Plan Strategique De Lutte Contre Le Cancer Du Col De L'Uterus Et Les Autres Cancers Gynecologiques Et Mammaires Au Benin

Objectives

The 2019–2023 Strategic Plan for the Prevention and Control of Gynaecological and Breast Cancers seeks a Benin in which women are freed from the burden of these cancers. It is aligned with the National Health Development Plan 2018–2022 and contributes to the World Health Organization ambition to eliminate cervical cancer as a public-health problem.[1][2][3]Its overarching goal is to reduce morbidity and mortality from gynaecological and breast cancers by 30% by 2023.[1][3]

• Reduce invasive cervical-cancer incidence by 50% by 2023, from a baseline of 13.6 to 6.8 per 100,000 population.[1][4]
• Ensure early diagnosis for 75% of cervical, breast, ovarian, vaginal, fallopian-tube and endometrial cancers, including diagnosis of cervical cancers at International Federation of Gynecology and Obstetrics stages I or II.[1][4]
• Provide appropriate care to all women with identified precancerous lesions or diagnosed gynaecological or breast cancer, including treatment of invasive disease.[1][4]
• Provide palliative care to all patients with incurable disease or identified need, with 100% coverage targets for metastatic patients followed by a palliative-care unit and receiving appropriate care.[1][5]
• Reduce oncogenic human papillomavirus prevalence among girls aged 18 to 25 by 30%, while prioritising vaccination of girls aged 9 to 13 before sexual activity.[1][6][7]
• Strengthen coordination, monitoring, evaluation and research on cervical, breast and other gynaecological cancers.[1][5]

The plan is organised around four strategic axes: primary prevention; early diagnosis and treatment; tertiary and quaternary prevention; and leadership, governance and research promotion.[8][9]Priority interventions include socio-behavioural communication, human papillomavirus vaccination, screening, treatment of precancerous lesions and invasive cancers, palliative care, workforce and infrastructure development, research, coordination and resource mobilisation.[9]

• Strengthen prevention through communication on cancer risks, healthy behaviours and screening, using mass media, social media, mobile messaging and community mobilisation.[10]
• Integrate human papillomavirus vaccination into routine immunisation, while maintaining screening because vaccines do not cover all oncogenic human papillomavirus types.[10]
• Expand early detection through cervical screening, breast assessment, referral capacity and screen-and-treat services for precancerous cervical lesions.[11]
• Develop specialist diagnosis and treatment through pathology, imaging, surgery, chemotherapy, radiotherapy, referral systems and expert centres.[12]

Implementation

Implementation is designed to integrate interventions into existing services where possible, use a multisectoral approach and progressively scale delivery across the health-system pyramid.[13][14]The plan was developed through a consultative process involving national and international experts, Ministry of Health directorates, clinicians, universities, hospitals, technical and financial partners and World Health Organization support.[15][2][3]

• Deliver communication and awareness through maternity services, civil-society organisations, community health workers, traditional practitioners, women’s associations, peer educators, schools, media and community, political, religious and traditional leaders.[14][7]
• Reach vulnerable and underserved groups, including rural and hard-to-reach women and girls, sex workers, women and girls living with HIV, and communities with limited resources.[7]
• Integrate cervical screening using visual inspection with acetic acid into maternity services and adapt technical guidance for cytology and human papillomavirus DNA testing where applicable.[11]
• Organise specialist care through designated expert centres, including CNHU, CHU-MEL, CHUD Parakou, Tanguiéta Hospital and Abomey CHD, with departmental hospitals acting as relay centres for simpler surgery and follow-up.[12]
• Strengthen the workforce through continuing education, specialist training and recruitment of gynaecologists, oncologists, pathologists, laboratory and radiology technicians, anaesthesia personnel, palliative-care specialists and epidemiology technicians.[10][16]
• Provide essential infrastructure and supplies, including radiotherapy, mammography, ultrasound and biopsy capacity, surgery equipment, pathology supplies and anticancer medicines.[17]

Governance assigns national strategic direction to the Minister of Health through the National Programme for the Fight against Non-Communicable Diseases, with coordination and follow-up led nationally by that programme, at intermediate level by Departmental Health Directorates, and operationally by health-zone bureaux.[18]National referral hospitals deliver care components, while health training institutions and universities support specialist workforce development; the National Vaccination Agency leads nationwide human papillomavirus vaccination.[18][8]

• Pilot activities in two health zones, one in the south and one in the north, for one semester before evaluation and national scale-up.[19]
• Prioritise cost-effective interventions during the first two years and defer more financially intensive activities until the third year where necessary.[9]
• Review implementation through annual national meetings, six-monthly departmental meetings and quarterly zone-level meetings.[18]
• Collect implementation and outcome data through the Cotonou and Parakou cancer registries and the District Health Information Software 2 system, with national analysis by the National Programme for the Fight against Non-Communicable Diseases.[19]
• Use annual workplans to specify operational indicators, and use mid-term and final evaluations to assess progress towards objectives.[20][4]
• Mobilise resources through autonomous budgeting of objectives and activities, partner advocacy, annual projected budgets, a proposed cancer control fund, medicine subsidies and state coverage of at least 50% of chemotherapy costs.[3][17][18]

