National Cancer Control Policy

Objectives

The policy establishes Papua New Guinea’s first comprehensive national framework for cancer care and control, aligned with the National Health Plan 2011–2020, the Health Sector Corporate Plan and relevant legislation and sector plans.[1][2]Its overarching goal is to reduce cancer morbidity and mortality while improving survival and quality of life through sustainable, evidence-based and locally appropriate prevention, diagnosis, treatment, palliative care, registration and surveillance.[3][4]The framework responds to a growing burden of non-communicable diseases alongside communicable diseases, with an estimated 10,000 to 15,000 cancer cases annually and unavailable national mortality data.[2]

• Establish a sustainable National Cancer Control Programme (NCCP) to coordinate comprehensive cancer control, replace fragmented and treatment-focused services, and give greater prominence to cancer care across Papua New Guinea.[4][5][6]
• Prioritise prevention of cervical, breast, oral and liver cancers, which are identified as major or priority cancers, while tailoring interventions to common cancers and available resources.[1][2][7]
• Reduce preventable cancer risks by addressing tobacco smoking, betel-nut chewing, harmful alcohol use, unhealthy diets, physical inactivity, risky sexual behaviour, environmental carcinogens and exposure to industrial, cytotoxic and pesticide waste.[1][4][8]
• Promote healthy lifestyles, public education and immunisation, including continued hepatitis B birth-dose vaccination and exploration of human papillomavirus vaccination for cervical cancer prevention and possible routine immunisation.[4][8]
• Provide locally appropriate, cost-effective and evidence-based screening and early treatment for at-risk populations, including approaches for cervical and oral pre-cancer and cancer detection.[6][8][9]
• Strengthen diagnosis, treatment, referral and specialist services at the National Cancer Centre, the national referral hospital and regional hospitals, including surgery, radiotherapy and chemotherapy where required.[1][10][6]
• Expand palliative care, oral-opiate access and psychosocial support from hospitals to provincial, district, health-centre and community levels.[10][6][11]
• Develop a phased national cancer registry and surveillance system to estimate and monitor cancer burden and trends, support evidence-based interventions and progress towards a population-based registry when feasible.[11][12]
• Build workforce, infrastructure, equipment, technology and research capacity while applying principles of equity, accessibility, affordability, cultural acceptability, scientific evidence, technological appropriateness, environmental adaptability and partnership working.[5][10]

Implementation

Implementation is based on national stewardship, coordinated planning and delivery across facility, provincial, district and community levels.[6][13]The National Department of Health (NDoH) is to establish and coordinate the NCCP through its responsible divisions, corporate and annual planning processes, provincial and hospital strategic plans and budgets, workforce planning, and a detailed preferably five-year implementation plan that allocates short-, medium- and long-term priorities and responsibilities.[6][13]Delivery combines prevention and community education with strengthened referral, diagnostic, treatment, palliative-care, registry and research systems.[14][4]

• Establish the National Cancer Coordination Committee within the NDoH governance structure, supported by a rotating secretariat from the Medical Standards and Public Health divisions, to oversee implementation, technical advice and policy evaluation.[13]
• Constitute the National Cancer Advisory Council to provide policy direction, with representation from government, health services, academic, research, civil-society and international organisations.[15][16]
• Coordinate implementation through the National Cancer Coordinating Committee, with reporting to the Secretary and Minister of Health through the Programme Committee and quarterly reviews.[15]
• Strengthen the National Cancer Centre at Angau Memorial General Hospital in Lae as a comprehensive centre of excellence for cancer care and research, including radiotherapy, brachytherapy and chemotherapy services.[7][11]
• Coordinate chemotherapy through Port Moresby General Hospital and regional and provincial hospitals under the National Cancer Treatment Centre, develop specialised surgical services in Lae and Port Moresby, and bring the primary Lae treatment facility to an acceptable standard before developing satellite radiotherapy facilities.[7][11]
• Train health workers, including health extension officers, nurses, community health workers, medical students and specialists, and integrate cancer screening, detection, treatment, palliative care, counselling and referral competencies into training curricula.[9][12]
• Integrate screening into existing public-health programmes, develop screening and diagnostic guidelines and standard operating procedures, strengthen laboratory capacity, and improve community awareness of cancer signs and symptoms.[9]
• Establish hospital-based registries initially at the National Cancer Centre in Lae and Port Moresby General Hospital, expand to regional sites, and require hospitals, private providers, non-governmental organisations and other stakeholders to submit cancer data to the National Health Information System.[12]
• Establish a Cancer Registry Committee with approved terms of reference to coordinate data collection and analysis and provide timely reports to the NDoH.[12]
• Formalise partnerships with private providers, churches, non-governmental organisations and other partners through memoranda of understanding or agreement under the Health Sector Partnerships Policy, clarifying roles, preventing duplication and supporting resource mobilisation.[6][13][15]
• Assign national responsibilities for policy, standards, procurement, workforce planning, research and technical support; assign provincial responsibilities for planning, budgeting, supervision, awareness and reporting; and assign district responsibilities for outreach, data collation and community action.[15]
• Monitor implementation through routine quarterly reviews and quarterly or annual programme or National Health Information System reporting, while developing measurable output, process and outcome indicators through the Public Health and Medical Standards divisions and the coordinating committee.[13][15]
• Finance major infrastructure and capital works through the government Development Budget and workforce requirements through normal health-sector workforce planning; develop and cost the NCCP implementation plan over five years and advocate annually for adequate funding.[13][12]

