Plano Nacional De Controlo Do Cancro 2019-2029

Objectives

The National Cancer Control Plan 2019–2029 provides Mozambique’s strategic framework for reducing cancer incidence, morbidity and mortality through a multidisciplinary, integrated and coordinated national response. Its mission is to establish a public health system that provides comprehensive prevention, diagnosis, treatment, survivorship and palliative-care services to all citizens.[1]

• Strengthen a decentralised public health system that delivers accessible cancer services nationwide across prevention, diagnosis, treatment, palliative care, cancer registration and health information systems.[2]
• Prioritise primary and secondary prevention, early detection, diagnostic investigation, follow-up and care for advanced disease.[3]
• Target priority cancers including cervical, breast and prostate cancers, Kaposi’s sarcoma and other HIV/AIDS-related cancers, leukaemias, head and neck cancers, paediatric cancers and liver cancer.[4][5]
• Reduce preventable risks associated with tobacco, alcohol, infections, obesity, unhealthy diets, physical inactivity and environmental exposures.[6]
• Promote health awareness, healthy diets, physical activity, safer sexual practices, human papillomavirus vaccination for eligible girls, hepatitis B vaccination, HIV prevention and control, and improved cervical, breast and prostate cancer detection.[7][8]
• Ensure high-quality and timely treatment, including reliable access to diagnostic inputs, essential medicines, equipment, radiotherapy, chemotherapy, blood-bank support, pain relief and palliative care.[9][10][11]
• Strengthen cancer surveillance, population-based and hospital-based registration, and health information systems in accordance with international standards.[4][12]

Guiding principles include equity and universal access, government leadership, partnerships, accountability, sustainability, evidence-based practice, continuous monitoring and evaluation, and strategic prioritisation of prevalent, preventable or treatable cancers.[13]The Plan is intended to build on review of the preceding decade’s actions and to adapt interventions so that their reach extends nationally.[14]

Implementation

Implementation is to be led through the Ministry of Health and its National Directorate of Medical Assistance, with the National Cancer Control Programme responsible for leading the ten-year plan.[15]Delivery is intended to integrate cancer control across all levels of Mozambique’s mixed health system, combining public services with private, non-profit and community provision.[16][5]

• Develop a second-phase Action Plan that links strategies to activities, targets and a budget over short-term periods of one to three years, medium-term periods of three to five years, and long-term periods of five to ten years.[5]
• Coordinate central, provincial and district health authorities with other government sectors, development partners, civil society, communities, service users, medical groups and cancer advocacy organisations.[4][17]
• Align cancer-control activity with the Health Sector Strategic Plan, National Palliative Care Policy, National Human Resources for Health Development Plan, multisectoral non-communicable disease strategy, and national sexually transmitted infection and HIV/AIDS control plan.[1]
• Deliver breast and cervical cancer prevention, early detection, diagnosis and treatment through primary health care where feasible, while integrating HIV and cervical cancer services so that women living with HIV can receive screening during the same visit regardless of age.[5][18]
• Establish appropriately staffed and equipped screening centres, public education, referral pathways and simplified referral processes to reduce diagnostic and treatment delays.[3][18]
• Expand diagnostic, pathology, laboratory, radiology, endoscopy, nuclear medicine, haematology, cytology and immunohistochemistry services, supported by quality-management systems, maintenance and technical support.[19]
• Expand treatment capacity through decentralised oncology care, chemotherapy infusion centres, cytotoxic-agent preparation units, radiotherapy, aseptic acute-leukaemia care and haematopoietic-cell-transplant services in central hospitals.[9][10]
• Develop national treatment algorithms, multidisciplinary care arrangements, radiotherapy-access priorities and electronic standardisation of diagnostic and cancer reports.[19][10]
• Strengthen professional education and continuing training in oncology, haematology, pathology, surgery, radiotherapy, medical physics, chemotherapy administration, palliative care and opioid use, including international training and virtual telementoring.[20][21][22]
• Establish decentralised palliative-care services, a national palliative-care network and community and home-based support involving families and civil-society organisations.[23][11]
• Improve procurement, inventories, maintenance and continuity of supply for diagnostic consumables, medicines, devices, equipment and pain-control medicines.[20][21][22]
• Establish structured hospital cancer registries in all cancer-treating hospitals, make cancer a notifiable disease, create population-based registries in provinces with quaternary-level health structures, and coordinate a national registry network through the Ministry of Health.[24]

