Strategic Plan and Action Plan for the Prevention and Control of Cancer in Jamaica 2013-2018

Objectives

Jamaica’s Strategic Plan and Action Plan for the Prevention and Control of Cancer provides a national framework and road map for paediatric and adult cancer prevention and control across the care continuum.[1][2]Its vision is to reduce cancer incidence and prevalence, while its overarching goal is to reduce preventable cancer-related morbidity, disability and avoidable premature mortality, together with associated costs, by 25% by 2025.[3][2]

• Reduce cancer incidence, mortality, inequities and socioeconomic impact through prevention, early detection, diagnosis, treatment, rehabilitation and palliative care.[4][2]
• Prevent avoidable cancers by reducing tobacco smoke exposure, harmful alcohol use, unhealthy diets, physical inactivity, obesity, and environmental, occupational and radiation-related carcinogenic exposures.[2][5][6][7]
• Strengthen nutrition-related cancer prevention by increasing fruit and vegetable consumption, reducing salt, trans-fatty acid, saturated-fat and free-sugar intake, and promoting healthier food environments.[8]
• Reduce infection-related cancers through hepatitis B vaccination, safer sex, prevention of blood-borne infections, and advocacy for human papillomavirus vaccination for girls and boys.[8]
• Identify cancers earlier through screening, public awareness and prompt referral, with targets including awareness of early signs and symptoms among more than 80% of patients and health-care providers, early referral and prompt treatment for more than 80% of specified patients, and a 50% reduction in late presentation.[9][7]
• Improve access to, availability and quality of diagnostic, treatment and rehabilitation services, including adequate diagnosis and treatment for more than 70% of patients identified through early detection and a 30% increase in five-year survival for cancers detectable early.[10]
• Provide integrated, equitable and sustainable supportive, rehabilitative and palliative care, including pain and symptom relief for at least 30% of people with advanced cancer.[11]
• Prioritise cervical and breast cancer control, basic diagnosis and treatment, cancer prevention and risk-factor reduction in a resource-constrained setting, while developing evidence on prostate cancer screening.[12]
• Build a capable cancer-care workforce, coordinate programme management, establish a National Cancer Registry, and develop a National Cancer Research Agenda to support evidence-based control.[9][13]

The strategic direction combines population-wide health promotion with strengthened clinical services. It seeks to intensify mass social marketing and behaviour-change interventions, evaluate and modify these using evidence, and use public-private partnerships, policy and legislation to address major cancer risk factors.[14]

Implementation

Implementation combines phased health-system strengthening, multisectoral prevention and an integrated National Cancer System of Excellence spanning community, secondary and tertiary care.[3][2]The plan was developed through stakeholder consultation and review by the National Cancer Technical Working Group and Task Force, and is linked to the wider National Strategic Plan for Non-communicable Diseases.[4][2]Delivery is phased, with Phase I actions intended within one to two years and Phase II actions within three to five years, subject to adjustment for available resources and evidence.[2]

• Establish a National Cancer System of Excellence in which tertiary services provide advanced imaging, radiotherapy, complex surgery, chemotherapy, rehabilitation, psychosocial support, self-help groups and patient education.[3]
• Strengthen primary and regional care by expanding cervical, breast, prostate and colorectal screening; introducing Visual Inspection with Acetic Acid and human papillomavirus testing; strengthening cytology and colposcopy; expanding mammography; and improving referral, counter-referral and follow-up.[10]
• Upgrade diagnostic and treatment capacity through imaging, endoscopy, laboratory and histopathology equipment; strengthened radiological and laboratory services; re-establishment of the public-sector Nuclear Medicine Programme; clinical guidelines; and radiotherapy upgrades at Cornwall Regional Hospital and Kingston Public Hospital.[14][10]
• Procure two simulators or treatment planners and two linear accelerators for Kingston Public Hospital and Cornwall Regional Hospital through public-private funding arrangements.[14]
• Expand supportive and palliative care by establishing palliative-care teams at all service levels, emphasising primary and home-based care, training providers and caregivers, ensuring access to oral morphine and other essential medicines, and developing national standards.[11]
• Recruit internationally and locally to address oncology, pathology, radiology, counselling, social-work and cancer-surveillance workforce gaps; develop a human-resource plan; and deliver cancer-care training across all levels of the system.[13]
• Coordinate prevention across the Ministry of Health, regional health authorities, education, finance, agriculture, customs, environmental and standards bodies, health-care providers, academic institutions, civil society, communities and private-sector partners.[5][6][8][7]
• Implement tobacco control through legislation, smoke-free settings, taxation, advertising restrictions, cessation support and youth-initiation prevention; integrate smoking-status recording and cessation referral into primary care and hospitals.[5]
• Implement alcohol, diet and physical-activity measures through service protocols, brief interventions, school and workplace programmes, healthier-food policies, food labelling, public education, taxes, subsidies and improved recreational spaces.[6][8]
• Establish a National Cancer Registry, make cancer a reportable disease, integrate cancer data into the National Health Information System, and collaborate with academic and international partners on the research agenda.[13]

