Plan Stratégique National De Lutte Contre Le Cancer Au Burundi 2024-2028

Objectives

The 2024–2028 National Strategic Cancer Control Plan provides Burundi’s framework for reducing cancer incidence, morbidity and mortality, improving quality of life, and advancing universal health coverage through equitable, continuous and quality prevention, diagnosis, treatment, rehabilitation and palliative care.[1][2]It aligns with national development and health-sector strategies and contributes to Sustainable Development Goal 3.4 on reducing premature mortality from non-communicable diseases.[1][3]

• Strengthen leadership, governance, coordination, financing and the institutional, legal and regulatory framework for cancer control.[2][4]
• Prevent cancer by addressing tobacco, alcohol, unhealthy lifestyles, infection-related cancers, occupational hazards and environmental carcinogens.[5][6][7]
• Expand screening and early detection, with targets to achieve at least 40% breast-cancer screening coverage and 30% cervical-cancer screening coverage by 2028, diagnose at least 40% of expected breast cancers among women aged 40–69 years, and treat all detected precancerous cervical lesions.[8]
• Improve diagnostic and therapeutic services by at least 25% over five years, construct a national oncology referral centre by December 2026, decentralise oncology care through regional referral hubs, and strengthen chemotherapy capacity.[9][10][11][12]
• Generalise palliative and supportive care, including pain management, psychosocial, nutritional and spiritual support, rehabilitation, and uninterrupted affordable access to morphine and other essential medicines.[13][14][15]
• Establish cancer registration, surveillance, strategic information and oncology research, including operationalising the Bujumbura cancer registry and digitising data collection in referral facilities.[16][17]

The framework is guided by equity, solidarity, quality, continuity and excellence, and promotes accessible, person-centred and holistic care consistent with international guidelines, standards and protocols.[2]Priority action responds to late diagnosis, unevenly distributed services, shortages of specialised staff and equipment, inadequate pathology and treatment capacity, limited palliative support, and weak cancer information systems.[18][19][20]

Prevention priorities include increasing primary prevention initiatives by at least 25% and infection-related cancer prevention interventions by 20% by 2028.[21][6]The plan aims to expand hepatitis B vaccination, achieve at least 80% human papillomavirus vaccination coverage among girls aged 9–13 years, reinforce tobacco and alcohol controls, and reduce workplace exposure to carcinogens.[22][23][24]

Palliative care has defined milestones to increase the number of qualified professionals by at least 30% by December 2027 and make services available through pilot health facilities in every health district by December 2026.[15][25]Surveillance and research priorities include validated cancer data, a consensual indicator manual, regular data validation, biennial reporting on the cancer situation, research coordination and continuous financing for registry and research activities.[26][27][28]

Implementation

Implementation relies on government ownership, multisectoral collaboration and progressively decentralised service delivery under the Ministry of Public Health and the Fight against AIDS, coordinated through the National Integrated Programme for the Control of Non-Communicable Chronic Diseases.[1][29]The plan was developed through a participatory process involving government ministries, civil society, public and private health actors, national experts, the World Health Organization and the International Atomic Energy Agency.[30][31]

• Coordinate national leadership through strengthened national and regional steering bodies, partner coordination mechanisms, stakeholder mapping, defined roles and information-sharing arrangements.[4][32][33]
• Deliver services through the four-level health system, linking central leadership, provincial support, district hospitals, health centres and community structures.[34]
• Establish regional oncology referral hubs in four hospitals, define their service packages, train personnel and support referral, follow-up and initial management closer to communities.[21]
• Develop national guidelines, protocols, standards, training modules and good-practice manuals for prevention, screening, diagnosis, treatment, palliative care and equipment management.[8][10][35]
• Engage private providers, civil-society organisations, professional bodies, universities, media, religious and community leaders in awareness, service delivery, advocacy and training.[36][32][37]

Screening delivery is intended to combine outreach and static services, single-visit screen-and-treat or screen-triage-and-treat pathways, human papillomavirus testing, visual inspection with acetic acid, cytology, self-sampling where appropriate, and referral and follow-up mechanisms tailored to vulnerable groups.[38][39]Mobile cervical and breast screening services, public-private coordination, accreditation of participating private facilities and common data-collection tools are planned to improve geographical access and quality assurance.[40][41]

Diagnostic and treatment capacity will be expanded through the national referral centre, pilot chemotherapy units in regional hospitals, strengthened pathology laboratories, telepathology, functional equipment, an oncology workforce plan and multidisciplinary consultation structures.[11][42][12][43]Cancer medicine management will use digital quantification of requirements, a technical management group and dedicated procurement for anticancer medicines, supportive medicines, morphine, consumables and medical devices.[44][45]

Palliative care implementation includes appointing a Ministry coordinator, developing national directives and pain-management standards, introducing standard records and supervision tools, establishing pilot facility teams, supporting home visits and ensuring continuous supplies of oral morphine and other essential medicines.[15][25][46][47]The plan also provides for a laboratory to prepare and dispense oral morphine, regulations on storage, dispensing and prescribing, and inclusion of essential palliative medicines in mutual health insurance coverage.[48][47][49]

