National Cancer Control Policy

Objectives

Papua New Guinea’s National Cancer Control Policy provides the country’s first comprehensive framework for cancer care and control, aligned with the National Health Plan 2011–2020. Its overarching goal is to reduce cancer morbidity and mortality, improve survival, and improve quality of life for people affected by cancer.[1][2]The vision is to build national capacity for prevention and treatment, provide quality palliative and support services for people with terminal disease, and reduce the long-term population burden of cancer.[2][3]

• Develop and implement sustainable, evidence-based strategies for preventing, diagnosing and treating common cancers, using appropriate technology, resources and safe, high-quality practice.[2][3]
• Establish a coordinated National Cancer Control Programme that addresses prevention, screening and early detection, diagnosis and treatment, cancer registration and surveillance, palliative care, psychosocial support, workforce development and financial resources.[4][5]
• Prioritise cancers of greatest identified burden, including cervical and breast cancer among women and oral and liver cancer in both sexes.[6]
• Reduce preventable cancers by addressing tobacco use, betel-nut chewing, harmful alcohol use, unhealthy diet, physical inactivity, risky sexual behaviour, environmental risks and exposure to carcinogens.[1][7][8]
• Strengthen vaccination-related prevention through hepatitis B virus birth-dose vaccination and assessment or implementation of human papillomavirus vaccination to prevent liver and cervical cancers.[7][8]
• Provide locally appropriate, evidence-based and cost-effective screening for cervical, oral and other priority cancers, particularly for populations at risk.[5][9]
• Strengthen diagnosis, treatment, referral and specialised services at the National Cancer Centre, the national referral hospital and regional hospitals, while improving access to surgery, radiotherapy and chemotherapy.[1][5][9]
• Expand palliative and psychosocial support, including oral opiates, counselling, nutrition, physical therapy and community-level support for people with cancer and terminal disease.[3][10]
• Establish a phased cancer registry and surveillance system to estimate cancer burden and trends, support research, and inform evidence-based prevention and care.[10][11]
• Apply principles of equity, accessibility, affordability, efficiency, cultural acceptability, scientific validity, technological appropriateness, environmental adaptability, innovation and partnership.[3]

Implementation

Implementation is intended to replace a fragmented and opportunistic response with a comprehensive national programme led and coordinated by the National Department of Health, adapted to limited resources and focused on priority concerns.[5]The programme is to combine prevention, early detection, diagnosis, treatment, referral, palliative care, registration, workforce strengthening, research and partnership-based delivery.[7][3]

• Coordinate implementation through the National Cancer Coordinating Committee within the National Department of Health governance structure, supported by a rotating secretariat from the Medical Standards and Public Health Divisions.[12]
• Seek technical direction from a National Cancer Advisory Council comprising experts, development partners, non-governmental organisations and other stakeholders.[12]The Council includes representation from health services, hospitals, academia, government departments, international partners, research institutions and cancer organisations.[13]
• Develop a detailed, costed implementation plan with stakeholder input, preferably phased over five years, and incorporate activities into National Department of Health corporate and annual plans and into provincial, Provincial Health Authority and public-hospital planning and budget processes.[12]
• Deliver prevention education and advocacy on cancer signs, symptoms and risk reduction, alongside policies, legislation and fiscal interventions concerning tobacco, betel nut, alcohol, unhealthy diet and physical inactivity.[8][9]
• Integrate screening and early detection into existing public-health programmes where feasible, develop screening guidelines, investigate Visual Inspection with Acetic Acid with or without cryotherapy, and develop approaches for oral pre-cancer and cancer detection and treatment.[9]
• Strengthen diagnostic capacity through health-worker training, referral guidance, diagnostic guidelines, standard operating procedures, laboratory equipment and regular maintenance and upgrading of diagnostic equipment.[9]
• Upgrade treatment capacity at the National Cancer Centre at Angau Memorial General Hospital in Lae, develop additional specialist human resources, expand supportive services, work towards a secondary histopathology service, and consider a future second cancer centre at Port Moresby General Hospital.[10]
• Develop hospital-based cancer registries initially at the National Cancer Centre in Lae and Port Moresby General Hospital, extend them to regional sites where appropriate, and pursue a longer-term population-based registry linked to the National Health Information System.[11]
• Build workforce capacity through specialist recruitment and training for national and regional centres, community-level cancer-care training, refresher courses, inclusion of cancer services in health-training curricula, and collaboration with international training institutions.[11]
• Formalise collaboration with churches, non-governmental organisations and private stakeholders through memoranda of understanding or agreement under the Health Sector Partnership Policy.[12]Provincial and district administrations support local planning, budgeting, advocacy, education, supervision, information collation, monitoring and links between facilities and communities.[14][13]
• Monitor implementation through routine quarterly reviews and quarterly or annual reporting through programme reports or the National Health Information System.[12]The National Cancer Coordinating Committee is responsible for monitoring stakeholders and evaluating policy implementation, while the Public Health and Medical Standards Divisions are to develop measurable output, process and outcome indicators.[12][14]
• Mobilise resources through annual funding advocacy, corporate and stakeholder support, government Development Budget funding for major infrastructure and capital works, and routine health-sector workforce planning.[11][12]The National Cancer Centre’s annual budget is reported as under two million Kina and insufficient for service improvement beyond routine operations.[11]

