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

Objectives

The National Cancer Control Plan provides a comprehensive national framework to reduce cancer incidence and mortality, improve quality of life for patients, families and communities, and guide public authorities, health institutions, professionals, communities and other stakeholders in cancer control.[1][2]It builds on the National Programme for Cancer Control (PNCC), a technical and regulatory body within the Ministry of Health responsible for organising, regulating and coordinating prevention, detection, diagnosis, treatment and cancer-registration activities.[3][4]

• Promote health and prevent cancer by addressing unhealthy diets, physical inactivity, obesity, tobacco and alcohol use, unsafe sexual practices, environmental and occupational carcinogens, inadequate health education and weak community support.[5]
• Strengthen early diagnosis and organised screening, initially prioritising cervical cancer and using cancer-registry evidence to identify other cancers suitable for early detection.[6][7][8]
• Deliver equitable, standardised cancer care across diagnosis, surgery, radiotherapy, pharmacotherapy, rehabilitation and palliative care, using national protocols and rational resource allocation.[9][10]
• Improve quality of life for people with progressive and terminal illness through pain and symptom control, communication, psychosocial and spiritual support, multidisciplinary care and family and community involvement.[11][12]
• Strengthen cancer research, ethical oversight, epidemiological surveillance and unified cancer registration to inform prevention, treatment, planning and public-health decisions.[13][14][15]
• Develop oncology human resources through workforce planning, specialist training, curriculum reform, continuing professional development and support for national and international exchanges.[16][17][18]

The plan gives particular attention to cancers with high incidence and to cancers that are preventable or curable, including cervical, breast, skin, lung, gastric and colorectal cancers, lymphomas, germ-cell tumours and major childhood cancers.[19]Cervical cancer is identified as the most frequent cancer in Honduras, representing 40% of all cancers and 50% of malignant tumours affecting women.[3]

Its strategic scope spans health promotion and prevention; screening and early detection; clinical diagnosis and care management; oncology surgery, radiotherapy and medicines; rehabilitation and palliative care; research; surveillance and registration; and human-resource development.[20][2]The plan also seeks to reorient and restructure the National Cancer Programme around prevention, promotion, timely diagnosis, treatment and palliative care.[19]

Implementation

Implementation is designed as an integrated, intersectoral response led by the Ministry of Health and PNCC, with community participation, institutional coordination, strengthened service networks and collaboration across the public sector, social security, private providers, civil society, universities and international partners.[21][4][2]Communities are expected to participate in setting priorities and choosing feasible strategies, while social communication should be embedded across activities in ways that respect local cultures, beliefs and customs.[2][22]

• Coordinate prevention and health-promotion activities with the Health Promotion Programme, health regulation authorities, municipalities, schools, social-security bodies, community organisations, religious institutions, non-governmental organisations and cooperating agencies.[22][23][24]
• Establish a National Cancer Commission for children and adults with cancer, develop unified management protocols, form tumour committees and strengthen alliances among governmental, private, civil-society and international organisations.[19][25][10]
• Implement screening standards, train health personnel, conduct priority cancer campaigns, analyse human papillomavirus conditions, formulate a vaccination-introduction plan and ensure screening is linked to effective treatment and sufficient service capacity.[6][7][8]
• Strengthen referral and counter-referral systems, recruit and train oncology personnel, improve infrastructure, maintain equipment, establish regional outpatient chemotherapy services and equip diagnostic, surgical and radiotherapy units.[9][10][26][27]
• Establish palliative-care units, multidisciplinary teams, community support groups, training programmes and improved access to opioids and other palliative medicines.[12][28][29][30]
• Develop research groups, research-training programmes, bioethics committees, public research databases, websites, institutional networks and infrastructure for cancer researchers.[31][32][33][34][35]

The information system is a central delivery mechanism. The plan calls for mandatory, standardised cancer notification and a unified national registry under Ministry of Health stewardship, supported by reporting from hospitals, clinics, oncology centres, pathology, radiology, haematology and other relevant services.[19][36]The Honduran Association Against Cancer is delegated to operate the population-based registry while Ministry of Health capacity remains insufficient, with technical guidelines to be developed jointly with PNCC and the Ministry.[37]Registration and surveillance are intended to generate reliable data on incidence, mortality, prevalence, survival, geographical distribution, risk factors and disease burden.[37][14]

Governance responsibilities extend across PNCC, the Secretariat of Health, health-service networks, health-promotion and regulatory directorates, the Honduran Social Security Institute, hospitals, universities, the National Health Human Resources Commission, research and science bodies, and international partners including the Pan American Health Organization, World Health Organization and International Atomic Energy Agency.[38][39][27][40][17]Implementation of many service, screening, registration and workforce actions is scheduled from 2009 onwards, while population-based registry actions are scheduled from 2013.[23][41][42][16]

Operational monitoring relies on service-readiness and delivery indicators, including functioning registries and surveillance systems, reporting institutions, screening campaigns and trained staff; equipped diagnostic, radiotherapy and treatment units; functioning palliative and rehabilitation services; research outputs; and oncology training capacity.[41][27][11][40][42][18]The plan identifies resource dispersion, insufficient budgets, workforce shortages, inadequate infrastructure and equipment, and limited research financing as major constraints.[21][4][43]It proposes budget review, project-based resource mobilisation, national-budget advocacy, external cooperation, scholarships and technical assistance, but does not specify monetary allocations or a total programme budget.[19][16][43]

