imPACT review.[2]The health system operates through six health regions and 39 districts, providing a decentralised structure for integrating cancer priorities into regional and district plans.[16]

• Coordinate implementation centrally through the multisectoral cancer consultation framework, the National Cancer Control Programme and the Division for Non-Communicable Disease Surveillance; coordinate prevention, care activities and partnerships.[17]
• Integrate cancer priorities into regional plans and corrective actions through regional management structures, and incorporate cervical-cancer interventions, intersectoral collaboration and indicator reporting in district operational plans.[17]
• Train providers and community actors across health-system levels, including 50 trainers, 585 health-care providers and 585 community actors; train journalists, non-governmental organisations and associations to support communication.[18]
• Use radio, television, public conferences, regional and district campaigns, World Cancer Day, Pink October and a dedicated communication plan to reach communities.[18]
• Organise screening for 2,000 women for integrated breast and cervical cancer, 2,000 men aged 50 years and over for prostate cancer, and 2,000 adults aged 50 years and over for colorectal cancer.[7]
• Operationalise the National Cancer Institute with radiotherapy, radiodiagnosis and nuclear medicine; designate oncology referral centres; reinforce existing services, including paediatric oncology at Sylvanus Olympio University Hospital in Lomé; and develop services closer to children’s homes.[9]
• Support families travelling for paediatric cancer care through a Parents’ House in Lomé, and improve availability of generic anticancer, hormonal, analgesic and other essential medicines.[9]
• Develop specialised oncology capacity through annual training of 30 regional trainers and 100 medical and paramedical specialists, clinical protocols and scholarships for specialised studies.[9]

Delivery is intended to involve ministries responsible for health, agriculture, education, youth and sport, quality-control bodies, community and professional actors, civil-society organisations, cancer associations, private-sector organisations, economic operators and development partners.[12][19]The World Health Organization, International Atomic Energy Agency, International Agency for Research on Cancer and other international partners are identified as potential technical supporters.[20][21][22]

Monitoring and evaluation use existing National Health Development Plan mechanisms, including committee sessions, joint missions with technical and financial partners, periodic evaluations, surveys, studies and supervision.[17][23]Annual and mid-term health-sector reviews are intended to assess performance and obstacles, with mid-term and final plan evaluations.[23]Indicators cover trained personnel, public knowledge, communication-material availability, screening campaigns, vaccination coverage, cancer cases confirmed in District Health Information Software 2, cancer-registry timeliness, studies completed, supervision, legal measures, multisectoral actions, partnerships and annual financing reports.[24][25][26][14]

Financially, the plan seeks a dedicated cancer-control budget line, subsidised or free cancer care, innovative domestic financing, strengthened partner support, and allocation of tobacco and alcohol taxes to cancer control.[27][19]No total costed budget, funding allocation, financing target or quantified funding gap is specified in the supplied material.[11][28]

Monitoring & Evaluation

The plan establishes a monitoring, evaluation and accountability architecture combining cancer surveillance, routine reporting, supervision, periodic reviews and formal evaluations. It aims to strengthen cancer case registration, operational, basic and clinical research, and monitoring and evaluation at all levels of the health system.[11]

• Operationalise the cancer registry, identify focal points and train staff in cancer-data collection and analysis within the national non-communicable disease programme.[9][29]
• Use hospital data, pathology records, haematology services and the emerging population-based cancer registry to improve evidence on cancer incidence and mortality. Registry data were not yet available in the earlier situation analysis, and incomplete diagnostic coverage and fragmented recording systems limited available evidence.[4][30]
• Report cancer information through the health information system, including the District Health Information Software 2 (DHIS2), alongside registry reports, activity reports and reports from diagnostic and cancer-care units.[27][31][26]
• Monitor early detection through indicators on new cases by cancer type, community screening campaigns, demand for cancer-care services, trained health and community workers, population knowledge of risk factors and early diagnosis, and availability of information and communication materials in primary-care facilities.[24][25]
• Track prevention through hepatitis B and human papillomavirus vaccination coverage, hepatitis screening campaigns, numbers of people screened and treated, and treatment cost.[31][32][8]
• Measure care-system progress through indicators on diagnostic and care centres, provider capacity, service accessibility and the proportion of patients receiving adequate cancer care.[31][32][10]
• Assess surveillance quality through the number of cancer types monitored, confirmed cases reported in DHIS2 and the timeliness of registry data.[26][33]
• Monitor research through the number of studies completed and results published, supported by scientific meetings, consultation on cancer problems and research on identified risk factors and common cancers.[9][29][26]

