Strategija Za Prevenciju, Tretman I Kontrolu Malignih Neoplazmi

Objectives

The 2012–2020 Strategy for the Prevention, Treatment and Control of Malignant Neoplasms in the Federation of Bosnia and Herzegovina establishes a comprehensive cancer-control framework intended to reduce cancer incidence and mortality, alleviate suffering among patients and families, improve quality of life and reduce health inequalities through effective use of available resources.[1][2][3]Its five strategic goals are to reduce incidence; ensure early detection and screening; provide effective diagnosis and treatment; provide effective palliative care; and establish continuous data collection, monitoring, evaluation and research.[4][3][5]

• Reduce exposure to modifiable cancer risks by promoting healthy lifestyles, personal responsibility for health, nutritious diets, physical activity and healthy body weight; reducing tobacco and harmful alcohol use; limiting harmful ultraviolet exposure; and addressing environmental and occupational carcinogens.[6][7][8]
• Strengthen infection-related cancer prevention through comprehensive hepatitis B immunisation and the widest feasible coverage of human papillomavirus immunisation, alongside reproductive and sexual health measures.[6][9][10]
• Achieve long-term reductions of 10% in regular smoking, harmful alcohol consumption, overweight and obesity, alongside a 10% increase in regular physical activity; improve safe-food access, water quality and air quality; and reduce carcinogenic contaminants in line with European Union recommendations.[7]
• Increase early diagnosis and establish organised population screening for breast, cervical and colorectal cancer, using mammography, cytology or Papanicolaou testing, and faecal occult blood testing followed by endoscopy where appropriate.[11][12][13]
• Target screening coverage of 80% for women aged 50–70 years for breast cancer, 70% for women aged 21–60 years for cervical cancer, and 70% for people aged 50–74 years for colorectal cancer.[14]
• Improve cancer diagnosis, treatment, follow-up, rehabilitation and survival through evidence-based standards for at least 10 common cancers, with diagnosis and staging within one month of serious suspicion and specific oncology treatment within one month of diagnosis.[15][16]
• Provide integrated palliative care that controls pain and other symptoms, gives psychosocial support to patients, families and carers, and enables dignified end-of-life care in a preferred feasible setting; the stated outcome target is adequate pain control for 90% of oncology patients.[17][18]
• Establish a comprehensive population-based cancer registry and a cancer monitoring, evaluation and research system, aiming for 95% registry coverage supported by standard methods, protocols, information flows, coordination and continuing education.[5]

Implementation

Implementation is designed as a phased, whole-of-government and multisectoral process integrating cancer control into health, social, economic and environmental policy.[19][20]It combines population prevention, organised screening, coordinated referral and specialist care, palliative support, information systems and research, while requiring equitable access for marginalised and vulnerable groups.[21][22][23]

• Lead and coordinate the Strategy through the Federal Ministry of Health, which initiates, supervises and coordinates implementation, supported by a professional coordinating commission for cancer control and topic-specific working groups.[24]
• Develop annual operational plans that assess the current situation, define objectives and organisational arrangements, specify staffing and resources, include financial calculations and annual actions, and set arrangements for implementation, supervision, control and final evaluation.[25]
• Prioritise interventions according to severity of need, feasibility and resource availability, distinguishing measures achievable through better use of existing resources from those requiring medium-term expansion or additional resources.[25]
• Coordinate action among federal, cantonal and municipal authorities, public-health institutes, health-insurance bodies, professional associations, universities, employers, schools, non-governmental organisations, communities, donors and international partners.[19][24][26]
• Deliver prevention through health promotion, legislation, education, media engagement, school and workplace programmes, environmental-health controls and tobacco, alcohol and nutrition policies.[27][28][29]
• Implement screening in phases between 2014 and 2020, supported by management, operational and professional structures; capacity assessments covering premises, staff, equipment and finances; standard equipment lists; communication protocols; repeated invitations; and access arrangements for at-risk and marginalised populations.[13][30]
• Replace opportunistic screening with organised, evidence-based population programmes that are linked to accessible diagnostic assessment and effective treatment, including surgery, radiotherapy, chemotherapy and psychosocial support.[22][12][15]
• Strengthen service delivery through multidisciplinary teams, clear referral pathways, standardised clinical pathways and protocols, quality standards, workforce development, health-technology planning, capital investment and a Federation-level oncology referral centre.[16][31]
• Develop palliative care through interdisciplinary teams, primary care, hospital departments, social-health institutions, pain clinics, home care, rehabilitation, hospices and specialised analgesic services; improve opioid availability and provide clinician education and certification.[18][32]
• Operate the cancer registry through public-health institutes, define a core dataset and internationally aligned indicators, establish the Cancer Health Information System with data-security and exchange standards, and issue annual cancer reports.[33][34][35]
• Monitor implementation continuously through indicators and additional data sources, conduct periodic independent reviews, and submit annual progress reports to the Federal Ministry of Health and the Government of the Federation of Bosnia and Herzegovina.[24][25]
• Finance implementation through the legal responsibilities of the Federation, cantons and municipalities, supplemented by development projects, Instrument for Pre-accession Assistance projects, European Union funds and donations; no overall budget or quantified funding gap is specified in the supplied material.[25]

