Plan Strategique National De Lutte Contre Le Cancer 2022-2025

Objectives

Côte d’Ivoire’s National Strategic Plan for Cancer Control 2022–2025 seeks to reduce mortality from prevalent adult and childhood cancers by 10% by 2025 and envisages a country in which cancer is a controllable chronic disease rather than a tragedy.[1][2]The plan is aligned with the National Health Development Plan 2021–2025 and is founded on leadership, inclusive participation, human rights, equity, gender equality and the commitment to leave no one behind.[3][4]

• Strengthen governance, leadership, coordination and sustainable financing for cancer control across all levels of the health system.[1][5][6]
• Improve cancer information, registration, research and use of reliable data for decision-making.[5][7][8]
• Expand equitable access to quality prevention, diagnosis, treatment, rehabilitation, palliative care, psychosocial support and nutritional care.[6][7][9]
• Increase the availability of functional oncology units, cancer centres, diagnostic infrastructure, radiotherapy, medicines, morphine and appropriately qualified personnel.[10][11][12]
• Strengthen health promotion, demand for services and protective behaviours among vulnerable populations through community, civil-society, media, administrative and religious actors.[11][13][2]
• Prioritise prevention and early detection through human papillomavirus and hepatitis B vaccination, cervical-cancer screening and treatment, mammography, colorectal screening, and earlier referral of suspected cancers.[14][15][16]

The mortality objective is supported by 2025 targets to reduce overall cancer mortality from 68% to 58%, breast-cancer mortality from 69% to 59%, cervical-cancer mortality from 54% to 44%, prostate-cancer mortality from 58% to 48%, and paediatric-cancer mortality from 38% to 28%.[17]The strategy recognises that late diagnosis, financial barriers, uneven geographical access, limited insurance coverage and weaknesses in service capacity constrain cancer outcomes.[18][19][20]

Implementation

Implementation uses a health-system-strengthening and results-based model, translated into annual operational plans and coordinated across central, regional and district levels.[5][21][22]The Ministry of Health, Public Hygiene and Universal Health Coverage, through the National Cancer Control Programme, leads implementation with other government sectors, public and private providers, civil society, professional bodies, communities, technical and financial partners and development partners.[3][22][17]

• Govern implementation through a steering committee chaired under the Director-General for Health, responsible for strategic direction, resource mobilisation and review of results.[22]
• Coordinate annual planning and delivery through a technical monitoring committee chaired by the directorate responsible for the National Cancer Control Programme, supported by implementation-monitoring arrangements and reactivated regional cancer-control committees.[22][20]
• Hold steering meetings at least annually, implementation-monitoring meetings semi-annually, technical-monitoring meetings quarterly, and periodic coordination meetings at central, regional and departmental levels.[22][20]
• Strengthen regulatory and institutional capacity through functional technical working groups, revised arrangements for the National Cancer Control Programme, cancer-related regulatory orders and legislation governing morphine.[17][23][24]
• Develop infrastructure by creating an oncology service at Bouaké Teaching Hospital and constructing the National Centre for Medical Oncology and Radiotherapy at Grand-Bassam, while upgrading public treatment facilities, laboratories, mammography capacity and cervical-screening services.[25][26][27]
• Develop the workforce through training in prevention, early detection, referral, pathology, oncology, radiotherapy, pharmacy, palliative care, nutrition and cancer surgery.[28][29]
• Build community demand through mass communication, local-language radio, digital tools, awareness events, training for community health workers and engagement with traditional-medicine practitioners.[30][31][32]

Service delivery combines public oncology facilities, specialised institutes, referral hospitals, primary-care screening services, community engagement and private-sector participation.[33][34][12]Planned access measures include advocacy for cancer coverage through universal health coverage, free breast-cancer surgery for 150 eligible patients annually, initial radiotherapy sessions for 150 breast-cancer patients annually, treatment for 100 children with cancer annually and targeted therapies for 300 eligible patients annually.[35][36]

Monitoring and evaluation are to use a dedicated framework defining information needs, indicators, collection tools, periodic analysis, surveys and communication of results.[21]Indicators draw on routine health-information data, surveys, studies, administrative archives, activity reports, DHIS2, Globocan 2020 and medicine-supply records.[8][12]Annual reviews, a mid-term review and a final evaluation are intended to identify implementation barriers, assess progress and measure achievement of planned results.[21][22]Key measures include cancer mortality, functioning technical working groups, budget allocation, service availability, treatment initiation, late detection, medicine-order satisfaction, palliative-care access, vaccination and screening coverage.[17][23][12][15]

Financing combines government operating and investment resources, development-partner contributions, private-sector partnerships, innovative financing mechanisms and a proposed national cancer-control fund.[6][37][24]The plan’s estimated four-year cost is 166.51 billion West African CFA francs, approximately 260.17 million United States dollars.[4]It also targets an increase in the health-sector budget share allocated to cancer from 1.15% in 2021 to 2.50% by 2025.[23]

