National Cancer Prevention and Control Plan Strategic

Objectives

Morocco’s National Cancer Prevention and Control Plan is a national, multi-sector roadmap developed by the Lalla Salma Association Against Cancer in partnership with the Ministry of Health. It seeks to reduce cancer incidence, mortality and risk factors, alleviate suffering and improve quality of life for patients and families through sustainable, equitable and efficient action suited to Morocco’s social, economic and cultural context.[1][2][3][4]The plan comprises 78 measures across prevention, early detection, diagnosis and therapeutic management, palliative care, communication, legislation, social support and implementation.[5][2][6]

• Reduce preventable cancer risk, recognising that approximately 40% of cancers may be avoidable through healthier lifestyles and action on major risk factors.[1][7]
• Prevent tobacco use and passive smoking; promote healthy diets, physical activity and healthy weight; reduce alcohol-related harm; prevent cancer-associated infections; and strengthen protection from occupational, environmental, food-related and radiation risks.[8][9][10][11]
• Establish surveillance of cancer incidence, mortality, behavioural and occupational risks, and public knowledge, attitudes and practices.[11]
• Prioritise early detection and early diagnosis, particularly for breast and cervical cancer, while improving public awareness, access, quality assurance, staff training and programme assessment.[12][13][14]
• Strengthen diagnosis and treatment through dedicated oncology facilities, national good-practice references, coordinated referral pathways, affordable medicines, trained personnel and multidisciplinary management.[15][16][17][18]
• Expand palliative care, pain management, morphine access, family and social support, and hospital, ambulatory and home-based care networks.[19][20][21]
• Promote communication, research, training, legislation and social mobilisation as cross-cutting enablers, guided by equity, solidarity, quality, excellence and protection of patient rights.[4][7]
• Reduce the prevalence of cancer risk factors by 30% as a stated outcome objective.[22]

Implementation

Implementation combines nationally coordinated planning, multi-sector participation and component-specific action plans. The plan was prepared by the Lalla Salma Association Against Cancer, validated through a steering committee and joint panel with the Ministry of Health, and supported by an ad hoc commission for follow-up and monitoring.[3][6]Its design drew on fifteen situation-analysis studies and six thematic workshops involving national and international experts, relevant departments, organisations and specialists.[6]

• Deliver prevention through public information and education, tobacco-control enforcement, cessation support, school and workplace initiatives, vaccination and infection control, occupational protection, environmental regulation, consumer protection, research and workforce training.[8][9][10][11][12]
• Organise early detection through clinical breast examination for women over 45 years and Acetic Acid Visual Inspection for cervical screening among women aged 30 to 50 years, initially through a pilot before wider implementation.[13]
• Integrate early-detection services into the health system by recruiting eligible women through health centres and general practitioners, confirming diagnoses through provincial services and private clinics, and linking treatment and follow-up to regional and specialist oncology services.[13]
• Operate a three-level cancer-care model: level 1 healthcare centres and general practitioners provide information, detection, referral and follow-up; level 2 provincial or prefectural hospitals, diagnosis centres and specialist services provide diagnostic confirmation and treatment; and level 3 university medical centres, regional oncology centres and specialised private clinics provide complex management, multidisciplinary planning, training and research.[15][16][23]
• Coordinate patient care through standardised records, patient follow-up notebooks, referral and communication mechanisms, pre-arranged appointments, and multidisciplinary consultation meetings involving relevant specialists in public and private services.[18]
• Strengthen service capacity by developing oncology centres, proximity services, specialised onco-gynaecology and paediatric haemato-oncology centres, diagnostic and treatment equipment, staffing standards, training and public-private service purchasing partnerships.[16][17][24][25]
• Improve medicine access by promoting generic medicines, reducing sale prices, reviewing distribution margins and pricing methods, encouraging local production, developing bioequivalence legislation and establishing a drug purchasing commission.[17]
• Deliver palliative care through regional oncology centres, proximity centres and primary healthcare institutions, supported by pain-management centres, hospital committees, outpatient clinics, mobile teams, telephone support, home care and community partnerships.[20][21]
• Monitor implementation continuously through component action-plan indicators covering risk-factor prevalence, screening coverage, functional screening structures, patients managed or cured, operational diagnosis and treatment facilities, and palliative-care access.[22]
• Apply quality assurance through written standards, audits, accreditation, equipment maintenance, traceable decisions and indicators covering diagnosis and treatment delays, treatment compliance, loss to follow-up, service coverage and patient satisfaction.[26][18]
• Use cancer registers, hospital registers, mortality data, occupational records and management information systems to register cases, assess service quality, record adverse events and support analysis and decision-making.[11][19]
• Implement actions through annexed timetables and budgets, including planned construction and extension of oncology, palliative-care, proximity and early-detection facilities.[22][27]

Monitoring & Evaluation

The plan establishes a broad monitoring, evaluation and accountability approach spanning cancer surveillance, risk-factor monitoring, service-quality assessment, programme indicators, patient records and information systems. It combines population and hospital cancer registration with monitoring across prevention, early detection, diagnosis, treatment and palliative care.[11][12][26][19][22]

