Plan Cancer Togo 2022-2025

Objectives

The National Cancer Control Plan aims to reduce cancer-related mortality in Togo through an integrated national response aligned with the Integrated Strategic Plan for Non-Communicable Disease Control and the National Health Development Plan.[1][2][3]It addresses a rising cancer burden, with 5,208 new cases and 3,468 deaths recorded in 2020, and prioritises breast, cervical and prostate cancers among the leading causes of incidence and mortality.[4][5]

• Strengthen primary prevention by raising community awareness of cancer risk factors, warning signs and the value of early diagnosis and screening.[6][7][3]
• Promote early detection of breast, cervical, colorectal and prostate cancers, alongside awareness of childhood cancer warning signs.[6][2][8]
• Increase vaccination against hepatitis B virus and human papillomavirus, and prevent liver cancer through screening and treatment for hepatitis B, C and D viruses.[9][10][8]
• Strengthen diagnosis and comprehensive curative and palliative care at every level of the health system, including access to medicines, diagnostic equipment, radiotherapy and standardised care protocols.[11][2][10]
• Develop oncology human resources through continuing education and specialised training in prevention, pathology, medical oncology, radiodiagnosis, radiotherapy, oncology surgery, medical physics and palliative care.[12][13][14]
• Promote cancer surveillance, registration, operational and clinical research, and monitoring and evaluation to improve the evidence base for policy and service delivery.[15][2][16]
• Reduce modifiable risk factors through legislative, regulatory, intersectoral and multisectoral measures addressing tobacco, alcohol, unhealthy diets, physical inactivity, carcinogenic substances and unhealthy environments.[17][18][19]
• Strengthen leadership, partnerships and domestic and external resource mobilisation, including advocacy for a dedicated cancer budget and the use of tobacco and alcohol tax revenues for cancer control.[20][21][22]

The plan is organised around five strategic orientations and 18 priority actions, covering prevention and early detection, quality and accessibility of diagnosis and care, surveillance and research, governance and healthy environments, and financing and partnerships.[13][8][23]

Implementation

Implementation is planned within the chronic diseases sector from 1 January 2022 to 31 December 2026, using a multisectoral, multidisciplinary and decentralised health-system approach.[24][3]Delivery is intended to combine community mobilisation, prevention and screening, vaccination, strengthened referral and treatment services, workforce development, surveillance, regulation and coordinated partner support.[13][18][8]

• Coordinate cancer control through the Ministry responsible for health, the National Cancer Control Programme, the National Cancer Institute and a Thematic Cancer Control Committee bringing together public, private and associative stakeholders.[1][25][2]
• Use the six health regions and 39 health districts, managed by regional and district health directorates and their management teams, to support decentralised implementation.[26]
• Make the National Cancer Institute operational, including radiotherapy, radiodiagnosis and nuclear medicine services, and strengthen authorised oncology referral centres and paediatric oncology services closer to patients’ homes.[10]
• Expand diagnostic capacity through pathology services, including creation of a pathology service at the University Hospital of Kara, while addressing current limitations in cellular-marker testing and diagnostic infrastructure.[27][10]
• Improve treatment access by promoting generic anticancer and hormonal medicines, supportive medicines, updated essential-medicine and consumable lists, and reliable supplies of quality products.[10][28]
• Train 50 trainers, strengthen the capacity of 585 health-care providers and 585 community-level actors, and train 30 regional trainers and 100 medical and paramedical specialists annually with partner support.[7][14]
• Deliver awareness through radio and television programmes, public conferences, community campaigns, communication materials and an early-detection guide, involving community leaders, journalists, non-governmental organisations, associations and opinion leaders.[7][29]
• Organise integrated breast and cervical cancer screening campaigns and screening campaigns for prostate and colorectal cancers among specified adult populations.[29]
• Engage the Expanded Programme on Immunisation, community health workers, health professionals, primary-care centres, diagnostic and treatment units, the cancer registry and the District Health Information Software 2 system in reporting, vaccination, service provision and data management.[8][30]
• Collaborate with the World Health Organization, International Atomic Energy Agency, International Agency for Research on Cancer, Union for International Cancer Control, pharmaceutical companies, technical and financial partners, civil society and private-sector actors.[24][12][11]