Monitoring & Evaluation

The strategy establishes a comprehensive monitoring, evaluation and research agenda for cancer control, centred on a population-based cancer registry, a Cancer Health Information System, defined datasets and indicators, and annual reporting.[5][33][34][36][35]It also requires continuous monitoring, periodic independent review and annual progress reports to the Federal Ministry of Health and the Government of the Federation of Bosnia and Herzegovina.[24][25]

• Establish a population-based cancer registry with standard methodologies, protocols, information flows, training, data-quality standards and a target of 95% coverage.[5][36]
• Develop the Cancer Health Information System, including common terminology, unique identifiers, communication and security standards, data definitions, protection and exchange protocols.[5][35]
• Define core datasets and indicators aligned with international recommendations, and produce annual cancer reports using these data.[5][33][36][35]
• Monitor cancer incidence, mortality, survival, inequalities, risk-factor exposure, screening coverage and outcomes, treatment quality, workforce, infrastructure, equipment and bed capacity.[14][12][15][16][37][23]
• Track screening outcomes, including target-population coverage, early-stage detection, invasive disease, survival and cancer-specific mortality; stated targets include 80% breast-screening coverage, 70% cervical- and colorectal-screening coverage, and a 10% reduction in overall cancer mortality.[14][22]
• Evaluate treatment results in every institution involved in cancer care, applying unified clinical guidance, protocols and quality standards.[31][17]
• Report implementation results through the professional coordinating commission, canton-level commissions, canton health ministries and public-health institutes, with Federal Ministry of Health oversight.[24][25]
• Strengthen registry reporting and analysis, as historical registry coverage, staffing, equipment, training and analysis of outcomes such as survival have been inadequate.[38][3][39]
• Use research to support evidence-based policy, including epidemiological, clinical, behavioural, psychological, environmental, health-service and socioeconomic-inequality research.[3][40]

Costing & Financing

No overall strategy budget, quantified funding gap, unit cost or detailed economic assumptions are provided.[25]Financing is nevertheless intended to be embedded in annual operational plans, which must specify financial calculations and organisational, staffing and resource requirements.[25]

• Finance preparation and implementation through the legally defined responsibilities of the Federation, cantons and municipalities, supplemented by development projects, Instrument for Pre-accession Assistance projects, European Union funds and donations.[25]
• Prioritise actions according to severity of need, feasibility and resource availability, distinguishing measures achievable through better use of existing resources from those requiring medium-term expansion or future resource availability.[25]
• Use available resources efficiently, consistent with the principles of economy, affordability and sustainability.[2][41][42]
• Recognise cancer and other chronic diseases as generating direct and indirect health costs, absenteeism, productivity losses, reduced household income, early retirement and increased reliance on social protection.[20]
• Mobilise investment for screening equipment, staffing, consumables, maintenance and servicing, and prepare a financial plan after assessing provider capacity, premises, personnel, equipment and finances.[43][13][30]
• Prepare health-technology, capital-investment and workforce-development plans for diagnosis, treatment and cancer control; monetary values are not specified.[16][26][44]
• Address the lack of depreciation funds for radiotherapy-equipment procurement, maintenance and renewal, while recognising that systemic-treatment access has improved through the Federal Solidarity Fund but remains vulnerable to rising costs and market conditions.[45]
• Develop palliative-care financing through a dedicated strategy, covering medicines, opioid analgesics, workforce development, home care, hospices, pain clinics and institutional networks.[18][32]
• Maintain adequate human and financial resources for cancer registration and information systems, which are necessary for planning staff, technology, beds and financial support.[33][37]
• Explore continuous financing for health-promotion interventions through existing budgetary resources raised by taxation of high-tariff goods and intersectoral participation.[11]