Plan Stratégique National De Lutte Contre Le Cancer 2022-2026

Objectives

The National Strategic Plan for Cancer Control 2022–2026 is the Republic of the Congo’s principal operational framework for coordinating cancer-control action. It is aligned with national health and development planning, contributes to Sustainable Development Goal 3, and seeks to reduce cancer-related morbidity and mortality through an integrated response rather than isolated interventions.[1][2][3][4]

• Strengthen governance, leadership, programme management and partnerships for cancer control, supported by principles of leadership, accountability, results-based management, decentralisation, community ownership, intersectoral action and diversified partnerships.[5][6]
• Mobilise domestic and external resources, improve the population’s financial access to cancer care, and seek to mobilise at least 80% of funds required for strategy implementation.[7][6]
• Expand access to cancer prevention, early detection, diagnosis, treatment, palliative care, medicines, infrastructure, equipment and qualified personnel.[5][7][8][6]
• Increase the cancer-control workforce by 50%, establish trained cancer-care teams in the 31 district referral hospitals and 10 general hospitals, and enable at least 30% of patients to access treatment appropriate to their cancer type.[7][8]
• Equip at least four health facilities for cancer laboratory examinations and provide radiotherapy and nuclear medicine in at least two general hospitals, one each in Brazzaville and Pointe-Noire.[5][7][9][10]
• Reach at least 50% of people aged over 12 years with information on cancer risks and early detection, screen at least 50% of those reached for precancerous lesions, and vaccinate at least 25% of target populations against human papillomavirus and more than 95% against hepatitis B.[7][8][11]
• Establish a cancer information and surveillance system, including a National Cancer Registry across all levels of the health system, with at least 95% of relevant data available for monitoring and evaluation.[8][6][12][13]
• Promote applied cancer research, including at least one registered cancer study annually and a 50% completion rate for planned research activities.[6][14][15]

Implementation

Implementation combines legal and institutional reform, decentralised service delivery, resource mobilisation, prevention and health promotion, strengthened clinical capacity, and data-driven monitoring. The Ministry of Health and Population and the National Cancer Control Programme lead delivery with health facilities, other government bodies, local authorities, civil society, communities, technical and financial partners, research actors and private-sector partners.[1][5][7][6][16]

• Strengthen the legal and regulatory framework by preparing implementing texts for Decree No. 2019-228, addressing regulatory gaps, developing programme normative documents, and establishing a steering committee to coordinate cancer-control interventions.[17][18]
• Coordinate stakeholders through governance and partnership arrangements involving the Ministry of Health and Population, the National Cancer Control Programme, ministerial bodies, civil-society organisations, Parliament, the Government Secretariat, radiation-protection and nuclear-safety authorities, and technical partners.[17][18][19]
• Prepare annual budgeted work plans based on the national strategy and pursue financing through State budget allocations, development-partner and corporate contributions, Universal Health Insurance, annual fundraising through the “LISALISI” event, and proposed tax-based mechanisms.[19][20][21][22]
• Improve service provision by developing decision algorithms for screening and care, expanding diagnostic imaging and laboratory capacity, installing radiotherapy equipment, supporting patient accommodation near treatment sites, and strengthening access to radiotherapy, brachytherapy and oncology surgery.[22][23][9][10]
• Establish hospital cancer-care teams, hold at least one medical staff meeting per team each month, develop a national palliative-care strategy for 2023–2026, and train personnel across all three health-system levels in specialised oncology-related fields.[24][25][26]
• Improve medicine access by advocating for free anticancer and supportive medicines, listing generic anticancer medicines as essential medicines, procuring stocks internationally, and supplying hospitals every six months through the Centrale d’Achat des Médicaments Essentiels et Produits de Santé.[27][28]
• Integrate cancer prevention into community and health-facility activity, address tobacco, alcohol, infection-related and environmental risks, conduct knowledge, attitudes and practices surveys, and strengthen awareness of risk factors and early detection.[29][30][11]
• Integrate cancer surveillance forms and indicators into District Health Information Software 2, establish the National Cancer Registry, train five cancer registrars in oncology classification, develop tumour files in district facilities, map cancers nationally, and conduct research on cancer risk factors.[13][31]
• Monitor progress through indicators covering legal instruments, operational structures, financing, workforce, service availability, medicine supply, prevention coverage, vaccination, registry completeness, reporting timeliness and research outputs.[5][7][8][6][32][33][34]

