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

Objectives

Burundi’s 2024–2028 National Strategic Cancer Control Plan seeks to reduce cancer-related morbidity and mortality and significantly improve the quality of life of people with cancer through equitable, accessible and high-quality care across the continuum from prevention and early detection to treatment, palliative support and follow-up.[1][2]It aligns cancer control with national health and development strategies, universal health coverage and Sustainable Development Goal target 3.4.[3][4][5]

• Strengthen leadership, governance, coordination, multisectoral collaboration and financing for cancer control.[1][6][2]

• Prevent cancer by addressing tobacco and alcohol use, unhealthy diet, physical inactivity, infectious agents, occupational and environmental carcinogens, and other modifiable risks.[7][5][8]

• Expand primary prevention initiatives by at least 25% and prevention interventions for infection-related cancers by 20% by 2028.[8]

• Strengthen hepatitis B and human papillomavirus prevention, including targets for hepatitis B vaccination coverage and at least 80% human papillomavirus vaccination coverage among girls aged 9 to 13 by 2028.[9][10][11]

• Improve screening and early diagnosis, with targets including at least 40% breast-cancer screening coverage, 30% cervical-cancer screening coverage, diagnosis of at least 40% of expected breast cancers among women aged 40 to 69 years, and treatment of all detected cervical precancerous lesions.[12][8][13]

• Improve diagnosis and treatment by increasing cancer-care capacity by at least 25% over five years, addressing shortages of pathology, imaging, medicines, trained personnel, standardised protocols and geographically equitable services.[14][15][16]

• Establish a national cancer referral centre by December 2026, develop regional oncology capacity and decentralise chemotherapy and specialist services.[15][17][18]

• Expand palliative care and rehabilitation nationwide through policy, essential medicines, training and structured services, including uninterrupted and affordable morphine access.[19][20][21]

• Strengthen cancer registration, epidemiological surveillance, strategic information and oncology research, particularly through a functioning Bujumbura cancer registry and digitised data collection.[22][2][23]

Implementation

Implementation is led by the Ministry of Public Health and the Fight Against AIDS through its National Integrated Programme for the Control of Chronic Non-Communicable Diseases, within the national health-system framework and in partnership with other ministries, health facilities, civil society, private providers, communities, development partners and international agencies.[3][24][25]The plan uses strategic matrices, performance frameworks, activity schedules and a planned costing process to translate its six pillars into operational action.[26][24][25]

• Coordinate national action through strengthened steering and consultation structures, clear stakeholder roles, information-sharing mechanisms, advocacy with decision-makers and multisectoral partnerships.[6][27][28][29]

• Deliver prevention through health promotion, communication campaigns, tobacco and alcohol regulation, workplace protection, vaccination, community engagement and collaboration with education, labour, commerce and other sectors.[8][30][31][32]

• Implement screening through national guidelines, quality assurance, referral and follow-up mechanisms, provider training, mobile services, public-private coordination and human papillomavirus-based cervical screening adapted for vulnerable groups.[33][34][35][36]

• Strengthen diagnostic and treatment services by maintaining and renewing equipment, expanding pathology and sample-referral systems, improving imaging and laboratory capacity, establishing multidisciplinary case review, standardising national protocols and improving medicine supply management.[37][38][39][40]

• Develop the referral centre through site selection, design, technical and environmental studies, construction, equipment and radiotherapy planning aligned with International Atomic Energy Agency standards, alongside annual fundraising and donor mobilisation.[18][41]

• Build workforce capacity through national curricula, training of trainers, cascade training, specialist partnerships, recruitment and retention measures, and oncology referral hubs in regional hospitals.[12][42][43][17]

• Deliver palliative care through pilot facilities, home visits, outpatient and hospital units, multidisciplinary teams, national guidelines, supervision tools, training, essential-medicines lists and an oral-morphine preparation laboratory.[44][45][46][47]

• Strengthen surveillance through registry staffing, hospital data focal points, standardised indicators, digital tools, quarterly data validation, annual data presentation and biennial cancer-situation reporting.[48][49][23][50]

• Monitor delivery through indicators covering mortality, budget execution, service coverage, screening, early diagnosis, treatment, five-year survival, quality of life, palliative-care access, registry functionality, workforce, infrastructure, equipment and research outputs.[2][51][52]A mid-term evaluation is planned for 2026, while quarterly performance reviews and dashboards are envisaged for implementation oversight.[25][53]

• Mobilise resources through a dedicated cancer budget line, annual procurement funding for anticancer and supportive medicines, morphine and equipment, proposed innovative financing, fundraising, private-sector incentives and possible redirection of alcohol and tobacco tax revenues.[12][54][55][56]Monetary allocations, total costs and quantified funding gaps are not specified in the supplied material.[25][54][57]

