NCCP Ethiopia Plan - ICCP Portal

FEDERAL MINISTRYOF

HEALTH ETHIOPIA

NATIONAL CANCER CONTROL PLAN2016-2020

NATIONAL CANCER CONTROL PLAN OF ETHIOPIA - 2016-2020

TABLE OF CONTENTS

ACRONYMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

LIST OF CONTRIBUTORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

ACKNOWLEDGMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

FOREWORD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

EXECUTIVE SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

PART 1 - BACKGROUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

1. INTRODUCTION: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

1.1. Global Burden of Cancer: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

1.2. The Situation of Cancer in Ethiopia: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Figure 1: An estimated 5-year prevalence of cancer in Ethiopia, Globocan 2012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

1.3 Stakeholders analysis: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Table 1: Stakeholder analysis of cancer control in Ethiopia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

1.4 SWOT Analysis OF THE National Cancer Control Activities . . . . . . . . . . . . . . . . . . . . . . 23

Table 2: SWOT analysis of national cancer control activities in Ethiopia . . . . . . . . . . . 23

1.5 The National Cancer Control Strategy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

1.6 Linkage with other existing strategies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Table 3: Linkage of NCCP with other strategies of FMOH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

1.7 Justifi cation for the National Cancer control Plan: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

PART 1I - THE NATIONAL CANCER CONTROL PLAN OF ETHIOPIA . . . . . . . . . . . 30

2. STRATEGIC FRAMEWORK: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

2.1 Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

2.2 Mission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

2.3 Goal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

2.4 General Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

2.5 Guiding Principles of the Cancer control Plan: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

2.6 Service delivery level and startegies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

2.6.1 Health service delivery organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

2.6.1.1 Primary Level Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

2.6.1.2 Community Empowerment, Engagement and Participation . . . . . . . . . . . . . 33

2.6.1.3 Secondary and Tertiary Level Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34


Table 4: Number, types and functional status of health facilities and health posts in Ethiopia, SPA 2014 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

2.6.2 The cancer control Continuum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Figure 2: The Continuum of Cancer Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

2.7 intervention strategies by service delivery level . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

2.7.1 Primary Prevention of Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Strategy 1: Promote public awareness on cancer prevention and care . . . . . . . . . . . . . 35

Table 5: Primary prevention of cancer by service delivery level: Strategy 1-Public Awareness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

Strategy 2:Tobacco control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

Table 6: Primary prevention of cancer by service delivery level: Strategy 2-Tobacco Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

Strategy 3: Promotion of healthy diet and physical activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

Table 7: Primary prevention of cancer by service delivery level: Strategy 3- healthy diet and physical activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Strategy4: Controlof harmful use of alcohol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Table 8: Primary prevention of cancer by service delivery level: Strategy 4- Control of harmful use of alcohol . . . . . . . . . . . . . . . . . . . . . . . . . 42

Strategy 5: Control of Biological Agents Causing Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

Table 9: Primary prevention of cancer by service delivery level: Strategy 5- Control of Biological Agents Causing Cancer . . . . . . . . 44

Strategy 6: Control of Environmental and Occupational Hazards . . . . . . . . . . . . . . . . . . . . 45

Table 10: Primary prevention of cancer by service delivery level: Strategy 6- reduce exposure to environmental hazards . . . . . . . . . . . . 45

2.7.2 Early Detection of Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

Strategy 1: Promote breast self-awareness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

Table 11: Early detection of cancer by service delivery level: Strategy 1- Promote breast self-awareness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

Strategy 2: Clinical Breast examination for all women above age 8 coming to health institutions for other complaints . . . . . . . . . . . . . . . . . . . . . 48

Table 12: early detection of cancer by service delivery level: Strategy 2- Clinical Breast examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

Strategy 3: Population-based cervical cancer screening using VIA (visual screening using acetic acid) for all women aged 30-49 every 5 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

Table 13: Early detection of cancer by service delivery level: Strategy 3- cervical cancer screening using via . . . . . . . . . . . . . . . . . . . . 50


2.7.3 Diagnosis and Treatment of Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

Table 14: diagnosis and treatment OF cancer by service delivery level . . . . . . . . . . . . . 54