Monitoring & Evaluation

The plan establishes a monitoring and evaluation system to track implementation, service delivery, outcomes and progress towards reducing morbidity and mortality from gynaecological and breast cancers. Operational indicators are to be detailed in annual workplans, while progress indicators are intended for mid-term and final evaluations.[20][4]

• Monitor primary prevention through indicators on facilities delivering socio-behavioural communication, awareness sessions, trained midwives, availability of human papillomavirus vaccination, two-dose vaccination coverage among girls aged 9 to 13, and adverse events following immunisation.[21]
• Track early diagnosis and screening through training coverage among health professionals, the proportion of facilities and maternity units conducting cervical and breast screening, availability of mammography and microbiopsy, mass-screening campaigns, screening results among women aged 25 to 65, and breast self-examination and clinical examination practices.[21][22][23]
• Measure treatment performance through the proportion of women with precancerous lesions, cervical cancer or breast cancer who receive appropriate treatment, including systematic treatment following identification of eligible lesions.[23]
• Assess tertiary and quaternary prevention through qualified personnel availability and ratios, referral-centre capacity for medico-surgical treatment and radiotherapy, treatment completion, palliative-care coverage and management of advanced disease.[23][24]
• Track outcome targets including reduction of invasive cervical-cancer incidence from 13.6 to 6.8 per 100,000 inhabitants by 2023, diagnosis of 75% of specified cancers at International Federation of Gynecology and Obstetrics stages I or II, and treatment of 100% of women diagnosed with cervical precancerous lesions or specified invasive cancers.[4]
• Monitor mortality targets of 5 per 100,000 women for cervical cancer and 6 per 100,000 women for breast cancer by 2023.[4]

Coordination and accountability are incorporated through indicators for meetings held with the required quorum and objectives achieved, corrective actions implemented, evaluation activities completed, scientific publications, partnerships, public awareness, screening registers and investment in cancer control.[25][5][26]

The National Programme for the Fight against Non-Communicable Diseases is responsible for national coordination and follow-up. It is to convene annual review meetings involving cancer focal points, departmental directors and epidemiology and monitoring-and-evaluation personnel; departmental reviews are scheduled every six months and health-zone reviews quarterly.[18]

Monitoring data are to be drawn from the Cotonou and Parakou cancer registries and the District Health Information Software 2 system. Registry data are centralised and periodically analysed by the National Programme for the Fight against Non-Communicable Diseases, while health-zone data are transmitted to the Ministry of Health’s Health Information Management Service.[19]

Financial performance is to be reviewed periodically through fiduciary expenditure control, with detailed quarterly financing reports prepared by the accounting officer of the National Programme for the Fight against Non-Communicable Diseases.[19]Existing registries face human-resource and financing constraints, which limit their effectiveness and may require future adaptation and expansion.[27][19]

The source does not specify standard reporting formats, data-verification procedures, complete indicator definitions, surveillance governance arrangements or named bodies responsible for enforcing corrective action.[20][26]

Costing & Financing

The plan envisages separate, autonomous budgeting of activities under each specific objective, strategic area and activity, intended to enable technical and financial partners to fund interventions aligned with their areas of work.[3][28]A provisional budget was prepared in March 2019 and reviewed during the validation workshop, but no overall costed budget is included in the supplied material.[29]

• Mobilise resources through advocacy to development and technical and financial partners, an annual projected budget, and proposals to increase the budgets of the national non-communicable disease programme and the Directorate of Maternal and Child Health.[17][14]
• Establish potential financing mechanisms including a partner round table, a cancer-control fund supported by health-related import taxes, a public telethon, hospital subsidies for anticancer medicines and state support for chemotherapy.[18]
• Provide a state subsidy covering at least 50% of chemotherapy care nationally.[12][18]
• Phase implementation because resource gaps are substantial and available resources limited, prioritising comparatively cost-effective interventions during the first two years and potentially deferring financially intensive activities until the third year.[9]
• Allocate substantial human and financial resources to referral, departmental and peripheral facilities, including needs for screening consumables, specialist training, pathology laboratories, scanners, oncology facilities, radiotherapy and surgical equipment.[8][11][12][17]

Financial protection is linked to prevention, screening and treatment of cervical precancerous lesions through Assurance for the Reinforcement of Human Capital, as invasive cervical-cancer treatment may require surgery, radiotherapy, chemotherapy and targeted therapy and is described as substantially more costly.[30]

Affordability and supply constraints include high costs for mammography, aromatase inhibitors and trastuzumab, stock-outs of chemotherapy medicines, and barriers to care for poorer patients.[31][32][33]The plan also identifies insufficient financing for cancer registries, cancer control and specialised workforce capacity.[27][13]

In 2017, public health expenditure represented 4.03% of the national budget, compared with the 15% Abuja Declaration commitment.[27]State mobilisation for non-communicable disease activities declined from 96% in 2013 to 26% in 2018, and programme expenditure depended heavily on technical and financial partners.[27]

No total plan budget, activity-level allocation, quantified funding gap, financing timetable or economic assumptions are specified in the supplied excerpts.[1][18][3]