National Strategy for Cancer Control in Ghana

Objectives

Ghana’s National Cancer Control Plan provides a comprehensive, evidence-based framework to reduce cancer incidence, morbidity and mortality, while improving the quality of life of patients and families through prevention, early detection, diagnosis, treatment, rehabilitation and palliative care.[1]It seeks to integrate cancer control into national health and development planning and to replace fragmented, limited-coverage activities with systematic nationwide action.[2][3]

• Reduce cancer incidence and mortality by 30% through primary prevention, screening and early detection; improve diagnosis and treatment by 30%; and improve patient and family quality of life by 40% through support, rehabilitation and palliative care.[4][5]
• Document at least 50% of cancer cases and establish a population-based cancer registry to support surveillance, cost-effective interventions, research, health planning and evaluation of screening programmes.[4][6]
• Prevent avoidable exposure to tobacco, unhealthy diets, harmful alcohol use, inactivity, excessive sunlight, infections, occupational hazards and other carcinogens.[1]
• Promote healthy diets, physical activity, tobacco and alcohol control, occupational and environmental safety, hepatitis B vaccination and safer practices to prevent infection-related cancers.[7][8]
• Strengthen public awareness of cancer risk factors and warning signs, organised and opportunistic screening, early diagnosis, referral and treatment for cancers amenable to early detection.[5][9]
• Prioritise breast, cervical, prostate, head and neck, childhood, haematopoietic, gastrointestinal and liver cancers.[5]
• Expand palliative care to address physical, psychosocial and spiritual needs, with a target to reach 25% of eligible patients by 2020.[10]
• Improve co-ordinated service delivery, human-resource capacity, infrastructure, pathology, laboratory quality, medicines access and multidisciplinary cancer management across the continuum of care.[4][11][12]

Implementation

Implementation is intended to be government-led, decentralised and integrated within the existing health system, using the World Health Organization programme modules of planning, prevention, early detection, diagnosis and treatment, palliative care, and policy and advocacy.[1][5]Delivery should combine national leadership and specialist services with regional referral, district and sub-district screening, and community education, while engaging public institutions, civil society, non-governmental organisations, researchers and international partners.[5][13]

• Elevate cancer control from the Non-Communicable Diseases Control Programme to a dedicated programme, appoint a Programme Manager, secure budgetary allocation and establish an advisory or steering committee.[6]
• Use the National Cancer Control Steering Committee to advise government, mobilise resources, develop the plan and registry, and co-ordinate prevention and control activities.[2]
• Include representation from public health, epidemiology, health communication, paediatric oncology, medical, radiation and surgical oncology, palliative care, government, civil society, patients, research and academia in programme governance.[13]
• Deliver care through teaching hospitals as national cancer centres, regional hospitals for treatment and complex referrals, district and sub-district facilities for screening, and communities for health promotion and client education.[13]
• Develop policies, legislation, guidelines, treatment protocols and referral pathways; establish Cancer Management Boards at cancer centres and regional hospitals; and form multidisciplinary oncology teams.[1][10][13]
• Implement prevention through food regulation, school and workplace initiatives, multimedia education, tobacco and alcohol controls, occupational safety measures, immunisation and infection-prevention services.[7][8]
• Deliver human papillomavirus vaccination through school-based, community-based and outreach services, using the existing Expanded Programme for Immunisation to reach girls in and out of school.[14]
• Integrate cervical screening into reproductive-health services, combine organised and opportunistic screening, and link visual inspection with acetic acid, Pap smear, human papillomavirus testing where accessible, treatment and follow-up.[15]
• Provide breast awareness and clinical screening through the Ghana Health Service with civil society and non-governmental organisations, and train health professionals to deliver clinical breast examinations.[16][17]
• Expand specialist treatment capacity progressively beyond the two national cancer centres, establish regional multidisciplinary teams, equip additional teaching hospitals, and address geographical and financial barriers to care.[18]
• Decentralise palliative care to sub-national and community levels, use community health workers for home visits and follow-up, make oral morphine available at all levels, and train providers and families in supportive care, referral and access to formal services.[19]
• Build workforce capacity through postgraduate fellowships, revised health-training curricula, continuing professional development, in-service training, internships and specialist placements.[11][12]
• Establish and scale a population-based registry from Accra and Kumasi to national coverage, using a consistent minimum data set, trained data officers, suitable software, technical oversight and annual reporting.[6]
• Monitor implementation through annual records reviews and surveys, including indicators for prevention communication, training, equipment, referrals, screening centres, treatment capacity, palliative-care access, registry functionality and pathology-based diagnoses.[20][21][22]
• Increase government resources for cancer control, include cancer medicines on the National Health Insurance Scheme list, develop endowment and childhood cancer treatment funds, and seek support from local and international partners for initial funding and training gaps.[23][13]