Monitoring & Evaluation

Monitoring and evaluation are to be integrated into implementation of the National Cancer Control Programme through cancer registration, routine reporting, quarterly reviews, research and governance oversight.[12][13][15]The policy does not provide a detailed indicator framework, targets or evaluation methodology.[13]

• Establish phased hospital-based cancer registries at the National Cancer Centre in Lae and Port Moresby General Hospital, expand them to regional sites, and work with the National Health Information System towards national burden estimates and a future population-based registry.[12]
• Require provincial and district hospitals, private providers, non-governmental organisations and other stakeholders to submit cancer data to the National Health Information System.[12]
• Form a Cancer Registry Committee with approved terms of reference to coordinate data collection and analysis and provide timely reports to the National Department of Health.[12]
• Use registry and surveillance data to estimate and monitor cancer burden, diagnostic trends and mortality, addressing current gaps in population-based data and knowledge of cancer mortality.[2][11]
• Develop measurable output, process and outcome indicators through the Public Health Division, Medical Standards Division and National Cancer Coordinating Committee.[15]
• Assign the Public Health Division to monitor prevention and health-promotion activities and Medical Standards to monitor hospital-based programmes.[15]
• Conduct routine monitoring through quarterly reviews, with programme or National Health Information System reporting on a quarterly or annual basis.[13][15]
• Require provincial administrations to monitor and report implementation, and require district administrations to collate facility and community information for reporting to the Provincial Health Information System.[15]
• Task the National Cancer Coordinating Committee with monitoring implementation, providing technical advice and evaluating the policy, under the policy direction of the National Cancer Advisory Council.[13][15]
• Use monitoring findings to identify corrective action, guide implementation and inform future policy review.[15]
• Coordinate and approve cancer research under the Health Sector Research Policy, and use operational research to generate evidence for programme implementation and review.[6][15]
• Manage confidential and sensitive programme information according to defined management guidelines.[6]

Costing & Financing

Financing is framed around securing long-term support for existing and new cancer programmes, costed implementation planning, government budgeting and stakeholder resource mobilisation.[12][13]The National Cancer Centre's annual budget is under two million Kina and is described as insufficient, as routine operations generally consume it.[12]

• Develop and cost a National Cancer Control Programme implementation plan on a five-year basis, with short-, medium- and long-term priorities and defined responsibilities across service levels.[12][13]
• Advocate annually for appropriate funding to sustain existing services, expand provision and support workforce training.[12][13]
• Finance major infrastructure and capital works through the government Development Budget, and plan and budget human resources through normal government health-sector workforce processes.[13]
• Incorporate programme activities into National Department of Health corporate and annual plans and into provincial and hospital strategic and annual budget processes.[13]
• Mobilise corporate organisations, non-governmental organisations, churches and other partners for financial support, expertise and aligned implementation through memoranda of understanding or agreement.[12][13][15]
• Address constraints in financing, personnel, facilities, radiation equipment, supplies, information technology and reliable procurement of cancer medicines and equipment.[7]
• Prioritise cost-effective, evidence-based and locally appropriate screening and early treatment, recognising that some approaches may be costly or difficult to implement in resource-poor settings.[6][8]
• Note that development partner support has been minimal and historical funding for service expansion and training has been limited.[12]

No total programme budget, detailed funding allocation, quantified funding gap or economic assumptions are specified.[12][13][15]