2.7.4 Palliative Care and Pain Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

Strategy 1: Capacity-Building for Health Facilities and Community . . . . . . . . . . . . . . . . . . 57

Table 15: palliative care and pain management OF cancer by service delivery level: Strategy 1- capacity building for health facilities and community . . . . . . . . 57

Strategy 2: Integrate palliative-care serviceS at all levels of health-delivery outlets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

Table 16: palliative care and pain management OF cancer by service delivery level: Strategy 2- Integrated palliative care services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

Strategy 3: Strengthen Home-Based Care and Volunteerism . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

Table 17: palliative care and pain management OF cancer by service delivery level: Strategy 3- STRENGTHEN home-based care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60

Strategy 4: Incorporate Palliative Care as Part of Health Sciences Studies Curriculum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60

Table 18: Palliative care and pain management of cancer by service delivery level: Strategy 4- integrate palliative care in curriculum . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

Strategy 5: Networking, partnership and collaboration among public health care system, non–state actors and the community . . . . . . . . . . . . . . . 61

Table 19: Palliative care and pain management of cancer by service delivery level: Strategy 5- networking and partnership . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62

2.7.5 Cancer Surveillance and Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62

Strategy 1: Enhancing surveillance for cancer and its risk factors . . . . . . . . . . . . . . . . . . . . 62

Strategy 2: Improve research capacity and establish collaboration . . . . . . . . . . . . . . . . . . . 63

2.7.6 Monitoring and Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

Strategy: StrengthenING monitoring and evaluation of cancer Control activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

3. COORDINATION OF CANCER CONTROL ACTIVITIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64

4. IMPLEMENTATION FRAMEWORK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66

4.1 Primary Prevention of Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66

4.2 Early Detection of Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72

4.3 Diagnosis and Treatment of Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75

4.4 Palliative Care and Pain Relief . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80

4.5 Cancer Surveillance and Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85

4.6 Monitoring and Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87

5. THE COST OF NATIONAL CANCER CONTROL PLAN OF ETHIOPIA . . . . . 88

6. REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90


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ACRONYMSBCC Behavior Change and Communication

CR Cancer Registry

CSO Civil-Society Organization

DHS Demographic and Health Survey

EFMHACA Ethiopian Food, Medicine and Health Care Administration and Control Authority

EML Essential Medicines List

ESA Ethiopian Standard Agency

FMoH Ethiopian Federal Ministry of Health

GAVI Global Alliance for Vaccine and Immunization

HBV Hepatitis B virus

HEW Health Extension Workers

HIV Human Immunodefi ciency Virus

HPV Human Papillomavirus

HW Health Workers

IEC Information, Education, Communication

LEEP Loop Electrosurgical Excision Procedure

MoA Ethiopian Federal Ministry of Agriculture

MoE Ethiopian Federal Ministry of Education

MoLSA Ethiopian Federal Ministry of Labor and Social Affairs

MoUDHCo Ethiopian Federal Ministry of Urban Development, Housing and Construction

MWECS Mathiwos Wondu -YeEthiopia Cancer Society

MWCYA Ethiopian Federal Ministry of Women, Children and Youth Affairs

NCCP National Cancer Control Plan

NCD Non-Communicable Diseases

PHCU Primary Health Care Unit

PI Pathfi nder International

PFSA Ethiopian Pharmaceutical Fund and Supply Agency

PHC Primary Health Care

PRRR Pink Ribbon Red Ribbon

RHB Regional Health Bureau

SC Sport Commission

VIA Visual Inspection with Acetic Acid

WHO World Health Organization


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LIST OF CONTRIBUTORS

S/N Names Institutions

1 Dr. Mahlet Kifl e Federal Ministry of Health of Ethiopia

2 Dr. Kunuz Abdella Federal Ministry of Health of Ethiopia and PRRR

3 Ademe Tsegaye Doctors with Africa-CUAMM

4 Ahlam Ahmed Mathiwos Wondu -YeEthiopia Cancer Society

5 Ali Beyene Ethiopian Public Health Association

6 Baharu ZewdieEthiopian Food, Medicine and Health Care

Administration and Control Authority (EFMHACA)