Monitoring & Evaluation

The 2022–2026 strategy establishes monitoring, evaluation, accountability and results-based management as guiding principles, supported by a cancer information sub-system, a National Cancer Registry and integration of cancer indicators into District Health Information Software 2 (DHIS2).[5][12][13][32]The monitoring and evaluation plan is intended to define actors’ roles, information flows, indicators, data sources, and processes for producing and disseminating reliable information for decision-making.[32]

• Establish the National Cancer Registry across all health-system levels, with a target of at least 95% of required factual cancer data.[8][6][12][13]
• Integrate cancer case-surveillance forms and trend indicators into DHIS2, and ensure that all reports from intermediate and peripheral levels reach the National Cancer Control Programme within required deadlines.[6][13][31]
• Track implementation through indicators on legal and regulatory instruments, operational structures, financing, workforce, service availability, diagnostic and treatment access, medicine supply, prevention, screening, vaccination, research and reporting.[5][7][8][6][32][33][34]
• Monitor information-system performance through registry availability, reporting completeness and timeliness, DHIS2 outputs, trained registrars, tumour files, national cancer mapping, research topics and studies informing interventions.[13][31]
• Assess service and workforce delivery through hospital cancer-care teams, regular clinical meetings, palliative-care coverage, continuing training, training-guide availability and decentralised workshops.[24][25][26][35]
• Use legal and governance indicators including numbers of normative texts developed, submitted, approved or promulgated; legal gaps addressed; annual budgeted work plans; and the proportion of structures operating in accordance with programme guidelines.[17][18][19]

Existing information assets include the Directorate of Health Information, the population-based Brazzaville Cancer Registry, DHIS2, national research institutions and collaboration with the African cancer-registry network.[36]Important gaps include the absence of national factual cancer data, a cancer-registration and surveillance technical working group, interoperable data platforms, applied research and established monitoring and evaluation mechanisms.[36][3]The strategy sets research targets of at least one registered cancer study annually and 50% completion of planned research activities.[6][14][15]

Roles are assigned for selected information activities, including the National Cancer Control Programme Directorate, the Directorate of Health Information, Evaluation and Research, and the Directorate of Hospitals.[13][31]However, the available extracts do not specify a detailed reporting calendar, evaluation methodology, escalation process, named accountability body or sanctions for underperformance.[5][6][13][31]

Costing & Financing

Financing and resource mobilisation form a dedicated strategic axis, intended to improve financial access to cancer care and secure domestic, partner, corporate and innovative sources of funding.[7][6][20][21][22]The strategy seeks to mobilise at least 80% of funds required for cancer-control interventions.[7]

• Increase State budget allocations, with advocacy for a 5% annual increase in cancer-control budget lines.[20]
• Mobilise contributions from development partners, technical and financial partners, businesses and corporate social-responsibility mechanisms.[37][20][21]
• Expand Universal Health Insurance coverage for people with cancer and improve access to free radiotherapy, nuclear-medicine examinations, anticancer medicines, supportive medicines and essential inputs.[20][23][27][28]
• Use innovative financing mechanisms, including the annual “LISALISI” fundraising event and proposed taxes on tobacco industries, pylons, alcohol and other carcinogenic products.[18][21][22][37]

Existing financing provisions include a recurrent State-budget line for the National Cancer Control Programme, Universal Health Insurance, national health accounts and bilateral and multilateral partnership agreements.[37]Identified constraints include absent dedicated investment funding, low disbursement of the recurrent programme budget, limited cancer coverage in insurance benefit packages, insufficient intervention funding, low partner contributions and inadequate financing for cancer research.[37][36][3]

Costed tables provide activity-level amounts, frequently without a stated currency, source, period or disbursement arrangement.[17][20][13]The estimated cost of Axis 2 is 87,618,501 with no currency specified, while Axis 3 is costed at 9,540,245,851 FCFA.[22][10]The 2022–2026 monitoring and evaluation plan is costed at 665,364,418 FCFA.[38]No consolidated programme budget, quantified funding gap, financing timetable or economic assumptions are specified in the supplied extracts.[7][6][23][38]