• Maintain and develop the Grand-Casablanca-Region population cancer register, create hospital registers in public and private oncology units, analyse data through the Regional Health Observatory, and consider a second population register.[11]
• Improve mortality surveillance by training physicians, checking death-certificate completion and linking cancer and mortality registers.[11]
• Monitor occupational carcinogenic exposures, behavioural risk factors, cancer incidence and mortality, and public knowledge, attitudes and practices through registers, surveys and studies.[11]
• Create a multi-sector body to surveil tobacco consumption and monitor and evaluate tobacco-control activities; conduct occupational exposure surveys, monitor radioactive sources and legislation, and identify radon-risk areas.[9][10]
• Use a dedicated ad hoc commission for project follow-up and monitoring; the steering committee and joint Association Lalla Salma against Cancer and Ministry of Health panel validated the plan during its development.[3][6]
• Monitor global indicators continuously through component action plans, covering risk-factor prevalence, breast and cervical screening coverage, functional screening structures, patients managed and cured, operational diagnosis and treatment structures, and patients receiving palliative care.[22]

The source provides baseline epidemiological evidence, including approximately 30,000 new cancer cases annually and a standardised incidence estimate of 101.7 new cases per 100,000 inhabitants per year.[28][4]The Grand-Casablanca-Region Cancer Register was described as the only valid epidemiological source at the time, covering a population sample representing 10% of Morocco; it recorded 3,336 cases in 2004.[6]

Early-detection monitoring is particularly detailed. The plan calls for written standards across each stage of early detection, systematic audits, accreditation of participating public and private facilities, and permanent monitoring using quantitative and qualitative indicators.[26]Indicators are to cover tests, examinations, treatments, adherence to procedures and deadlines, patient satisfaction and cost evolution.[26]Standardised information forms, computerised data collection and feedback, periodic external reviews, and operational research are envisaged, including comparison of Acetic Acid Visual Inspection with cervical smear testing in the Moroccan context.[26]

• Define quality-assurance and monitoring protocols for early detection and case management, and introduce indicators and an analysis system to assess screening programmes.[12]
• Measure care-management performance through time from first consultation to diagnosis, time from diagnosis to treatment, adherence to chemotherapy and radiotherapy, treatment intervals, loss to follow-up, diagnosed and treated proportions, and patient satisfaction.[18]
• Set thresholds for management indicators at each level of care and ensure traceability of actions through standardised patient records, follow-up notebooks and documented multidisciplinary referral decisions.[18]
• Introduce an information system to register diagnosed and treated cases, exchange information across levels and sectors, record serious adverse events, archive medical files and support measurement of major evaluation indicators.[19]
• Maintain palliative-care records at proximity centres to support monitoring and evaluation.[21]

Patient follow-up is identified as a major data-quality constraint: 74% of cases were followed for less than two years, around half of patients were lost after one year, 83% by three years and 96% by five years.[29]Reliable five-year survival is regarded as an essential quality indicator, but cannot currently be estimated reliably because of loss to follow-up.[29]

Although the plan specifies numerous surveillance, quality and information mechanisms, the supplied material does not consistently define reporting frequency, named bodies responsible for reporting, numerical performance targets, evaluation methodologies or formal accountability procedures.[11][12][25][19][22]

Costing & Financing

The plan includes a provisional budget for 2010 to 2019 and annexed timetables and detailed budgets linked to component action plans.[5][22]Costing is intended to inform targeted programmes by considering proposed actions, implementation costs and resources that are available or may become available.[1][2]

• Allocate an early-detection subtotal of 23,600 thousand Moroccan dirhams in both 2010 and 2011.[14]
• Present annual costing-table totals rising from 525,700 Moroccan dirhams in 2010 to 987,700 Moroccan dirhams in 2019, with a table total of 7,237,000 Moroccan dirhams.[30][23]
• Include additional annex budget totals of 30,500, 20,000 and 510,000, although the supplied extract does not identify their currency or budget-line labels.[31]
• Provide annual allocations for one unidentified budget line from 2010 to 2019, but without a stated currency.[31]

Cancer care is characterised as financially burdensome. More than two thirds of the population lacked medical coverage, and patients could bear up to 90% of treatment costs for certain cancers.[3]High treatment costs, insufficient financial resources and lack of health insurance are identified as barriers to early detection and access to care.[4][29]Non-standardised diagnostic and treatment protocols are also associated with poor-quality and high-cost patient management.[29]

The plan identifies major resource requirements for screening, diagnosis, treatment and palliative care, including specialised facilities, equipment, trained staff, medicines, information systems, transport and home-based support.[13][16][17][21]It promotes affordability measures for medicines, including generic medicines, lower sale prices, a drug purchasing commission, revised distribution margins and pricing methods, local production, and bioequivalence legislation.[17]

• Assess the cost-benefit ratio of preventive measures through operational research.[12]
• Evaluate the benefits, treatment efficiency, nuisances and economic costs of early detection using Moroccan and international evidence.[12]
• Track cost evolution as an early-detection monitoring indicator and assess screening-test costs in periodic evaluation studies.[26]
• Increase tobacco taxes as a prevention measure, without specifying a tax rate, expected revenue or allocation of proceeds.[8]
• Support palliative-care delivery through adequate resources, paid-for transport, reimbursement of home-care fees and public-private partnerships.[21]

Funding sources, financing mechanisms, resource-mobilisation targets, funding gaps and economic assumptions are not specified in the supplied extracts.[5][16][17][30][23]