Monitoring & Evaluation

Cancer monitoring and evaluation centre on a population-based national cancer registry, routine service data, surveys, records reviews, operational research and technical supervision. The registry is intended to document at least 50% of cancer cases, generate complete and confidential data, support planning and research, evaluate screening, and publish annual reports on incidence, prevalence, treatment and survival.[4][5][6][23]

• Establish and progressively expand population-based registration from Accra and Kumasi to national coverage, using a consistent minimum data set, trained data officers, functional software, integrated data systems and technical and advisory committees.[6]
• Disseminate timely registry reports to the Ministry of Health, Ghana Health Service, hospitals, clinicians and other interested parties to inform service planning and management.[6]
• Strengthen strategic information, surveillance, routine data collection and operational research to guide evidence-based cancer control and assess programme impact.[4][24][1]
• Address known data limitations, including mortality information that excludes teaching hospitals where many cancers are diagnosed and treated, preventing accurate national assessment of cancer mortality rankings.[25][26]
• Conduct baseline research on assessment indicators and provide technical supervision and monitoring across national, regional and district levels.[13][23]

The monitoring framework specifies annual records reviews and surveys for prevention, screening, treatment, palliative care and cancer registration, although some indicator tables have unpopulated baselines and incomplete outcome measures.[20][21][22]

• Measure prevention through information, education and communication materials produced and distributed, facility availability of materials, mass-media outputs, advocacy activities, population knowledge and prevalence of cancer risk factors.[20]
• Measure screening and early detection through trained personnel, equipment procured, referrals of suspected cases, screening centres established, population awareness, stage distribution reported by facilities and screening among at-risk populations.[20][21]
• Measure treatment through trained professionals, guidelines and protocols, medicines procured, continuing professional development, cancer centres established, patients cured and survival. The baseline for cancer centres is two at national level.[21]
• Measure palliative care through trained professionals, facilities using oral morphine, morphine use, guidelines, service integration, hospices and the proportion of eligible patients accessing care.[21]
• Measure registry performance through trained personnel, equipment, functional facility registration systems, facility links to the national registry, annual reports and pathology-based diagnoses.[21][22]

Outcome objectives include reducing cancer incidence and mortality by 30%, improving diagnosis and treatment by 30%, improving quality of life for patients and families by 40%, and providing palliative care to 25% of eligible patients by 2020.[4][5][10]Cancer Management Boards at cancer centres and regional hospitals are intended to oversee management, while the programme advisory board has responsibilities for implementation coordination, monitoring and evaluation.[3][10]The source does not provide indicator definitions, targets or reporting arrangements for every area, nor a fully specified evaluation design or formal accountability process.[4][20][21]

Costing & Financing

The plan identifies cancer control as under-resourced and calls for increased government allocation, partner support, insurance coverage and resource mobilisation, but the supplied text provides no quantified national budget, programme costing, funding gap or economic model.[3][23]

• Mobilise financial support from partners and collaborators, with the National Cancer Control Steering Committee mandated to assist the Minister of Health with resource mobilisation.[2][3]
• Increase government resource allocation because cancer care represents a negligible proportion of health expenditure despite the growing cancer burden.[23]
• Allocate resources for workforce development, infrastructure, screening equipment, laboratory accreditation, equipment maintenance, essential medicines, oral morphine, registry systems and decentralised palliative care.[1][19][11][12]
• Include chemotherapeutic agents and other treatment drugs in the National Health Insurance Scheme list and make them available through registered pharmacies.[23]
• Encourage higher insurance premiums for more comprehensive cancer management, establish national, regional and district endowment funds, create a childhood cancer treatment fund and provide hostels for children and carers at teaching hospitals.[23]
• Use tobacco and alcohol taxation proceeds for cancer and other non-communicable disease control.[4][7]

Prevention is characterised as the most cost-effective long-term cancer-control approach, and routine human papillomavirus vaccination is described as highly cost-effective for pre-adolescent girls, adolescent girls and young women.[5][14]Gastrointestinal screening tools are considered infeasible in the short to medium term and not apparently cost-effective.[27][28]The plan also notes high patient, household and health-system costs associated with prostate cancer screening and treatment, expensive cervical cancer treatment requiring prolonged follow-up, and unaffordable or irregular chemotherapy supplies for childhood cancers.[29][30][31]

Household expenditure data show that, in 2005, alcoholic beverages accounted for 2.6% of annual household expenditure, tobacco for 1.6%, and health-related expenses for 3.5%.[7]Apart from these percentages, the source does not specify monetary values, financing allocations, implementation costs, funding commitments, funding gaps or economic assumptions.[7][23]