Plano Nacional De Controlo Do Cancro 2019-2029

Objectives

Mozambique’s 2019–2029 National Cancer Control Plan seeks to reduce cancer incidence, morbidity and mortality by developing a decentralised, strengthened public health system that provides accessible, comprehensive prevention, diagnosis, treatment, survivorship and palliative-care services nationwide.[1][2]It responds to a growing cancer burden amid epidemiological, demographic, urban and nutritional transitions, while communicable diseases remain prominent.[3][4]

• Prioritise equitable and universal access, government leadership, partnership, accountability, sustainability, continuous evaluation, evidence-based practice and improved quality of life.[5]
• Focus on cancers that are prevalent, preventable or amenable to early detection and treatment, including cervical, breast and prostate cancers, Kaposi’s sarcoma and other HIV-related cancers, leukaemias, head and neck cancers and paediatric cancers.[6][5]
• Organise action across prevention and health promotion, diagnosis, treatment, palliative care, cancer registries and health information systems, with research, communication and workforce training as cross-cutting components.[6]
• Reduce modifiable risks through tobacco and alcohol control, healthier diets and physical activity, safer sexual practices, prevention and management of human immunodeficiency virus, and vaccination against human papillomavirus and hepatitis B virus.[7][8]
• Increase public knowledge of cancer and its risk factors; strengthen cervical screening, referral and follow-up; expand early detection of breast, prostate and other cancers; and reduce diagnostic and treatment delays.[1][4]
• Expand diagnostic, pathology, laboratory, radiotherapy, chemotherapy, palliative-care, registration and clinical-record capacity, alongside reliable management of medicines, supplies and equipment.[1][9]
• Strengthen palliative care through symptom control, pain management and end-of-life support integrated across all health-system levels.[10][11]
• Establish cancer registration and health-information arrangements that support surveillance, resource allocation, service management and implementation of cancer-control strategies.[12][13]

Implementation

The Plan uses a multidisciplinary, integrated and coordinated approach across all levels of care, linking primary prevention, screening, early recognition, referral, diagnosis, treatment, follow-up, survivorship and palliative care.[14][15]It establishes a National Cancer Control Programme within the Ministry of Health’s National Directorate of Medical Assistance and envisages phased action over short-term, medium-term and long-term periods.[14]

• Coordinate implementation among central, provincial and district health authorities, other government sectors, cooperation partners, civil society, communities, service users and health professionals.[16][15]
• Align cancer-control activity with national health-sector, non-communicable disease, palliative-care, human-resources, sexually transmitted infection and HIV/AIDS frameworks.[15][2]
• Use primary health care as the principal platform for prevention and health promotion, while extending activities into communities through linguistically and culturally appropriate engagement.[4]
• Deliver public campaigns, advocacy and communication materials at all care levels; incorporate cancer prevention into health-training curricula; and engage civil society, political representatives, religious groups, government officials and the media.[17]
• Ensure that screening and early-detection centres have qualified personnel, appropriate equipment and referral pathways for further assessment or treatment of positive cases.[18]
• Build workforce capability through specialist and continuing education for clinical, laboratory, imaging, pathology, oncology, haematology, radiotherapy, administrative and palliative-care personnel, including international training and virtual telementoring.[19][20][11]
• Decentralise diagnostic, treatment and palliative-care services by defining responsibilities at each care level, while retaining the Central Hospital of Maputo as a national training reference centre for radiotherapy specialists and medical physicists.[21][22][23]
• Expand diagnostic services through cytology, immunohistochemistry, frozen-section examination, nuclear medicine and cytogenetics, and standardise diagnostic reporting electronically with quality-control arrangements.[24][21]
• Improve treatment delivery through medicine and equipment-management plans, radiotherapy, chemotherapy infusion and cytotoxic-preparation capacity, aseptic acute-leukaemia units, haematopoietic-cell transplantation, blood-bank support, national treatment algorithms and multidisciplinary care.[22][25]
• Develop palliative-care networks, hospital and home-care pain-management algorithms, decentralised services and community participation, recognising that end-of-life care commonly occurs at home.[10][23]
• Strengthen cancer surveillance by training registry staff, creating registrar roles, maintaining structured hospital registries, establishing a Ministry of Health-coordinated national registry network, expanding population-based registries, improving data quality and making cancer notifiable.[12][26]
• Monitor oncology indicators through health information systems, improve connectivity and electronic management, conduct regular monitoring and evaluation, and disseminate consolidated registry reports periodically.[13][26]

