National Cancer Control Plan 2025 - 2030

Objectives

Zimbabwe’s National Cancer Control Plan for 2025–2030 seeks to provide quality cancer-control services for all by 2030 and reduce cancer morbidity and mortality through evidence-based, cost-effective interventions across prevention, early detection, diagnosis, treatment, palliative care, rehabilitation, survivorship, surveillance and research.[1]The Plan aligns cancer control with universal health coverage, national health and development strategies, and Sustainable Development Goal 3.[2]

• Improve equitable access, availability, affordability and quality of services throughout the cancer-care continuum, while reducing fragmentation and the concentration of specialised care at tertiary and quaternary levels.[2][3][4]
• Strengthen prevention by addressing infectious agents, tobacco, alcohol, unhealthy diets, physical inactivity and environmental or occupational hazards through awareness, vaccination, healthier lifestyles, supportive policy and research.[5]
• Expand early detection through screening, recognition of warning signs, identification and treatment of precancerous lesions, health-worker training, effective referral and follow-up pathways.[5]
• Build diagnostic and treatment capacity through decentralised oncology services, improved pathology and imaging, surgery, radiotherapy, systemic therapies, reliable medicines and commodities, and strengthened palliative, rehabilitative and survivorship care.[6][7]
• Increase competent cancer human resources, improve conditions of service and retention, promote task shifting where appropriate, and ensure safe working environments.[4][8]
• Provide reliable, timely and cost-effective cancer data for policy-making, prevention, management and research, while strengthening surveillance, monitoring, evaluation and research capacity.[9][4]
• Secure sustainable funding and strengthen leadership and governance for comprehensive, integrated cancer services at all levels.[4][9]

Priority cancers are cervical, prostate, breast, colorectal, childhood and lung cancers.[4][9]Cervical cancer elimination is a central priority, with targets by 2030 of 90% human papillomavirus vaccination coverage among girls before age 15, 70% screening coverage, and 90% treatment coverage.[9][10]Childhood cancer priorities include earlier diagnosis, specialist training, family and caregiver support, treatment access and centres of excellence.[11][12]Lung-cancer priorities include tobacco control, smoking cessation, reduced environmental and occupational exposures, improved diagnostic differentiation from tuberculosis, risk profiling and earlier detection of high-risk populations.[13][11]

The Plan is guided by client-responsive, needs-based and integrated care; universal health coverage; cross-sectoral partnerships; and compliance with the Patient’s Charter and the Health Professions Act.[1]It also frames prevention as the most cost-effective intervention in resource-constrained settings, noting that 30% to 40% of cancers may be preventable through avoiding known risk factors.[5]

Implementation

Implementation is based on a population-wide, integrated and decentralised model that embeds prevention, screening and early detection in existing health programmes and progressively strengthens services across all levels of care.[2][5][14]The Ministry of Health and Child Care leads delivery, coordination, resource mobilisation, workforce development, monitoring and implementation of the Plan through existing health-sector structures.[15][16]

• Integrate cancer prevention and early detection into sexual and reproductive health, HIV services, human papillomavirus and hepatitis B immunisation, maternal and child health, occupational and environmental health, and lifestyle programmes.[5]
• Expand cervical screening using human papillomavirus DNA testing, decentralise treatment of precancerous lesions, strengthen pathology, referral and follow-up systems, and develop vaccination, procurement, cold-chain and workforce arrangements.[10][17]
• Develop cancer communication and community-engagement mechanisms through health facilities, outreach, schools, mass media, community leaders, advocacy organisations, traditional and faith-based healers, and workplace programmes.[5][10][18]
• Upgrade and maintain infrastructure, diagnostic equipment and radiotherapy capacity; apply international guidance to procurement; assess donated equipment; and include maintenance and service arrangements in purchasing.[14]
• Strengthen supply chains for equipment, medicines, reagents, consumables, blood products and palliative-care opioids, including affordable access at primary-healthcare level.[9][18]
• Train, deploy and retain multidisciplinary personnel; establish cancer teams; strengthen pre-service and specialist education; and use mentorship, staff rotation and task sharing to support decentralisation.[19][8][20]
• Develop national guidelines for screening, diagnosis, treatment, palliative care, rehabilitation and survivorship, alongside standards-based service delivery and patient-navigation pathways.[18][19]

