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

Objectives

Jamaica’s 2013-2018 National Cancer Prevention and Control Strategy and Action Plan provides a five-year national framework for reducing the incidence, morbidity, mortality and socioeconomic impact of paediatric and adult cancers. Its vision is to reduce cancer incidence and prevalence, while its overarching goal is to reduce preventable morbidity, disability and avoidable premature mortality due to cancer by 25% by 2025.[1][2]The plan addresses the full continuum of prevention, early detection, diagnosis, treatment, rehabilitation, supportive care, palliative care, workforce development, programme management, surveillance and research.[1][3]

• Reduce exposure to tobacco smoke, harmful alcohol use, unhealthy diets, obesity, insufficient physical activity, cancer-causing infections, occupational and environmental carcinogens, and radiation.[4][3][5][6]
• Promote healthier diets by increasing fruit and vegetable consumption, reducing salt, trans-fat, saturated-fat and free-sugar intake, and halting the rise in obesity.[5]
• Prevent infection-related cancers through safer sex, hepatitis B vaccination, human papillomavirus vaccination and prevention of blood-borne infections.[5]
• Strengthen early detection and early diagnosis for cervical, breast, prostate, colorectal and stomach cancers, including greater public and provider awareness, timely referral and reduced late presentation.[3][6][7]
• Improve accessible, available and quality diagnosis and treatment, including care for disseminated cancers, with a target for adequate specialist diagnosis and treatment among patients identified through early detection.[1][7]
• Integrate supportive, rehabilitative and palliative care, aiming to relieve pain and physical, psychosocial and spiritual problems for at least 30% of people with advanced cancer.[1][8]
• Build a competent and retained cancer-care workforce, reorient health services across the cancer-care continuum, and strengthen national leadership, governance, surveillance and research.[1][8][9]

Implementation

The plan uses a phased, health-system approach developed through stakeholder consultation and review by the National Cancer Technical Working Group.[4][1]Delivery is planned over 2013-2017, with short-term actions in the first one to two years and medium- to long-term actions over three to five years; implementation may be adjusted in response to available resources and emerging evidence.[2]The strategy is aligned with Jamaica’s wider National Strategic Plan for Non-communicable Diseases and Vision 2030, and seeks multisectoral action, community participation and patient empowerment.[1]

• Deliver public health services through four Health Regions managed by Regional Health Authorities, while retaining the Ministry of Health’s functions in policy-setting, norms, standards, monitoring and evaluation.[10]
• Organise specialised cancer care through a National Cancer System of Excellence spanning tertiary, regional and community levels, with referral, treatment, rehabilitation, psychosocial support, patient education and home-based care.[11]
• Integrate cancer screening and early diagnosis into primary health care, curative, family-planning and HIV/AIDS clinics, using cervical, breast, prostate and colorectal screening services and strengthened referral, counter-referral and follow-up arrangements.[7]
• Expand diagnostic and treatment capacity through mammography at regional hospitals, colposcopy services, strengthened cytology, histopathology, radiology and laboratory services, nuclear medicine, radiotherapy equipment, linear accelerators and brachytherapy at Cornwall Regional Hospital and Kingston Public Hospital.[12][11][7]
• Strengthen palliative and rehabilitative care at all levels, particularly through primary health care and home-based services, national standards and protocols, trained multidisciplinary teams, caregiver training, access to oral morphine and other essential medicines, and the Hope Institute’s role as a palliative-care training reference centre.[8]
• Recruit internationally and locally for oncology, pathology, radiology, cytotechnology, psychosocial-support and surveillance posts; develop a human-resource plan and cancer-control training programme for health workers at all levels.[9]
• Implement risk-reduction measures through tobacco-control legislation and cessation support, alcohol interventions, physical-activity policies, nutrition measures, vaccination, food safety, occupational and environmental regulation, and radiation protection.[13][14][5][6]
• Coordinate implementation through the Ministry of Health, National Cancer Technical Working Group, non-communicable disease bodies, Regional Health Authorities, public hospitals, laboratories, academic institutions, private providers, community leaders and caregivers.[10][7][8][9]
• Establish a National Cancer Registry, make cancer a reportable disease, integrate cancer information into the National Health Information System, develop a National Cancer Research Agenda and use registry evidence for policy and programming.[9]
• Monitor targets covering cancer mortality, risk-factor prevalence, early-detection awareness, referral and treatment, late presentation, survival, paediatric cure rates, palliative-care coverage, workforce recruitment, training, technical-working-group meetings and research projects.[3][13][14][7][8][9]
• Fund core staff positions and key projects through the Government of Jamaica, seek programme and project grants from national, corporate and international partners, and prioritise core programmes if resources are insufficient.[13]The supplied material does not specify a total budget, allocations, unit costs or financing shares.[13][7]