Performance management will use a logical framework, cancer-registry and hospital data, activity reports, dashboards, quarterly reviews and a mid-term evaluation in 2026.[21][16][35][29]Key measures include budget execution, screening and treatment coverage, early diagnosis, five-year survival, quality of life, palliative-care coverage, registry functionality, workforce and equipment availability, guideline adoption and oncology research outputs.[17][50][51]

Financing actions include budgeting the plan, establishing annual budget lines for medicines and palliative care, subsidising diagnosis and treatment, mobilising domestic and partner resources, creating special funds, and pursuing innovative mechanisms such as allocating 15% of alcohol and tobacco tax revenue, telecommunications contributions, telethons and incentives for private donations.[21][52][53][54][55]The supplied summaries identify a detailed budget table but do not provide a verified overall currency or complete financing gap.[56]

Monitoring & Evaluation

The plan establishes a performance-oriented cancer-control framework centred on cancer registry data, hospital and cancer-care centre records, activity reports, published research, surveys, and validated guidelines and protocols. It combines outcome monitoring with service, workforce, infrastructure, financing and research measures, although some detailed indicator definitions and accountability arrangements are not specified.[16][17][50][57][58][51]

• Measure cancer morbidity and mortality, screening coverage, early diagnosis and treatment, five-year survival, quality of life, palliative-care coverage, hospital coverage with cancer services, budget execution and oncology research publications.[17][50][58][51]
• Track prevention and screening targets, including a 25% increase in primary prevention initiatives by 2028, breast-screening coverage of at least 40%, cervical-screening coverage of at least 30%, diagnosis of at least 40% of expected breast cancers among women aged 40 to 69 years, treatment of all detected precancerous cervical lesions, and follow-up of at least 80% of participants with positive screening results.[21][6][8][9][36]
• Monitor infection-related cancer prevention through a 20% reduction target by 2028, hepatitis B vaccination coverage targets, human papillomavirus vaccination coverage of at least 80% among girls aged 9 to 13 years by 2028, and vaccine-safety monitoring.[7][22][23][24][59]
• Assess service-capacity expansion against a target of at least 25% improvement over five years, construction of a national oncology referral centre by December 2026, establishment of four regional chemotherapy pilot units, functional equipment, qualified personnel and validated clinical guidance.[10][58][51][11][42][12]
• Strengthen palliative-care oversight through technical supervision, standardised records and registers, six-monthly visits to pilot facilities, and milestones for a 30% increase in qualified professionals by December 2027 and service availability in pilot facilities in every health district by December 2026.[15][25][46][60][61]
• Establish epidemiological surveillance through registry guidelines, a consensual indicator manual, strengthened Bujumbura cancer-registry operations, digitised data collection, quarterly validation meetings, annual data presentations and a biennial cancer situation report in 2026.[16][62][26][63][27][64][65]
• Conduct a mid-term evaluation in 2026, quarterly performance reviews, semi-annual formative supervision of digitised data collection, and periodic competency assessments.[29][35][65]

Key implementation risks include historically weak execution, insufficient financing, unavailable or zero baselines for some indicators, deficient cancer information systems, and the potential effect of the 2027 election on quality-of-life measurement.[66][50][58][51][35]The supplied extracts do not consistently specify reporting schedules, indicator calculation methods, independent audit procedures or named accountability bodies.[21][36][58][51]

Costing & Financing

The plan combines a detailed but currency-uncertain costing table with strategic financing measures intended to expand affordable cancer prevention, diagnosis, treatment, palliative care, surveillance and research. The supplied table gives a total pillar cost of 96,829,200 dollars, but does not identify the currency represented by the dollar symbol or provide a complete financing plan.[56]

• Allocate dedicated annual budget lines for anticancer and supportive medicines, morphine, consumables, medical devices and palliative-care activities at central and decentralised levels.[21][15][67][45][49]
• Mobilise domestic resources by advocating for 15% of alcohol and tobacco tax revenue to support cancer activities, using government special-purpose funds, telecommunications-related contributions, an annual telethon and an 80% tax deduction on private-sector donations.[52][54][55]
• Create and replenish a special fund to subsidise cancer diagnosis and treatment, advocate for free screening and treatment of cervical precancerous lesions and childhood cancers, and purchase diagnostic services from private pathology laboratories where needed.[36][53][41]
• Seek international and partner financing for radiotherapy, medical imaging, specialised training, oncology infrastructure and research through technical cooperation, development partners, pharmaceutical companies, foundations and specialised cancer centres.[52][53][28]
• Support financial protection by including oral morphine and other essential palliative-care medicines in the mutual health insurance benefit package and by adopting subsidised medicine prices.[21][15][48][33][49]
• Establish reliable continuous financing for cancer-registry operations, epidemiological surveillance and cancer research.[16][28]

Affordability is a major concern: diagnostic examinations, anticancer medicines, morphine, pathology and imaging services may exceed household purchasing power, while earlier plan implementation was constrained by insufficient funding.[68][66][69][70]Economic conditions also include gross domestic product per capita declining from US$289.4 in 2015 to US$216.8 in 2020 and inflation rising from 8.4% in 2021 to more than 18.9% in 2022.[71][34]Except for the specified costing lines and service prices, the extracts do not provide confirmed funding sources, allocations by activity, funding-gap values, expenditure shares or economic assumptions.[56][72][73]