Governance is integrated into the Ministry’s Health Sector Coordination Framework and is operationalised through Technical Working Groups, including a Cancer Technical Working Group.[11][19]The Cancer Technical Working Group includes the Ministry, professional associations, private-sector representatives, health development partners and United Nations technical agencies.[11][19]A whole-of-government and whole-of-society approach involves other ministries, civil-society organisations, private providers, universities, development partners and international non-governmental organisations in advocacy, service delivery, technical assistance, research, local production, guideline development and resource mobilisation.[16][14]

Performance accountability uses the Integrated Results-Based Management Framework, led through the Permanent Secretary’s Performance Contract.[11]Quarterly Operational Plans link departmental agreements with Ministry annual strategic plans, the National Health Strategy and the Plan’s implementation annex.[11]Monitoring combines routine reporting with rapid assessments, process evaluations, mid-term and end-term evaluations.[21]The Zimbabwe National Cancer Registry is a central surveillance source, undertaking active and passive case-finding across public and private facilities, while the reactivated Bulawayo Cancer Registry is also to be strengthened.[21][1]

Information systems include the District Health Information Software 2, national health-management databases, electronic health records, vital statistics, screening registers, HIV and AIDS registers, risk-factor surveys and sentinel surveillance.[21][22]The framework tracks inputs, activities, outputs, outcomes and impact, with performance indicators, baselines and targets reported through existing and new mechanisms.[21]Financing priorities include domestic and external resources, ring-fenced non-communicable disease and cancer revenue from the sugar tax, advocacy for taxes on harmful products, a proposed Cancer Fund, and a costed cancer workplan.[15][22][23]No total Plan budget, quantified funding gap or activity-level costing is specified in the supplied material.[23]

Monitoring & Evaluation

The National Cancer Control Plan establishes a results-oriented monitoring, evaluation and learning system intended to generate credible data, track inputs, activities, outputs, outcomes and impact, and support evidence-informed policy and programme decisions.[21]Its monitoring framework is linked to the Integrated Results-Based Management Framework, quarterly Operational Plans, Departmental Integrated Programme Agreements, Ministry Annual Strategic Plans and the National Health Strategy.[11]

• Monitor performance through a Cancer Prevention and Control Monitoring and Evaluation Framework, overseen by the Ministry of Health and Child Care, with the Cancer Technical Working Group and proposed National Cancer Forum contributing to coordination.[12][16]
• Track priority impact measures including cancer mortality and incidence, particularly for cervical, prostate, childhood and lung cancers, alongside treatment outcomes.[24]Lung cancer mortality has a reported baseline of 146.7 deaths per 100,000 population and a target trajectory to below 100, while lung cancer incidence has a baseline of 202.5 per 100,000 population.[24]
• Measure cervical, prostate and childhood retinoblastoma incidence, with reported baselines of 25% for cervical cancer in 2020, 11% for prostate cancer in 2018 and 16% for retinoblastoma in 2018.[24]
• Track treatment coverage, including treatment of women who test positive through Visual Inspection with Acetic Acid for precancerous lesions, targeted at 90% in several periods and 93% later, and prostate cancer treatment completion, targeted to increase from 30% to 35%.[24]
• Monitor service readiness and implementation through indicators on screening-related diagnosis, radiotherapy and chemotherapy availability, specialist workforce numbers, morphine stock-outs, palliative-care coverage, facility capacity, equipment, medicines, guidelines, public awareness, training and operational research.[25][26][27]
• Use routine and special data sources including the Zimbabwe National Cancer Registry, the reactivated Bulawayo Cancer Registry, District Health Information Software 2, National Health Management Information System, Ministry reports, National Cancer Control Programme reports, demographic and health surveys, pharmacy and inventory records, workforce records and facility-readiness reports.[1][25][26][27]
• Expand District Health Information Software 2 reporting beyond cervical, breast and prostate cancers to include lung cancer, multiple myeloma and childhood cancers.[1]
• Conduct rapid assessments, process evaluations, mid-term and end-term evaluations, supported by a cancer module in the Zimbabwe Demographic and Health Survey, World Health Organization STEPwise risk-factor surveillance, School Based Health Survey and sentinel surveillance.[21]
• Strengthen surveillance by using the Zimbabwe National Cancer Registry as a central source for plan monitoring, with active and passive case-finding across public and private facilities and notifications from provincial, district, rural and mission hospitals.[21]
• Improve data linkage among vital statistics, cancer screening, human immunodeficiency virus and acquired immunodeficiency syndrome registers, District Health Information Software 2 and electronic health records, and advocate for cancer to become a reportable disease by 2025.[22]
• Analyse and disseminate findings through reports, dashboards, portals, websites, workshops and meetings, using qualitative and quantitative analytical software in line with Ministry guidance.[21]
• Strengthen cancer research, including clinical trials, periodic publication of cancer data, regional and global research participation, and investigation of Indigenous Knowledge Systems in cancer management.[22]