Monitoring & Evaluation

The plan establishes a performance-oriented cancer-control framework centred on reducing cancer-related morbidity and mortality, improving quality of life, and strengthening governance, prevention, diagnosis, treatment, palliative care, cancer information and research.[52][58]Monitoring combines programme indicators, activity outputs, cancer-registration data, health-facility records, supervision and periodic evaluation, although several elements, including reporting procedures and accountability arrangements, remain incompletely specified.[22][2][25]

• Measure overall outcomes through reductions in cancer morbidity and mortality, using the cancer registry, cancer-care centres and hospital registries as verification sources.[2]
• Track performance through indicators covering budget execution, functional cancer-care coverage in public hospitals, screening participation, incidence, early diagnosis and treatment, five-year survival, quality of life, palliative-care access, cancer-registry functionality and publication of planned research.[2][51][52][58]
• Use annual or 2024–2028 targets for many indicators, while recognising that some baselines are unavailable and some extracted target values are malformed.[52][58][25]
• Conduct a mid-term evaluation in 2026 and quarterly performance reviews of plan measures, producing evaluation reports.[25][53]
• Develop a logical framework with implementation stages, activities, indicators and calendars, supported by a dashboard of management indicators.[12][57][53]
• Strengthen surveillance through the Bujumbura cancer registry, cancer-care and hospital registries, digitised data collection in referral facilities, a consensual cancer-indicator manual and a reliable cancer database for strategic planning.[22][2][59][48][60]
• Address registry weaknesses, including its limited prior operation, lack of operational funding, insufficient data-collection resources and shortages of qualified personnel.[61][62]
• Improve data quality by training focal points, revising collection tools, equipping facilities, validating data quarterly, presenting data annually and publishing a biennial national cancer-situation report.[23][50]
• Use formative supervision for digital data collection twice yearly, cervical early-detection services and palliative-care facilities, including six-monthly supervision visits to pilot facilities.[63][46][64]
• Monitor prevention against explicit targets, including a 25% increase in primary-prevention initiatives by 2028, 40% breast-screening and 30% cervical-screening coverage, and treatment of 100% of detected cervical precancerous lesions.[12][8][13]
• Track human papillomavirus vaccination coverage and adverse events, including an 80% coverage target among girls aged 9 to 13 years by 2028 and a 90% target among 15-year-old girls through communication campaigns.[10][11][31][65]
• Monitor palliative-care progress through service outputs, standardised clinical and home-visit records, medicine availability, staff-training milestones and targets for a 30% increase in qualified professionals by December 2027.[20][44][66][67]

Responsible institutions are identified for selected actions, particularly the Ministry of Public Health and the Fight against AIDS and its national non-communicable disease programme, but the extracts do not provide a complete reporting calendar, standardised indicator definitions, independent evaluation design or formal accountability process.[25][54][42][55]

Costing & Financing

Financing is a strategic pillar of the cancer-control plan, which seeks to cost activities, establish dedicated budget lines, mobilise domestic and external resources, improve affordability and address substantial resource constraints.[6][12][54]The supplied material does not provide an overall programme budget, financing envelope, expenditure forecast, monetary funding gap or detailed economic assumptions.[25][57][37]

• Cost planned activities through a post-drafting workshop involving partners, while including a dedicated cancer-plan budget line and budget allocations by objectives and health-system pillars.[24][6][25]
• Allocate annual funding for anticancer medicines, supportive medicines, morphine, consumables and medical devices, including palliative-medicine activities at central and decentralised levels.[12][20][68]
• Mobilise resources for radiotherapy, medical imaging, surveillance, research, screening, early diagnosis, cancer-centre construction and subsidised diagnosis and treatment.[54][42][18][41]
• Redirect a proposed 15% of alcohol and tobacco tax revenues to cancer control and pursue telecommunications contributions, an annual telethon and tax incentives for private donations.[54][56]
• Establish a special fund to subsidise diagnosis and anticancer treatment, and advocate for free screening, early detection and management of cervical precancerous lesions and childhood cancers.[42][69]
• Improve affordability through subsidised prices for morphine, anticancer medicines and related supplies, a proposed assessment package price, and inclusion of oral morphine in health-insurance mutual coverage.[20][70][37][68]
• Address constraints arising from insufficient programme subsidies, limited implementation financing, high diagnostic and treatment costs, weak insurance coverage and limited financing for surveillance and registry operations.[71][62][72][37]
• Support palliative care through funding for medicine supply, oral-morphine production capacity, training, supervision and pilot service delivery.[21][47][66][73]
• Undertake a cost-effectiveness study of cancer-prevention interventions in 2026 to improve evidence on the economic efficiency of preventive actions.[64]

Economic pressures affecting implementation include high poverty, declining gross domestic product per capita between 2015 and 2020, and rising inflation between 2021 and 2022.[74]Patient-facing costs vary substantially between public and private diagnostic providers, reinforcing the need for affordability measures.[75]