Monitoring & Evaluation

Monitoring and evaluation are centred on phased cancer registration, routine programme review, National Health Information System reporting, and National Department of Health coordination. The framework seeks to generate reliable information on cancer burden, diagnosis trends and intervention effects, while recognising that population-based data, mortality data and functioning national registries have been inadequate.[6][15][10][11]

• Establish hospital-based cancer registries initially at the National Cancer Centre in Lae and Port Moresby General Hospital, expand to regional sites where appropriate, and pursue a longer-term population-based registry.[11]
• Coordinate registry data with the National Health Information System and information from provincial and district hospitals, private providers, non-governmental organisations and other stakeholders.[11]
• Establish a Cancer Registry Committee with approved terms of reference to coordinate collection and analysis of registry and National Health Information System data and provide timely reports to the National Department of Health.[11]
• Use registry and surveillance information to estimate and monitor cancer burden, incidence and diagnostic trends, and to inform evidence-based prevention and care interventions. Hospital-based data and capacity reviews are identified as interim sources, but they exclude people who do not attend health facilities.[10][11]
• Coordinate implementation monitoring and evaluation through the National Cancer Coordinating Committee, with the Public Health Division overseeing prevention and promotion and the Medical Standards Division overseeing hospital-based programmes.[14]
• Develop measurable output, process and outcome indicators through the Public Health Division and Medical Standards Division working via the National Cancer Coordinating Committee.[14]
• Conduct routine quarterly reviews and report quarterly or annually through programme reports or the National Health Information System.[12][14]
• Report implementation through governance channels to the Secretary and Minister of Health, with technical direction from the National Cancer Advisory Council and coordination through the National Cancer Coordinating Committee.[14]
• Support implementation and policy review through operational and other research on the National Cancer Care and Control Programme.[14]

The source identifies cancer registration, surveillance, research, indicator development and routine reviews as the principal evaluation mechanisms. It does not provide a detailed indicator framework, indicator baselines, targets, surveillance case definitions, evaluation methodology, or formal accountability thresholds.[12][14]

Costing & Financing

Financing provisions focus on securing sustainable resources for cancer care, developing a costed five-year implementation plan, advocating for annual funding, and using government and partner mechanisms to support infrastructure, workforce and service improvements. The available evidence nevertheless indicates substantial resource constraints and does not provide a complete national programme budget or quantified funding gap.[11][12]

• Maintain and improve cancer services despite shortages of finance, personnel, facilities, equipment, supplies, information-technology support and reliable procurement of medicines and equipment.[15]
• Recognise that cancer treatment is resource-intensive and requires specialist skills and infrastructure, including surgery, radiotherapy, chemotherapy, laboratory services and supportive care.[16][15]
• Allocate the National Cancer Centre an annual budget described as under two million Kina, which is reported to be insufficient and generally absorbed by routine operations.[11]
• Develop and cost the National Cancer Control Programme implementation plan on a five-year basis, and advocate annually for appropriate funding.[11]
• Mobilise corporate organisations and other stakeholders for technical expertise and financial support, while using partnerships to maximise resources and reduce duplication.[5][11]
• Source major infrastructure and capital works through the government Development Budget process, and plan and budget human resources through routine government health-sector workforce planning processes.[12]
• Plan and budget provincial cancer activities and interventions through provincial administrative processes, with the National Department of Health advocating to central agencies for adequate funding.[14]
• Prioritise cost-effective, locally appropriate screening and early-detection approaches, including integration with existing public-health programmes in a resource-constrained setting.[8][9]
• Support resource mobilisation through non-governmental organisation networks and technical assistance from development partners for capacity building and health-system strengthening.[13]

Funding is needed for equipment maintenance and upgrading, laboratory capacity, workforce development, radiotherapy expansion, cancer registries, palliative care and psychosocial support.[9][10]The source does not specify detailed financing commitments, funding sources by amount, activity-level cost estimates, a quantified funding gap, or wider economic assumptions.[11][12]