7 Dr. Abebayehu Assefa World Health Organization-Ethiopia

8 Dr. Abera Balcha Gondar University

9 Dr. Aregawi Kassa Mekelle University

10 Dr. Bogale Solomon Oncologist from United Vision Clinic

11 Dr. Fassil Shiferaw World Health Organization-Ethiopia

12 Genet Negusie Clinton Health Access Initiative /Federal Ministry of

Health

13 Dr. Mamo Desalegn Jimma University

14 Dr. Mathewos Assefa Addis Ababa University, College of Health Sciences

15 Dr. Mengistu Asnake Pathfi nder International

16 Dr. Senbeta Guteta Ethiopian Medical Association

17 Dr. Shamil Nuri Hawassa University

18 Dr. Shimeles Nigussie Haromaya University

19 Dr. Yoseph Mamo FMOH/Jimma University

20 Grom Moges Cancer Care Ethiopia

21 Serkalem Getaneh Ethiopian Cancer Association

22 Sintayehu Hailu Mary Joy

23 Solomon Asmare Addis Ababa Cancer Registry

24 Sr. Takelech Moges Federal Ministry of Health

25 Tsigereda Yisfawessen Hospice Ethiopia

26 Wondu Bekele Mathiwos Wondu -YeEthiopia Cancer Society

27 Zelalem Gizachew American Cancer Society

28 Zelalem Mengistu Mathiwos Wondu -YeEthiopia Cancer Society


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ACKNOWLEDGMENTThe Federal Ministry of Health of Ethiopia wishes to thank all those who contributed to the successful completion of this document.

This National Cancer Control Plan has benefi ted from wide consultations with national and international partners. Special appreciation goes to the Pink Ribbon Red Ribbon, the American Cancer Society and Mathiwos Wondu-YeEthiopia Cancer Society for their technical assistance and generous fi nancial support by sponsoring the fi rst consultative workshop that made profound inputs to the design and development of this document.

The Non-Communicable Case Team within the Disease Prevention and Control Directorate of the Federal Ministry of Health of Ethiopia coordinated the writing of this document.


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FOREWORDCancer is one of the major non-communicable diseases (NCDs), which include cardiovascular diseases, diabetes and chronic respiratory diseases. Together they cause over 60% of total global mortality every year. It is estimated that cancer kills over 7.9 million people globally every year constituting close to 13% of total deaths worldwide. While communicable diseases still remain the leading killers in many developing countries, the incidence and mortality from non-communicable diseases is rising rapidly. This has resulted in a ‘double burden’ of diseases, which is imposing strain on existing health system.

In Ethiopia, cancer accounts for about 5.8% of total national mortality (Globocan 2012). Although population-based data do not exist in the country except for Addis Ababa, it is estimated that the annual incidence of cancer is around 60,960 cases and the annual mortality is over 44,000. In Ethiopia, patients often present with advanced stages of cancer. Over 80% of deaths from NCDs are caused by four main diseases- cardiovascular disorders, cancer, diabetes mellitus and chronic obstructive pulmonary disease. These four major NCDs share similar risk factors. Modifi cation of risk factors has been shown to reduce morbidity and mortality in people at greater risk.

This fi rst Ethiopian National Cancer Control Plan is aligned with the priorities of the National Health Sector Transformation Plan (HSTP) 2015/16 - 2019/20 of the Federal Democratic Republic of Ethiopia, and recommends a comprehensive cancer control strategy and interventions with estimates of the cost required to deliver the plan over fi ve years. The plan outlines interventions to reduce the burden of cancer through changes in lifestyle, primary prevention, screening and early diagnosis, appropriate follow-up, treatment and provision of palliative care.

Recognizing the need for multi-sectoral involvement in the fi ght against cancer, this plan was developed through wide consultations with all relevant stakeholders, including associations of cancer patients. Therefore, the Federal Ministry of Health (FMoH) believes that this document is an outcome of a shared vision and commitment to beat cancer in Ethiopia.

In conclusion, this plan is intended to be the basis of national response to the burden of cancer in line with the Political Declaration of the United Nations High-Level Meeting on the Control of NCDs and the Global Action Plan for the Control of NCDs 2013-2020.