Governance arrangements assign central coordination and implementation follow-up to the multisectoral cancer consultation framework, the National Programme for the Control of Chronic Diseases and the Division for Non-Communicable Disease Surveillance. Regional management teams are expected to apply the plan, incorporate cancer priorities into regional plans and take corrective measures, while district teams integrate cervical-cancer interventions into operational plans, promote intersectoral collaboration and complete indicators.[17]

Monitoring draws on existing National Health Development Plan mechanisms, including statutory or extraordinary monitoring-committee sessions, joint missions with technical and financial partners, supervision, surveys, studies and periodic evaluations. Annual and mid-term health-sector reviews are intended to assess performance and obstacles; the plan provides for both mid-term and final evaluations.[17][23]Semi-annual reviews of interventions and actors across the health-service pyramid are also planned.[29]

The logical framework contains process, outcome and impact indicators. Process indicators measure implementation of activities, whereas outcome and impact indicators assess progress towards objectives. Reporting sources include training reports, surveys, evaluation reports, routine activity reports, vaccination reports, registry reports, mission reports, meeting minutes and annual financial reports.[23][6][34][31][14]Reporting frequency is generally annual, although population-knowledge surveys are planned every two years and certain reporting and supervision activities range from monthly to six-monthly.[6][34][8][10][33]

Accountability also covers annual review of laws, decrees and orders, new legal and regulatory texts, multisectoral meetings and actions, partnerships formed, supervisory activities, interventions evaluated and annual financial reporting.[26][14][28]Key evidence gaps include the absence of recent national cancer data, recent non-communicable disease risk-factor studies and research on occupational exposures such as asbestos, wood dust, pesticides, herbicides and tannins.[27]

Costing & Financing

Financing and resource mobilisation are strategic priorities, but the supplied material does not provide a quantified total budget, detailed costing table, expenditure allocation, financing target, funding gap or economic assumptions for the cancer plan.[11][31][14]

• Establish a dedicated cancer-control budget line within the State budget and advocate for a substantial budget to be voted and allocated to implementation.[11][19]
• Mobilise domestic, external, traditional and innovative resources through partnerships with civil society, development partners, economic operators, private mining companies and international health funds.[27][11]
• Allocate tobacco and alcohol tax revenues to cancer control and broader non-communicable disease action.[27][19]
• Advocate for universal and free cancer care, subsidisation of cancer services, reduced hepatitis-treatment costs and affordable generic anticancer, hormonal and supportive medicines.[11][7][9][19]
• Track the amount of State-budget resources and development-partner financing dedicated to cancer control, as well as the increase in funding obtained for cancer-plan activities through annual financial reports.[14][28]

The financing context includes the absence of a dedicated cancer budget, limited domestic resource-mobilisation capacity, dependence on external assistance, insufficient chronic-disease funding, low universal health coverage and financial barriers to care.[27][22]The situation analysis also identifies insufficient financial-resource mobilisation strategies and limited stakeholder prioritisation of cancer as constraints to implementation.[35][21][14]

Health regions and districts each have a budget line in the general State budget, but no cancer-specific allocation is supplied.[16]Economic context data report gross domestic product per capita of 404,674 West African CFA francs in 2018, alongside annual gross domestic product growth ranging from 4.4 to 5.4 between 2015 and 2019.[36]These figures are contextual indicators rather than a cancer-plan financing commitment.[36]