Governance and oversight are assigned principally to the Ministry of Health, which sets policy, norms and standards and monitors service delivery, alongside Regional Health Authorities responsible for regional service management.[15]The National Cancer Technical Working Group and Non-Communicable Disease Subcommittee are to monitor implementation and provide oversight, with a target of at least four meetings annually.[13]

Progress measures include workforce recruitment targets of 50% of essential staff in year one and 100% in year two; cancer-screening, referral, treatment, survival and palliative-care indicators; risk-factor indicators for tobacco, alcohol, diet and physical activity; and implementation of two cancer research projects annually.[6][10][11][13]Financing relies on government support for core posts and projects, programme and project grants, and applications to local, regional and international funders; if resources are inadequate, the Non-communicable Diseases Committee and Ministry of Health Non-communicable Diseases Unit are to prioritise core programmes.[5]The provided text does not specify total budgets, allocations, financing shares or detailed costings.[16][5]

Monitoring & Evaluation

The plan establishes an evidence-based monitoring and accountability approach centred on cancer surveillance, a National Cancer Registry, research, service-performance targets and oversight by the Ministry of Health, National Cancer Technical Working Group and Non-Communicable Disease Subcommittee.[9][13]Existing national cancer incidence and outcome data are incomplete, with the Kingston and St Andrew Cancer Registry covering 24% of the population.[17]

• Establish a National Cancer Registry, make cancer a reportable disease, integrate cancer information into the National Health Information System, and develop a National Cancer Research Agenda to inform policy, programming and evaluation.[9][13]
• Monitor progress towards reducing preventable cancer morbidity, disability and avoidable premature mortality by 25% by 2025.[3][2]
• Measure awareness of early cancer signs and symptoms, with a target exceeding 80% among patients and health-care providers; achieve early referral and prompt treatment for more than 80% of patients with specified common cancers; and reduce late presentation by 50%.[9][7]
• Track diagnostic and treatment performance, including more than 70% adequate diagnosis and treatment among patients identified through early detection, a 30% increase in five-year survival for cancers detectable early, and cure rates above 40% for children with acute lymphatic leukaemia and Hodgkin lymphoma.[9][10]
• Monitor palliative and supportive care through the proportion of advanced cancer patients receiving standards-based and home-based care, pain and symptom relief for at least 30% of advanced cancer patients, workforce training, and establishment of four telemedicine sites.[11]
• Track workforce implementation through recruitment of 50% of essential staff in year one and 100% in year two, development of a human-resource plan and training programme, and at least four National Cancer Technical Working Group and Non-Communicable Disease Subcommittee meetings annually.[13]
• Measure prevention outcomes through adult and adolescent tobacco-use prevalence, tobacco sales, smoke-free settings, cessation-service access and smoking-status documentation; implementation of alcohol-harm reduction interventions and a 2% relative reduction in alcohol use; and a 5% relative reduction in insufficient physical activity.[5][6]
• Monitor nutrition, infection and exposure risks through a 100% increase in consumption of more than five daily servings of fruit and vegetables, a 10% reduction in mean salt intake using national health-survey subsamples in 2012 and 2017, halted obesity growth, hepatitis B vaccine coverage, human papillomavirus vaccine introduction, exposure registries, and a 5% reduction in occupational and environmental carcinogen exposure.[8][7]
• Use reported baseline data including age-standardised cancer incidence of 188.8 per 100,000 men and 144.2 per 100,000 women in 2003-2007, declining cervical cancer incidence, and paediatric cancer registry trends to assess burden and programme progress.[17][18][12]

The supplied text does not specify a comprehensive reporting timetable, formal evaluation methodology, unified indicator framework, or detailed accountability process beyond the identified institutional responsibilities, registries, targets and oversight arrangements.[4][9][10][11]

Costing & Financing

The plan recognises that cancer control requires investment in prevention, screening, diagnosis, treatment, rehabilitation, palliative care, workforce capacity, surveillance and research, while aiming to use scarce resources efficiently, close service gaps and reduce duplication.[14][2][10][13]

• Allocate government resources to core staff posts and priority projects, and seek programme and project grants to support implementation.[5]
• Mobilise potential funding from the National Health Fund, Culture Health Arts Sports and Education Fund, corporate foundations, Pan American Health Organization, World Health Organization, Inter-American Development Bank and World Bank.[5]
• Prioritise a limited set of core programmes and projects through the Non-communicable Diseases Committee and Ministry of Health Non-communicable Diseases Unit if adequate resources are not secured.[5]
• Use public-private funding arrangements to procure two simulators or treatment planners and two linear accelerators for Kingston Public Hospital and Cornwall Regional Hospital.[14]
• Apply taxes and subsidies as policy instruments to improve the affordability of healthier foods and discourage less healthy options.[8]
• Resource major capacity requirements including mammography, colposcopy, imaging, laboratories, radiotherapy, surgical and intensive-care capacity, rehabilitation, essential medicines, home-based palliative care, telemedicine, workforce recruitment and training, registry establishment and research.[14][3][10][11][13]

No monetary programme costs, total budget, funding allocations, financing shares, quantified funding gaps or economic assumptions are specified in the supplied text.[16][2][5][8][10]