I wish to thank the Ethiopian National Cancer Committee for its dedication and inspiration to all of us in advancing the goal of building a healthy nation.

I hope that all partners, stakeholders and health care workers will adopt and continue to support us in implementing cancer Control interventions as outlined in this plan.

_________________________

Dr. Keseteberhan Admasu

Minister, Federal Ministry of Health of Ethiopia


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EXECUTIVE SUMMARYCancer imposes an enormous burden on society both in more- and less-economically developed countries alike. The occurrence of cancer is increasing because of the growth and aging of the population, as well as an increasing prevalence of established risk factors, such as smoking, overweight, physical inactivity, and changing reproductive patterns associated with urbanization and economic development. Based on the GLOBOCAN estimates, about 14.1 million new cancer cases and 8.2 million deaths occurred in 2012 worldwide. Lung and breast cancer are the most frequently diagnosed cancers and the leading causes of cancer death in men and women, respectively, both overall and in less-developed countries.

In Ethiopia, cancer accounts for about 5.8% of total national mortality. Although population-based data does not exist in the country except for Addis Ababa, it is estimated that the annual incidence of cancer is around 60,960 cases and the annual mortality over 44,000. The most prevalent cancers in Ethiopia among the entire adult population are breast cancer (30.2%), cancer of the cervix (13.4%) and colorectal cancer (5.7%). About two-thirds of annual cancer deaths occur among women (AACR 2014).

The National Cancer Control Plan is a response by the FMoH and stakeholders to prioritize cancer Control in Ethiopia. It recognizes that the disease cannot be eradicated, but that its effects can be signifi cantly reduced if effective measures are put in place to control risk factors, detect cases early and offer good care to those with the disease. The aims of this strategy are to reduce the number of people who develop and die of cancer. It also aims to ensure a better quality of life for those living with the disease. The strategic plan covers the years 2015/16 to 2019/20, and explains the scientifi c basis for cancer control and prevention; outlines a vision and mission; and suggests objectives, as well as interventions, to prevent and control cancer in Ethiopia. The strategy draws from experiences gained in various countries that have similar programmes, and also includes technical advice provided by relevant partners.

Vision, Mission and goal :

This strategy document envisions the fi rst step for an effective and effi cient National Cancer Control Plan to achieve the long-term goal of reducing cancer morbidity and mortality in Ethiopia. Its mission is to build a health care system that is equipped, staffed, trained, and empowered to provide a full range of cancer prevention, screening, diagnostic, treatment, and care options to cancer patients in Ethiopia.

Objectives:

The objectives of this strategy are to cover the entire continuum of cancer control. It aims to promote cancer prevention and early detection, and to improve diagnosis and treatment, including palliative care. The strategy also aims to promote cancer surveillance, registration and research. To achieve this, the strategy aims to build and promote partnership and


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collaboration in cancer control, and to promote innovation in approaches to preventing and treating the disease. It also aims to integrate cancer control activities within the National Health Sector Transformation Plan.

Key interventions:

This strategy identifi es the following key thematic areas and suggests interventions in order to prevent and control cancer in Ethiopia. The list is not exhaustive and new strategies can be expanded as new challenges arise and innovations are developed:

i) Primary prevention of cancer:

About 40% of cancers are preventable through interventions such as tobacco control, promotion of healthy diets and physical activity, protection against exposure to environmental carcinogens and vaccination against specifi c infections. Primary prevention is thus considered the most cost-effective way of combating cancer.

ii) Early detection of cancer:

This is a approach that promotes vigilance for signs and symptoms that may be indicative of early disease. Early detection and treatment of cancer is known to greatly reduce the burden of cancers and improve outcomes. The strategy focuses not only on enhancing early detection and the treatment of pre-cancerous lesions or early-stage disease, but also streamlining referral of diagnosed cancer patients for better treatment.

iii) Diagnosis and treatment of cancer:

The strategy focuses on improved and timely diagnostic services, improved accessibility of cancer treatment services and enhancing human capacity in all fi elds of cancer management. The goals are to cure or prolong the life of cancer patients and ensure the best possible quality of life for cancer survivors.

iv) Palliative care:

The strategy focuses on enhancing palliative-care services at all levels of care, especially community- and home-based care as part of comprehensive cancer care.

v) Cancer surveillance and research:

As a fundamental element of any cancer-control strategy, surveillance provides the foundation for advocacy and policy development. The strategy focuses on enhancing cancer-surveillance systems at all levels of the health system, especially cancer registration. It suggests ways to improve research capacity, and the dissemination and use of research fi ndings.