Monitoring & Evaluation

The plan establishes a results-based monitoring, evaluation and accountability system linked to its objective of reducing mortality from prevalent adult and childhood cancers by 10% by 2025.[1][17][2]It combines routine health information, cancer registries, surveys, studies, administrative records and activity reports to monitor implementation, service delivery, prevention and outcomes.[22][8][15]

• Monitor mortality by cancer type against 2020 baselines and annual targets through 2025, using Globocan 2020 for major adult cancers and hospital-survey data for paediatric cancers.[17]
• Track governance and financing through functional technical working groups, cancer-related regulations, morphine legislation, the health-budget share allocated to cancer, universal health coverage inclusion and achievement of outcome and product indicators.[17][23][24]
• Use the National Health Information System, including District Health Information Software 2, alongside updated collection tools, cancer registries, digitisation, internal reports, surveys and National Public Health Pharmacy records.[8][12]
• Strengthen cancer surveillance by extending registration beyond Abidjan, continuing paediatric registration, piloting cervical-cancer case collection, digitising data and improving data validation, archiving, feedback and quality control.[38][36]
• Measure service availability, accessibility, quality, volume, integration and utilisation, including functional oncology units and cancer centres, late diagnosis, treatment initiation, medicine-order satisfaction, palliative-care access and treatment of precancerous cervical lesions.[20][12]
• Track prevention through human papillomavirus and hepatitis B vaccination, mammography, cervical-cancer screening, colorectal-cancer screening, public awareness, supervision and training of community, media and civil-society actors.[14][15][2]
• Conduct annual reviews, a mid-term review and a final evaluation; monitoring committees are responsible for annual and mid-term reviews, while the final evaluation is intended to assess overall results attainment.[21][22]
• Validate annual operational plans and progress reports through technical and implementation-monitoring committees, with implementation status reported to the steering committee.[22][20]

Governance meetings provide a recurring accountability mechanism: steering, implementation-monitoring and technical-monitoring bodies meet at least annually, semi-annually and quarterly respectively, supplemented by coordination meetings at central, regional and departmental levels.[22][20]The plan assigns oversight roles to the Cabinet for Health, Directorate-General of Health, National Cancer Control Programme, Directorate of Planning and Health Information, finance and budget authorities, regional directorates and implementing facilities.[17][23][24]

Specific performance targets include reducing late detection from 74% to 64%, increasing access to anticancer treatment to 80%, palliative-care access to 95%, treatment initiation after diagnosis to 80%, and satisfaction with public-sector anticancer medicine orders to 80%.[12]Additional targets cover mammography capacity, cervical-screening coverage, medicine and morphine availability, radiotherapy capacity, workforce development and pathology staffing.[39][40][41]

Several extracts identify implementation weaknesses that monitoring is intended to address, including delayed data production and dissemination, incomplete integration of data sources, inadequate financing and staffing for real-time data collection, weak feedback loops and limited use of information in decision-making.[38][42]The source does not provide a complete reporting calendar, indicator definitions, surveillance protocol or evaluation methodology for every indicator.[43][14]

Costing & Financing

The National Cancer Control Plan for 2022–2025 has an estimated total cost of 166.51 billion West African CFA francs, approximately 260.17 million United States dollars, for the four-year period.[4]Financing priorities include increasing the health-sector budget share for cancer control, mobilising public and private resources, establishing a cancer-control fund, using innovative financing and integrating cancer services into universal health coverage.[1][6][24]

• Increase the health-sector budget share allocated to cancer from a 1.15% baseline in 2021 to 2.50% by 2025.[23]
• Mobilise government operating and investment resources, development-partner contributions, private-sector support and public-private partnerships, while incorporating activities into public expenditure and investment programming.[37][21]
• Improve financial access through insurance coverage, treatment subsidies and proposed free or subsidised services for breast cancer, radiotherapy, childhood cancer and targeted therapies.[35][36]
• Address substantial household payments, which contribute to reduced uptake and discontinuation of cancer care; nearly 6% of people with cancer are reported to have health insurance, while the universal health coverage benefits package does not cover non-communicable diseases including cancer.[18]
• Fund infrastructure, cancer centres, diagnostic and treatment equipment, registries, information systems, research, specialist training, medicines, palliative care and community communication activities.[26][27][44][45]

Public health expenditure increased from 330.4 billion West African CFA francs in 2016 to 588 billion West African CFA francs in 2019.[18]In 2018, households accounted for 39.43% of health financing, the public sector for 28.81%, the private sector for 19.44% and external sources for 12.32%.[18]

The plan identifies financial barriers to cancer medicines, screening, treatment, information systems, research, palliative care, equipment maintenance and workforce retention.[38][46][47][48]Although the source includes many activity-level allocations, several extracts do not identify their currency, financing source, year, funding gap or economic assumptions.[49][30][44]