Monitoring & Evaluation

The plan establishes cancer registration and epidemiological surveillance as its core monitoring architecture, linking data collection to cancer control planning, research, service delivery and accountability. It combines mandatory notification, hospital and population-based registries, service-readiness measures, workforce monitoring and activity indicators, although many sections lack defined outcome targets, evaluation methods and reporting cycles.[19][14][42][16]

• Strengthen and unify the National Cancer Registry within the Ministry of Health, using standardised mandatory notification and centralised governance.[19][2][14]
• Require hospitals, clinics, oncology centres, and relevant diagnostic and support units to report cancer cases, with quarterly written reports on new malignant tumours or reports provided when requested by the Ministry of Health.[36]
• Record notifying institutions, patient identifiers and clinical details, tumour sites, histopathological diagnoses and diagnostic bases, while maintaining confidentiality and allowing authorised access to information.[36]
• Use population-based registry data to measure cancer morbidity and mortality nationally, address fragmented institutional records, and support estimates of incidence, prevalence, mortality and survival.[37][3]
• Implement hospital and histopathological registration, prepare a cancer situation diagnosis, publish findings, establish epidemiological surveillance, and develop a population-based registry model.[15][42][16]
• Monitor surveillance through the number of institutions conducting local surveillance, epidemiological characterisation of people diagnosed with cancer, institutions reporting to the National Programme for Cancer Control, and publication of registry findings.[42][16]
• Use surveillance to identify geographical distribution, risk factors, incidence, prevalence, morbidity, mortality, disability, disease burden and economic costs for planning and management.[14]
• Track prevention and screening implementation through indicators such as functioning healthy-lifestyle projects, enforcement of tobacco and alcohol legislation, skin-cancer campaigns, occupational-health programming, cancer-information services, screening standards and trained personnel.[23][44][24][8]
• Review cervical-screening performance against the 2006 baseline of 392,154 cytologies among women aged 30 to 59 years, coverage below 30%, 3,826 abnormal results and a 0.97 positivity index against a stated standard of 1.[7]
• Monitor clinical-service readiness through functioning referral systems, trained and recruited personnel, maintained equipment, refurbished oncology units, operational protocols and tumour committees, waste-management arrangements, equipped diagnostic units and functioning operating theatres.[41][26][45][46]
• Track radiotherapy, medicines, rehabilitation and palliative-care delivery through functioning treatment units, treatment abandonment, trained staff, use of a unified medicines list, dispensing standards, rehabilitation services, palliative-care units, support groups and access to essential palliative medicines.[27][47][11][28][29][30]
• Monitor research through functioning research groups, defined research lines, completed studies, ethics opinions, trained personnel, scholarships, research databases, funding-source records, financial execution and dissemination through websites and other channels.[13][40][31][32][43][34][48][35]
• Assign selected oversight functions to the Ministry of Health, National Programme for Cancer Control, responsible service units, bioethics committees and a medicines-quality commission; require supervision of budgetary resource use and institutional results where resources are allocated.[19][11][13][14]

Implementation of registry, surveillance and workforce actions begins in 2009, while population-based registry actions are scheduled from 2013; several service and prevention activities are also scheduled from 2009 onwards.[23][41][42][16][17]Detailed reporting schedules, evaluation designs, formal accountability timetables and comprehensive quantitative outcome targets are not consistently specified.[4][2][27][28][31]

Costing & Financing

The plan identifies substantial resource constraints across cancer prevention, diagnosis, treatment, research, registration and workforce development, but provides no monetary budget, currency-denominated allocation, unit cost, quantified funding gap or economic assumption.[21][3][4][43]Financing priorities centre on reallocating and supervising resources, mobilising domestic and international support, embedding selected posts and research activities in budgets, and undertaking feasibility or budget-planning exercises.[19][47][17][43]

• Address inadequate budget allocation and inefficient dispersion of resources for cancer prevention, treatment and cure by reviewing allocations against agreed objectives and supervising institutional use and results.[21][19]
• Resource laboratory, radiology, pathology, blood-bank and nuclear-medicine services adequately, alongside workforce, equipment, infrastructure, medicines, supplies, maintenance and rehabilitation services.[25][9][10][41]
• Mobilise funds for infrastructure improvements, high-risk oncology waste management, diagnostic services, radiotherapy and surgical equipment through project preparation, budget definition, procurement and maintenance planning.[26][45][46][27]
• Undertake cost-feasibility and actuarial studies for regional outpatient chemotherapy services, including chemotherapy rooms, preparation units, day hospitals and minor ambulatory surgery rooms.[47]
• Seek lower-cost procurement of palliative medicines and improve access to opioids and other required medicines, without a stated financing mechanism or numerical target.[12][30]
• Obtain financing and technical assistance from cooperating organisations and national and international networks for research, registry development, oncology training, scholarships, exchanges and placements.[13][40][16][17][18]
• Include budgetary posts within oncology service institutions for personnel undergoing training, while prioritising domestic and external support for specialist education.[17][18][49]
• Prepare, approve and procure budgets for cancer-research infrastructure, computing, library, connectivity, equipment, logistical support and technical personnel.[33][50]
• Seek political support for a national cancer-research budget, international financing and research scholarships, noting that no national budget allocation existed for cancer research or related human-resource training.[43]
• Finance research dissemination through the national budget, international organisations’ budgets or individual study budgets, and monitor funds assigned to investigators.[34][35]

Screening is expected to proceed only where effectiveness is demonstrated, resources are sufficient across levels of care to reach nearly the whole target population, and disease prevalence is high enough to justify the required effort and costs.[6]The document does not specify aggregate programme costs, committed funding sources, financing shares, affordability thresholds, or the value of identified funding shortfalls.[6][27][12][31]