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vi) Coordination of cancer Control activities:

Coordination of all activities to prevent and control cancer ensures the effi cient use of resources. This helps to direct efforts of all key stakeholders towards a common goal, ensures the smooth implementation of programs, and avoids overlaps and redundancies. The FMoH will play a key coordination and networking role at the national level. The plan is costed using the One-Health tool of the FMoH, and costs are aligned with other relevant existing strategies and policies. The document refers to already existing strategies and plans, to avoid any duplications and waste of resources.

vii) Monitoring and evaluation:

The strategy proposes continuous measurement of the progress and impact of cancer control activities to ensure the planned interventions are achieved within the set timelines. The plan will have a midterm review to evaluate progresses.

The National Cancer Control Plan envisions a scenario in which all activities will be carried out to ensure equitable access to services, and owned by all implementing agencies and communities.


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PART 1

Radiation

Surgery

Chemotherapy

Immunotherapy

BACKGROUND


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1. INTRODUCTION:Cancer is a general term used to refer to a condition in which the body’s cells begin to grow and reproduce in an uncontrollable way. These cells can then invade and destroy healthy tissue, including organs. Cancer sometimes begins in one part of the body before spreading to other parts. Cancer refers to over 100 different diseases characterized by uncontrolled growth and spread of abnormal cells. Cancer arises from one single cell following abnormal changes in the cell’s genetic material. These genetic changes affect the mechanisms that regulate normal cell growth and cell death leading to uncontrolled cell growth. The abnormal changes are caused by interactions between genetic and environmental factors. Environmental factors include physical carcinogens (e.g,. ionizing radiation), chemical carcinogens (e.g., asbestos, components of tobacco smoke and afl atoxins) and biological carcinogens (e.g., certain viruses, bacteria and parasites). Cancerous cells have a tendency to proliferate uncontrollably, invading neighboring tissues and eventually spreading to other parts of the body.

Cancer can affect almost any part of the body. Carcinoma is the cancer that begins in the skin or tissues that line or cover organs. Sarcoma is a cancer that begins in bone, cartilage, fat, muscle blood vessels or other connective tissue. Leukemia is cancer that starts in blood-forming tissues such as bone marrow. Lymphoma and multiple myeloma are cancers that begin in cells of the immune system.

Owing to its nature, cancer is diffi cult to treat, and cannot be eradicated at population level. However, it is possible to signifi cantly reduce the effects of cancer on society if effective measures are put in place to control risk factors associated with cancer, promote early detection and offer good care to those affected. According to Globocan 2012 estimates, about 40% of cancers are preventable.

The risk factors for cancer are profoundly associated with socio-economic status; they are higher for populations with low-socio-economic-status populations,, where cancer survival is lower than in wealthier social settings. The risk factors for cancer can be broadly categorized into four types, namely behavioral risk factors, biological risk factors, environmental risk factors and genetic risk factors. Behavioral risk factors include tobacco use, harmful use of alcohol, unhealthy diet and physical inactivity. Biological factors include overweight, obesity, age, sex of the individual and genetic/hereditary make up. Environmental risks include exposure to environmental carcinogens such as chemicals, radiation and infectious agents (including certain viruses).


15

1.1. Global Burden of Cancer:Cancer imposes an enormous burden on society in low- and high-income countries. The occurrence of cancer is increasing because of the growth and aging of the population, as well as an increasing prevalence of established risk factors such as smoking, overweight, physical inactivity, and changing reproductive patterns associated with urbanization and economic development. Based on the GLOBOCAN estimates, about 14.1 million new cancer cases and

8.2 million deaths occurred in 2012 worldwide. Lung and breast cancer are the most frequently diagnosed cancers and the leading causes of cancer death in men and women, respectively, both overall and in less-developed countries. Over the years, the cancer burden has shifted to less developed countries, which currently account for about 57% of cases and 65% of cancer deaths worldwide. The burden of cancer will continue to shift to less-developed countries due to growth and aging of the population, lifestyle changes and increasing prevalence of known risk factors.

