Plan Estratégico Nacional Para La Prevención Y El Control Del Cáncer 2009-2013

Objectives

Honduras’s National Cancer Control Plan provides an integrated framework to reduce cancer incidence, morbidity and mortality and improve quality of life for patients, families and communities. It frames the National Programme for Cancer Control as the technical and regulatory body for organising prevention, detection, diagnosis, treatment, registration and follow-up, spanning the cancer continuum from risk reduction to palliative care.[1][2][3]

• Promote healthy lifestyles and reduce exposure to modifiable risks, including tobacco, harmful alcohol use, unhealthy diets, obesity, physical inactivity, risky sexual practices, occupational and environmental carcinogens, excessive solar exposure and ionising radiation.[4][5]
• Prevent cancer through health education, intersectoral action, enforcement of tobacco and alcohol legislation, environmental and radiological protection, occupational health measures, support groups, volunteering and a national plan for human papillomavirus vaccination.[5][6][7]
• Strengthen early diagnosis and screening by standardising procedures, training personnel, expanding cervical-cancer screening and developing organised programmes for other cancers where effectiveness, disease prevalence and capacity for treatment justify screening.[7][8][9]
• Improve comprehensive clinical care, including diagnosis, oncology surgery, radiotherapy, pharmacotherapy, rehabilitation, referral and counter-referral, tumour committees, treatment protocols, safe medicines management and reliable access to supplies.[10][11][12]
• Expand palliative care to manage pain and other symptoms while addressing communication, psychosocial and spiritual needs, with the aim of securing the best possible quality of life for people with progressive or terminal cancer and those close to them.[13][14]
• Develop oncology research to identify risk and protective factors, inform prevention, treatment and control, establish national priorities and strengthen ethical review, research networks, training and dissemination.[15][16][17]
• Establish reliable cancer intelligence through unified hospital, histopathology and population-based registration, a national epidemiological-surveillance subsystem, mandatory notification and publication of cancer information.[18][19][20]
• Build oncology workforce capacity through national baselines, continuous professional development, specialist internal and external training, and incorporation of cancer subjects into undergraduate and postgraduate medical education.[20][21][22][23]

Implementation

Implementation relies on restructuring and coordinating the National Programme for Cancer Control within the Ministry of Health through a comprehensive, multidisciplinary and intersectoral model. The plan envisages a National Cancer Commission covering childhood and adult cancer, collective follow-up by public, private, civil-society and international actors, and community participation that respects local cultures, beliefs and customs.[24][25][3][4]

• Coordinate delivery through the Ministry of Health, the National Programme for Cancer Control, health-promotion, surveillance, service-network, sanitary-regulation, hospital, human-resources, planning and evaluation bodies, with responsibilities varying by area of action.[9][26][27]
• Engage the Honduran Social Security Institute, public and private hospitals, specialist oncology centres, the Honduran Association Against Cancer, the League Against Cancer, the Emma Romero de Callejas Cancer Centre, universities, municipalities, professional associations, non-governmental organisations and community groups.[28][29][15]
• Seek technical cooperation and strategic alliances with the Pan American Health Organization, World Health Organization, International Atomic Energy Agency, cooperating organisations and other national and international partners.[30][10][31]
• Use legislation, fiscal and tax measures, education reform, public communication, advocacy and institutional training alongside health-service interventions to create supportive conditions for prevention and control.[4][6][32]
• Implement standardised protocols and guidelines for screening, diagnosis, adult and paediatric treatment, palliative care, medicines dispensing, high-risk oncology waste management and the operation of tumour committees.[9][11][12][33]
• Strengthen service infrastructure through maintenance arrangements, refurbishment, modern equipment, laboratory and pathology support, radiology, nuclear medicine, surgical capacity, radiotherapy, chemotherapy facilities, rehabilitation units and palliative-care units.[12][34][35][36][33]
• Operate mandatory cancer reporting and progressively unify cancer registration under Ministry of Health stewardship, while coordinating reporting institutions and using registry and surveillance data for planning, screening priorities, research and decision-making.[28][18][37][20]
• Monitor implementation through operational indicators such as functioning services and units, trained staff, protocols and programmes implemented, reporting institutions, registry outputs, research activities, ethics approvals, equipment availability and dissemination activities.[26][35][31][27][38]
• Mobilise resources through review and reorientation of existing budgets, preparation of infrastructure and research projects, national-budget negotiation, cooperation funding, scholarships and technical assistance. The supplied material identifies inadequate and fragmented resources, infrastructure and equipment deficits, and workforce shortages, but provides no consolidated monetary budget or costed financing plan.[39][24][21][40][41]