Accountability is intended to operate through the Permanent Secretary's Performance Contract, existing Ministry platforms, the Health Sector Coordination Framework and the Cancer Technical Working Group.[11]The framework also includes indicators for research publications, risk surveys, registry-data linkage, reportable cancer types, monitoring meetings, costed workplans, regulatory review, national cancer policy and guidelines.[23]However, several extracts do not provide a consolidated reporting timetable, complete indicator definitions, evaluation methodology, surveillance targets or accountability sanctions.[1][9][16]

Costing & Financing

The Plan identifies sustainable financing as a strategic requirement for comprehensive cancer prevention, diagnosis, treatment, palliative care, survivorship, surveillance and research, but the supplied material provides no overall budget, quantified funding gap, costing methodology or economic assumptions.[4][9][23]Earlier cancer-control efforts were underfunded amid competing priorities, and the preceding 2014-2018 strategy was not costed.[3][28]

• Increase domestic and external resources for cancer control, with cancer and non-communicable diseases included in the Ministry of Health and Child Care budget and external grants and non-governmental organisation support contributing to financing.[15]
• Secure specific budgetary provision for cancer and invest in supply chains, infrastructure, equipment, medicines, vaccines, workforce capacity, registries and research.[3][1][4]
• Establish a ring-fenced, sustainable multisectoral funding mechanism for essential cancer-management equipment, including foreign-currency funds for external servicing, repairs and upgrades.[18]
• Allocate adequate funding for palliative-care opioids and provide them free of charge at primary-healthcare level.[18]
• Mobilise revenue through taxes on unhealthy foods, drinks and other harmful substances associated with cancer, including use of the ring-fenced sugar tax for non-communicable diseases and cancer care.[15][9][22]
• Develop a costed cancer workplan and establish a ring-fenced Cancer Fund by 2030 for cancer services and equipment procurement or repair.[23]
• Address financial protection gaps, as most patients pay out of pocket, private insurance covers less than 10% of the population and some services are rationed, contributing to catastrophic costs.[15]
• Monitor catastrophic expenditure through the proportion of households spending more than 25% of monthly income on cancer services, while supporting vulnerable patients with free medicines and other assistance.[23]
• Use public-private partnerships, private insurance, bilateral support and development-partner assistance as potential complementary financing mechanisms.[29]

Key resource pressures include high diagnostic, transport, accommodation and private-radiotherapy costs; inadequate public-sector chemotherapy, blood products, specialised treatments, infrastructure, equipment and specialist personnel; and high equipment-maintenance and servicing costs.[6][7][30][20]Prevention is characterised as the most cost-effective intervention in resource-constrained settings, and integration of screening and early detection into existing programmes is expected to have minimal cost implications.[5][3]