The overall burden of cancer in the world is projected to continue to rise, particularly in developing countries. It is projected that an estimated 21 million people will be diagnosed, and 13 million will die of cancer in the year 2030. Although incidence rates for all cancers combined are twice as high in more developed compared to less-developed countries, mortality rates are only 8% to 15% higher in more-developed countries. This disparity primarily refl ects differences in cancer profi les and/or the availability of and accessibility to diagnostics and treatment. For example, liver cancer, a highly fatal cancer, is much more common in less-developed countries, thus contributing disproportionately to the overall cancer mortality rate in these countries. Similarly, cancers are more often detected at a later stage in less-developed countries, which contribute to the disparity in mortality rates relative to the incidence.

Breast and cervical cancers are the leading cancers among women in developing countries, with estimated annual new cases of 882,900 and 444,500 respectively. More than 324,300 and 230,400 women die from these cancers every year, respectively.

Breast cancer is the most-frequently diagnosed cancer and the leading cause of cancer death among females worldwide, with an estimated 1.7 million cases and 521,900 deaths in 2012. Breast cancer alone accounts for 25% of all cancer cases and 15% of all cancer deaths among females. More-developed countries account for about one-half of all breast cancer cases and 38% of deaths.

An estimated 1.8 million new lung cancer cases occurred in 2012, accounting for about 13% of total cancer diagnoses. Lung cancer was the most frequently diagnosed cancer and the leading cause of cancer death among males in 2012. Among females, lung cancer was the leading cause of cancer death in more-developed countries, and the second-leading cause of cancer death in less-developed countries.


16

There were an estimated 527,600 new cervical cancer cases, and 265,700 deaths, worldwide in 2012. It is the second most commonly diagnosed cancer and third leading cause of cancer death among females in less-developed countries. Incidence rates are highest in sub-Saharan Africa. Nearly 90% of cervical cancer deaths occurred in developing parts of the world: 60,100 deaths in Africa, 28,600 in Latin America and the Caribbean, and 144,400 in Asia.

In developed countries, cancer is the second-most-common cause of death after cardiovascular conditions, and epidemiological evidence indicates the emergence of a similar trend in developing countries. The principal factors contributing to this projected increase in cancer are the increasing proportion of elderly people in the world (in whom cancer occurs more frequently than in the young), an overall decrease in deaths from communicable diseases, the decline in some countries in mortality from cardiovascular diseases, and the rising incidence of certain forms of cancer, notably lung cancer resulting from tobacco use. Approximately 20 million people are alive with cancer at present, and by 2020 this number is projected to increase to more than 30 million.

The impact of cancer is far greater than the number of cases would suggest. Regardless of prognosis, the initial diagnosis of cancer is perceived as a life-threatening event, with over one-third of patients experiencing clinical anxiety and depression. Cancer is also distressing for the family, profoundly affecting both the family’s daily functioning and economic situation. The economic shock includes both the loss of income and the expenses associated with health care costs.

In many developing countries the rapid rise in cancers and other non-communicable diseases has resulted from increased exposure to risk factors, which include tobacco use, harmful use of alcohol and exposure to environmental carcinogens. Other risk factors for some cancers include infectious diseases, such as HIV/AIDS (Kaposi’s sarcoma and lymphomas), human papillomavirus (HPV-- associated with cervical, anal, vulva, vagina, penile and oral cancers), and Hepatitis B and C (liver cancer); bacterial infections, such as Helicobacter pylori (the stomach cancer) and parasitic infestations, such as schistosomiasis (the bladder cancer).

1.2. The Situation of Cancer in Ethiopia:In Ethiopia, cancer accounts for about 5.8% of total national mortality. Although population-based data do not exist in the country except for Addis Ababa, it is estimated that the annual incidence of cancer is around 60,960 cases and the annual mortality is over 44,000. For people under the age of 75 years, the risk of being diagnosed with cancer is 11·3% and the risk of dying from the disease is 9·4%.