Governance actions include clarifying actors’ roles, appointing a cancer-control coordinator, conducting legislative and regulatory reviews, convening multisectoral meetings, and strengthening engagement with parliamentarians and government on subsidised or free cancer care.[25][2][30]The plan uses the National Health Development Plan monitoring architecture, including national and regional monitoring committees, joint field visits with partners, supervision, periodic surveys and evaluations.[31]

Operational oversight includes annual performance and financial reporting, annual reviews of cancer-control interventions, mid-term and final plan evaluations, and twice-yearly supervision of trained providers, associations and other actors.[14][31][32]Resource mobilisation relies on partnerships, State budget advocacy, technical and financial partner support, private-sector engagement and proposed innovative financing mechanisms, although detailed budget allocations and funding shares are not specified.[20][22][33]

Monitoring & Evaluation

The plan establishes a monitoring, evaluation and accountability approach centred on cancer registration, routine health-information reporting, performance review, supervision, research and periodic plan evaluations. It recognises major baseline evidence gaps, notably the absence of national factual cancer data and delayed availability of population-based registry data.[34][25][2][31]

• Strengthen cancer surveillance by making the national cancer registry operational, training registry focal points to collect and analyse data, formalising the registry initiated at the University Hospital Centre Sylvanus Olympio, and improving facility case surveillance.[15][14]
• Use hospital data, pathology and laboratory records, non-communicable disease surveillance reports, the national health-information system and DHIS2 cancer-recording software while registry data are consolidated.[34][27][15][8][31]
• Track indicators covering community and provider knowledge, trained personnel and community health workers, availability of information materials, communication-plan implementation, screening campaigns, reported and early-detected cases, and hepatitis B and human papillomavirus vaccination coverage.[3][8][35][36]
• Monitor service performance through indicators on detected and treated cases, treatment cost, diagnostic and care centres, workforce capacity, access to diagnosis and care, adequacy of care, and gains in years of life.[8][36][37][16]
• Measure data and research performance through cancer-data availability and quality, cancer types monitored, confirmed cases entered in DHIS2, registry-data timeliness, completed studies, scientific publications, supervisory visits and evaluated interventions.[30][33][16]
• Review governance and financing progress through legislative and regulatory measures, multisectoral meetings and actions, financing partnerships, increased funding secured, State budget allocation and partner funding for cancer control.[23][33][16][32]
• Use activity, training, performance, survey, assessment, evaluation, supervision, immunisation, scientific, legal, annual financial and annual performance reports as verification sources.[3][8][30][23][31][32]
• Conduct statutory or extraordinary monitoring-committee meetings, joint field visits with technical and financial partners, periodic surveys and studies, and supervision through national, regional and local health-sector mechanisms.[31]
• Review health-sector performance annually and at mid-term with sector stakeholders, undertake one mid-term and one final plan evaluation, and review cancer-control interventions annually.[14][17][31]
• Supervise trained providers, associations and other actors twice yearly across health-system levels; apply indicator-specific review frequencies ranging from monthly to annual and, for some measures, every two years.[14][31][35][36][37][16]

Costing & Financing

Financing and resource mobilisation are explicit priorities, but the plan identifies constrained domestic mobilisation, no specifically allocated cancer budget in the earlier situation analysis, and continued dependence on external assistance.[20]A total plan budget of 4,597,956,095 is reported, although the source does not identify its currency, detailed allocation or funding shares.[33]

• Develop traditional and innovative resource-mobilisation mechanisms, strengthen partnerships, establish a dedicated cancer budget and advocate a State budget line for cancer control.[20][22]
• Mobilise funding from technical and financial partners, international institutions, private mining companies, pharmaceutical companies, civil society, economic operators and the wider private sector.[11][20][22]
• Direct revenue from tobacco and alcohol taxes, and potentially other carcinogenic products, towards cancer control and non-communicable disease activities.[20][22]
• Advocate subsidised or free cancer care through engagement with parliamentarians and government, alongside approval and allocation of a substantial budget to the plan.[25][21]
• Monitor financing through annual financial and stakeholder performance reports, including increased funding obtained, financing partnerships, State budget allocation and partner contributions.[23][33][32]
• Recognise that treatment cost is a monthly monitoring indicator, although no treatment price or currency amount is provided.[36]
• Note that detailed costed activities, funding gaps, financing projections and economic assumptions are not specified beyond the total plan budget; low purchasing power is identified as a risk or assumption affecting implementation.[3][33][32]