Monitoring & Evaluation

The monitoring framework centres on a unified National Cancer Registry, mandatory cancer notification, epidemiological surveillance, service-delivery indicators and oversight of resource use. It is intended to improve the reliability, completeness and use of cancer data for planning, priority-setting and national decision-making.[24][3][18][37]

• Operate a mandatory cancer information system covering diagnosed cancer cases, with Ministry of Health hospitals and relevant public and private facilities submitting written reports quarterly or when requested.[28]
• Record patient and tumour information including notifying institution, identifiers, age, sex, primary tumour site, histopathological diagnosis and diagnostic basis, while maintaining confidentiality subject to Ministry of Health access decisions.[28]
• Strengthen and unify hospital, histopathology and population-based cancer registration, publish and disseminate findings, and use registry analysis to identify priority cancers and modifiable risk factors.[19][27][20]
• Establish cancer epidemiological surveillance to document disease distribution, risk factors, incidence, prevalence, morbidity, mortality, disability and economic burden, and support public-health decisions.[18][37]
• Monitor prevention through implementation of intersectoral healthy-lifestyle projects, tobacco and alcohol law enforcement, skin-cancer campaigns, occupational-health activities, social communication and operation of a cancer documentation centre.[6][30][32]
• Track early detection and screening through analysed registry information, identified cancers and risk factors, prepared standards, trained staff, screening campaigns and functioning organised programmes.[9]In 2006, 392,154 cervical cytology tests were recorded among women aged 30 to 59 years, with coverage below 30% of the stated risk population and a positivity index of 0.97.[8]
• Measure care capacity through referral-system implementation, oncology personnel recruited and trained, equipped operating theatres, functioning radiotherapy and dosimetry services, regional treatment units, treatment abandonment, medicines-management arrangements and rehabilitation units.[26][35][36][13]
• Assess palliative care through trained personnel, education content, cooperation agreements, emergency teams, functioning units, protocols, essential-medicine listing and operating support groups.[42][33][43]
• Monitor research through functioning interdisciplinary groups, completed studies, training activities, ethics opinions, research databases, web-platform access and studies entered into the database.[31][18][16][44]
• Review budgetary-resource use and results achieved by recipient institutions.[24]

Responsibilities for registry, surveillance and implementation are assigned principally to the National Programme for Cancer Control and Ministry of Health bodies, with participation from hospitals, social-security institutions, universities and public and private oncology providers.[28][37][27]Many sections do not specify common reporting formats, evaluation designs, baseline values, outcome targets, reporting cycles or formal accountability processes beyond the listed indicators and responsible bodies.[10][12][35][16]

Costing & Financing

No consolidated, currency-denominated cancer-control budget, costed implementation plan, quantified funding gap or economic assumptions are specified. The plan nevertheless identifies major resource constraints and proposes budget reorientation, resource mobilisation, external cooperation and incorporation of selected activities into institutional or national budgets.[39][24][21][41]

• Address inadequate cancer-budget allocation, fragmented resource use, deficient infrastructure and equipment, and shortages of specialised oncology personnel.[39]
• Review and reorientate existing budgetary resources against agreed objectives, while supervising expenditure and institutional results.[24]
• Mobilise funds for infrastructure improvements, equipment maintenance, diagnostic supplies and high-risk oncology waste management, including preparation of projects and defined budgets where required.[12][34][45]
• Provide resources for surgical, radiotherapy, dosimetry, chemotherapy, medicines-management and rehabilitation capacity; undertake feasibility and actuarial cost studies for regional outpatient chemotherapy services.[35][36][13]
• Seek lower-cost procurement and improved access to palliative-care medicines, including opioids and other essential treatments.[43]
• Secure financing and technical support for oncology workforce development, including scholarships, exchanges, placements and funded posts for personnel undergoing training.[21][22]
• Fund research capacity through national-budget allocations, external cooperation, fellowships, methodology courses, research dissemination, infrastructure, information technology, libraries and technical support staff.[40][46][41][47]
• Use potential support from the Pan American Health Organization, World Health Organization, International Atomic Energy Agency, cooperating organisations and other national or international partners, although no commitments or amounts are specified.[15][31][16]

Screening is considered appropriate only where effective treatment and sufficient resources are available across levels of care, and where disease prevalence justifies the required effort and costs.[7]The material identifies limited resources for prevention, diagnosis, treatment and research, but does not provide financial values for the proposed response.[1][15]