Monitoring & Evaluation

The Plan envisages a cancer surveillance, registration and health-information architecture that supports policy formulation, resource allocation, service management and oversight of implementation. It seeks to create oncology indicators, monitor them through the health information system, improve connectivity between levels of care, and use an electronic management system to track implementation of the National Cancer Control Plan.[12][13][26]

• Strengthen cancer registration through structured hospital registries in all hospitals treating cancer, a Ministry of Health-coordinated national registry network, population-based registries in provinces with advanced referral structures, dedicated registrar posts, trained personnel, and appropriate computers and software.[12][26]
• Make cancer a notifiable disease and improve surveillance through effective registration and feedback mechanisms.[12][26]
• Improve data quality through a quality-control plan, more complete and regular reporting, and periodic dissemination of consolidated registry reports.[12][13][26]
• Document active care, complications, survival, treatment outcomes and service quality through strengthened clinical records, cancer-registration systems and medical documentation.[1][6][15]
• Standardise diagnostic reporting electronically and implement diagnostic quality-control arrangements, alongside national treatment algorithms and multidisciplinary care.[19][21][25]
• Build research, monitoring and evaluation capability through health-professional education, with information and communication treated as cross-cutting Plan components.[1][6]

Available baseline evidence includes estimated 2018 national cancer incidence of 131 age-standardised cases per 100,000 people, mortality of 97.8 per 100,000, 25,631 new cases and 17,813 deaths, based on Globocan estimates.[16]Mozambique had population-based registries in Beira and Maputo and a hospital-based registry at Maputo Central Hospital, although available data did not support temporal analysis.[16]Mortality estimates require cautious interpretation because registration data may be inaccurate or imprecise.[27]

The Plan identifies constraints affecting surveillance and information quality, including shortages of trained staff, inadequate primary information sources, maintenance problems, limited pathology services and deficient clinical records.[6][15][12]These weaknesses can compromise patient care and restrict monitoring of performance and treatment outcomes.[6][15]

Accountability principles include government leadership, clearly assigned tasks and responsibilities, continuous monitoring and evaluation, evidence-based practice and quality assurance.[5]The Ministry of Health is intended to coordinate the national cancer-registry network and use the health information system to supervise Plan implementation.[12][13]However, the supplied text does not define indicator values or targets, a consolidated indicator framework, reporting frequency beyond periodic registry-report dissemination, evaluation schedules, or formal accountability procedures.[13][26]

Costing & Financing

Financial sustainability is a guiding principle, understood as responsible and effective resource allocation with adequate financial support for implementation.[5]The Plan also recognises that prevention and screening can reduce cancer incidence, morbidity, mortality and health-sector expenditure while improving quality of life.[14]

• Provide government financial support for cancer-control activities alongside supportive public-health policy and legislation.[27]
• Develop a subsequent implementation phase with activities, targets, timeframes and an implementation budget for short-term periods of 1–3 years, medium-term periods of 3–5 years and long-term periods of 5–10 years.[6]
• Resource workforce development, infrastructure, equipment, essential medicines, supplies, information technology, connectivity, registry software, palliative-care services and maintenance systems.[7][28][11][12][13]
• Address constraints including deficient infrastructure, shortages of trained and specialised personnel, unreliable medicine and supply availability, inadequate diagnostic and treatment equipment, limited blood-product provision, restricted opioid import quotas and high equipment-maintenance costs.[27][6][9][20][10]

No completed budget, monetary allocation, unit cost, financing-source breakdown, quantified funding gap, resource-mobilisation target or economic assumption is provided in the supplied text.[29][6][5][13]Although a radiotherapy unit was constructed at Maputo Central Hospital, no cost or financing information is provided and its capacity is described as insufficient for national demand.[19]