Monitoring & Evaluation

The plan establishes a monitoring and evaluation direction centred on reducing preventable cancer morbidity, disability and premature mortality by 25% by 2025, with an expected annual reduction in cancer deaths of 2%. It combines outcome targets, service-delivery indicators, surveillance systems, research and institutional oversight.[1][3]

• Monitor prevention outcomes, including a 10% reduction in smoking prevalence among adults and adolescents, a 2% relative reduction in alcohol use, and a 5% relative reduction in insufficient physical activity.[13][14]
• Track nutrition, infection and exposure indicators, including fruit and vegetable consumption, salt intake, obesity trends, hepatitis B vaccine coverage, human papillomavirus vaccine introduction, occupational and environmental carcinogen exposure, radiation-dose registry coverage and abnormal dose readings.[5][6]
• Measure early-detection performance through awareness of cancer warning signs, early referral and prompt specialised treatment for cervical, breast, prostate, colorectal and stomach cancers, late presentation at diagnosis, and five-year survival. Targets include awareness and timely referral for more than 80% of relevant patients, a 50% reduction in late presentation, and a 30% increase in five-year survival for selected early-detectable cancers.[3][6]
• Assess diagnosis, treatment and supportive care through the proportion of early-detected patients receiving adequate specialist care, support provided to people diagnosed with cancer, cure rates for children with acute lymphatic leukaemia and Hodgkin lymphoma, and relief of pain and physical, psychosocial and spiritual problems among people with advanced cancer.[3][7][8]
• Track health-system capacity through cancer-care workforce retention, staff recruitment, training, upgraded radiological and laboratory services, telemedicine sites and palliative-care professional capacity. Essential-staff recruitment is targeted at 50% in year one and 100% in year two, while four telemedicine sites are targeted.[8][9]
• Strengthen surveillance by establishing a National Cancer Registry, making cancer reportable, integrating cancer information into the National Health Information System, and using registry data for policy and programme development.[9]

Available baseline evidence was incomplete: national cancer-incidence and outcome data were unavailable during the period described, while the Kingston and St Andrew Cancer Registry covered 24% of the population and recorded age-standardised incidence rates of 189 per 100,000 men and 144 per 100,000 women in 2003-2007.[15]Cancer mortality data showed 3,198 deaths in 2010, equivalent to 118.2 per 100,000 population and 21% of all deaths.[10]A 2008 baseline found that 62.4% of women of reproductive age had received at least one Pap smear.[12]

Accountability is to operate through Ministry of Health policy-setting, standards, monitoring and evaluation functions, Regional Health Authorities’ service-delivery management, and oversight by the National Cancer Technical Working Group and non-communicable disease subcommittee.[10][9]The oversight groups are expected to meet at least four times annually, and cancer-research implementation is to be monitored against a target of two projects per year.[9]Regional monitoring arrangements also assign Caribbean Community and Pan American Health Organization bodies roles in evaluating regional non-communicable disease and food-security commitments.[16][17]

The supplied material does not specify a unified reporting timetable, data-quality protocol, evaluation design, indicator baselines for all targets, or a detailed formal accountability process beyond the named institutions, oversight groups and indicators.[3][9]

Costing & Financing

Financing provisions are principally strategic rather than quantified. The plan seeks to reduce the cost of preventable morbidity, disability and avoidable premature mortality, while using scarce resources efficiently by closing service gaps and reducing duplication.[1][2]

• Fund core staff positions and key projects through the Government of Jamaica, while seeking additional programme and project grants from multiple funding agencies.[13]
• Mobilise potential support from the National Health Fund, the Culture Health Arts Sports and Education Fund, corporate foundations, the Pan American Health Organization, the World Health Organization, the Inter-American Development Bank and the World Bank.[13]
• Use public-private funding arrangements to procure radiotherapy simulators, treatment planners and linear accelerators for Kingston Public Hospital and Cornwall Regional Hospital.[12]
• Prioritise a limited set of core prevention and control programmes and projects through the National Non-Communicable Diseases Committee and Ministry of Health Non-Communicable Diseases Unit if adequate resources are not secured.[13]
• Consider fiscal measures affecting food affordability, including subsidies for fruit and vegetable production and taxes or subsidies related to healthier diets.[5]
• Direct public revenue from tobacco, alcohol and similar products towards non-communicable disease prevention, health promotion and support for relevant commissions under the accompanying regional declaration.[18]

Resource requirements include screening and diagnostic equipment, mammography units, colposcopy services, histopathology and flow-cytometry laboratories, radiotherapy infrastructure, medicines, intensive-care capacity, prosthesis services, telemedicine, rehabilitation and palliative-care provision, workforce recruitment and training, cancer registry development and research.[12][11][7][9]

No total budget, programme allocation, unit cost, financing share, expenditure estimate, quantified funding gap or economic assumption is specified in the supplied material.[19][13][9]