Implementation oversight is supported by a multidisciplinary working group created in March 2014, which developed the planning methodology and initial proposal and supported technical groups for individual plan sections.[15]Monitoring actions include creating oncology-care indicators, quality-controlling registry data, periodically publishing consolidated registry reports, using health information systems to supervise implementation, and expanding internet connectivity and electronic management systems across facilities.[12][24]The Plan identifies a need for adequate financial support and responsible resource allocation, but does not specify budget amounts, financing sources, allocations, funding gaps or a detailed costing methodology.[5][13]

Monitoring & Evaluation

The Plan establishes cancer registration, health information systems, continuous monitoring and evaluation, and accountability as core elements of cancer control, but the supplied sections do not provide a complete results framework with defined indicators, baselines, targets, reporting frequencies or evaluation methods.[25][13][12][24]

• Strengthen cancer surveillance through population-based and hospital-based cancer registries, building on existing population-based registries in Beira and Maputo and the hospital registry at Maputo Central Hospital.[4]
• Establish structured hospital cancer registries in all hospitals treating cancer, make cancer a notifiable disease, and create a Ministry of Health-coordinated national cancer-registry network.[26][24]
• Develop population-based registries in provinces with quaternary-level health-care structures, supported by dedicated registry posts, trained registration professionals and Ministry of Health staff able to analyse registry data.[26][24]
• Improve the quality, completeness and use of cancer data through quality-control plans for collected and registered information, strengthened clinical records, electronic standardisation of cancer reports, and documentation of care, complications and survival outcomes.[2][19][26][24]
• Address recognised surveillance constraints, including insufficient trained personnel, maintenance difficulties, irregular submission of complete reports, poor-quality primary information sources and limited pathology services.[26]
• Disseminate consolidated cancer-registry reports periodically and use registry information to inform policy formulation, resource allocation, management and implementation of cancer-control strategies.[11][26][12][24]
• Monitor oncology-care indicators through the health information system, create indicators for oncology monitoring and evaluation, and incorporate cancer-surveillance variables and indicators into that system.[12][24]
• Expand internet connectivity across health facilities and implement an electronic management system to track actions and supervise implementation of the National Cancer Control Plan.[12][24]
• Develop quality-control arrangements for diagnosis and treatment, including diagnostic quality-control plans, national standardised treatment algorithms, multidisciplinary management and local prioritisation for linear-accelerator use.[19][20][21]
• Strengthen palliative-care monitoring through opioid-consumption records and standardised algorithms for pain and symptom control in hospital and home settings.[11][22]
• Maintain clear tasks, responsibilities, accountability and continuous monitoring and evaluation as implementation principles, with technical review supported by the multidisciplinary working group and engagement across district, provincial and central levels.[15][13]
• Recognise limitations in mortality data, as cancer mortality estimates may be understated because of inaccuracies in death-registration data.[3]

The Action Plan is intended to link strategies to activities and targets over short-term, medium-term and long-term periods, but the supplied material does not specify the targets themselves, indicator definitions, reporting timetable, independent evaluation approach or a formal accountability body beyond the Ministry of Health’s registry coordination role.[15][5][24]

Costing & Financing

Financing is acknowledged as necessary for sustainable cancer control, and the planned second-phase Action Plan is intended to include a budget linked to activities and targets; however, the supplied sections provide no total budget, quantified allocations, financing sources, costing methodology, resource-mobilisation plan, economic assumptions or monetary funding gap.[3][5][13]

• Include a budget in the second-phase Action Plan for activities and targets scheduled over short-term periods of one to three years, medium-term periods of three to five years, and long-term periods of five to ten years.[5]
• Allocate resources responsibly and effectively, with adequate financial support, to promote sustainability.[13]
• Provide government financial support for cancer control alongside coordinated contributions from government, medical services, civil society and communities.[17][3]
• Recognise that prevention and screening can reduce cancer incidence, morbidity, mortality, quality-of-life impacts and health-sector expenditure.[17]
• Address resource constraints affecting implementation, including shortages of essential medicines and specialised human resources, difficulties in managing material resources, and high costs of equipment maintenance.[27][28]
• Resource diagnostic, treatment and palliative-care expansion, including infrastructure, training, medicines, consumables, equipment, radiotherapy, chemotherapy, blood-bank services, transplantation capacity, opioid availability and home-based support.[19][9][10][11][22]
• Resource cancer-registration and information-system requirements, including dedicated personnel, equipment, software, connectivity and electronic management systems.[26][12][24]
• Recognise that late diagnosis, limited screening and restricted treatment options can make cancer care less effective and more costly, while private-sector growth is constrained by household income.[16][6]

The Ministry of Finance is identified as a collaborating institution, but no role in financing, budget approval, allocation or resource mobilisation is specified in the supplied material.[29]