The most prevalent cancers in Ethiopia among the adult population are breast cancer (30.2%), cancer of the cervix (13.4%) and colorectal cancer (5.7%). About two-thirds of

reported annual cancer deaths occur among women.


17

Figure 1: An estimated 5-year prevalence of cancer in Ethiopia, Globocan 2012

Ethiopia: Both SexesEstimated 5-year prevalent cancer cases, adult population (total: 129,962 )

GLOBOCAN 2012 (IARC)-5.6.2015

Other: 38,256(29.4%)

Non-Hodgkin lymphoma: 3,206(2.5%)

Leukaemia: 3,349(2.6%)

Kaposi sarcoma: 5,659(4.4%)

Thyroid: 6,251(4.8%)

Cervix uteri: 17,362 (13.4 %)Colorectum: 7,361(5.7%)

Breast: 39,293(30.2%)

Ovary: 5,787(4.5%)

Prostate: 3,438(2.6%)

Based on 2013 data from the Addis Ababa Cancer Registry, breast cancer accounted for 31.4%, cervical cancer for 14.3% and ovarian cancer for 6.3% of all cancer cases.

Despite the fact that non-communicable diseases (NCDs), such as cardiovascular diseases, cancers, diabetes and chronic respiratory diseases, are on the increase in Ethiopia, the health systems in the country have traditionally concentrated on the Control of communicable diseases. As a result, health and development plans have not adequately invested in the Control of NCDs. The silent epidemic of NCDs now imposes a ‘double burden of disease’ to the country, that unless addressed, will overwhelm itin the near future.

According to the only oncology centre in the country (the Tikur Anbessa (Black Lion) Specialized Hospital), about 80% of reported cases of cancer are diagnosed at advanced stages, when very little can be done to treat the disease. This is largely due to the low awareness of cancer signs and symptoms, inadequate screening and early detection and treatment services, inadequate diagnostic facilities and poorly structured referral. The country has very few cancer specialists (only 4 qualifi ed oncologist for the entire population). This makes it diffi cult for a great majority of the population to access cancer treatment services, which results in long waiting times and cause many potentially curable tumors to progress to incurable stages.


18

The reason for this despondent situation is that the cancer-treatment infrastructure in Ethiopia is inadequate and some cancer-management options are not readily available, within the health care system, cancer is treated through medical, surgical or radiation therapy, but

some patients seek cancer treatment abroad. Effective cancer treatment requires surgical, radiation and therapy be available in the same setting to avoid distant referral and delays in treatment administration. Currently, the Ethiopian Essential Medicines List does not include chemotherapy for cancer. Even the essential medicines for pain-management are rare to fi nd in most public hospitals.

However, there are opportunities for a program to prevent and control cancer to develop and expand in Ethiopia. The country has adopted a comprehensive National Action Plan on the Prevention and Control of Chronic Non-Communicable Diseases, including cancer. Expansion of cancer treatment services is underway. The country plans a nation-wide scale up of the screening and treatment for cervical pre-cancer into over 800 health facilities (one health facility per district). The First Lady of Ethiopia guides and leads the cancer-control programme with the Minister of Health, serving as co-chairs of the National Cancer Committee (NCC)

Cancer research in Ethiopia is not commensurate with the magnitude of the problem. This is due to inadequate funding and training facilities in cancer research. There is also no comprehensive cancer surveillance system, and population-based cancer registry limited to the Addis Ababa region at present.

NA

TIO

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1.3

Stak

ehol

ders

ana

lysi

s:

Tab

le 1

: Sta

keho

lder

ana

lysi

s of

can

cer

cont

rol i

n Et

hiop

ia

Stak

ehol

der

Rol

e of

sta

keho

lder

Cur

rent

sta

tus

Interest

Infl uence

Position

Impact

Offi

ce o

f the

Fi

rst

Lady

•

Adv

ocac

y an

d re

sour

ce-m

obili

zatio

n•

Ensu

re p

oliti

cal c

omm

itmen

t

• A

ctiv

e in

volv

emen

t in

the

N

atio

nal C

ance

r C

oord

inat

ion

thro

ugh

co-c

hair

ing

the

NC

CH

HSu

ppor

tive

VH

FMoH

-Eth

iopi

a•

Nat

iona

l coo

rdin

atio

n an

d le

ader

ship

• Es

tabl

ishe

d N

CD

Cas

e Te

am•

Led

the

deve

lopm

ent

of N

CC

P•

Can

cer

cont

rol s

et a

s a

prio

rity

, and

refl

ect

ed in

the

H

STP

• R

esou

rce-

mob

iliza

tion,

pr

iori

tizat

ion

HH

Proc

ess

owne

rV

H

Reg

iona

l Hea

lth

Bure

aus

(RH

Bs)

Reg

iona

l coo

rdin

atio

n &

lead

ersh

ip

• En

dors

ing

natio

nal p

olic

ies/

stra

tegi

es•

Reg

iona

l NC

D fo

cal p

oint

es

tabl

ishe

d•

Reg

iona

l res

ourc

e-m

obili

zatio

n,

prio

ritiz

atio

n

HH

Reg

iona

l pr

oces

s ow

ner

VH

NA

TIO

NA

L C

AN

CE

R C

ON

TR

OL

PL

AN

OF

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Oth

er

gove

rnm

ent

line

min

istr

ies

• C

ontr

ol t

obac

co u

se a

nd a

lcoh

ol c

onsu

mpt

ion

• In

crea

se t

axat

ion

on t

obac

co a

nd a

lcoh

ol, a

nd u

se

the

reve

nue

to s

uppo

rt a

ctiv

ities

aga

inst

NC

Ds

and

canc

er c

ontr

ol p

rogr

amm

es•

Info

rmat

ion

in

curr

icul

a on

he

alth

y lif

e st

yles

(M

inis

try

of E

duca

tion)

• Bu

ild s

port

faci

litie

s an

d pr

omot

e co

mm

unity

pla

y-

grou

nd s

pace

to

enco

urag

e ph

ysic

al a

ctiv

ity, s

port

s, (M

UPH

Co)

• Pr

omot

ion

of s

port

s/ph

ysic

al a

ctiv

ity.

– (S

port

s C

omm

issi

on)

• Se

curi

ty o

f agr

icul

tura

l pro

duct

s, fo

ods

and

fi she

ry

prod

ucts

(M

inis

try

of A

gric

ultu

re?)

Con

trol

and

reg

ulat

ion

of im

port

ed fo

ods

• M

inis

try

of W

omen

, ch

ildre

n an

d yo

uth

affa

irs,

part

icul

arly

for

wom

en's

canc

ers-

bre

ast,

ovar

ian,

ce

rvic

al e

tc. A

lso

may

be

inte

rest

ed in

gen

der

issu

es

and

acce

ss fo

r w

omen

for

care

for

all c

ance

rs

• La

ck

of

coor

dina

tion

of

mec

hani

sm•

Not

act

ivel

y in

volv

edL

MSu

ppor

tive

H

Civ

il So

ciet

y O

rgan

izat

ions

(C

SOs)

Adv

ocac

y on

:•

Can

cer

info

rmat

ion

diss

emin

atio

n•

Stig

ma-

redu

ctio

n•

Res

ourc

e-m

obili

zatio

n•

Com

mun

ity p

artic

ipat

ion

• Eq

ual a

cces

s an

d op

port

unity

to c

ance

r he

alth

car

e se

rvic

es•

Del

iver

y of

qua

lity

canc

er s

ervi

ces.

• Ve

ry f

ew, a

nd m

ost

loca

lized

in

the

capi

tal

• G

ener

al la

ck fu

ndin

g fo

r ca

ncer

MM

Supp

ortiv

eH

NA

TIO

NA

L C

AN

CE

R C

ON

TR

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Can

cer

patie

nts,

surv

ivor

s an

d th

eir

asso

ciat

ions

• H

ave

the

righ

t to

ge

t tr

eatm

ent,

psyc

hoso

cial

su

ppor

t an

d pa

lliat

ive

care

• Br

eak

the

sile

nce,

and

get

inv

olve

d in

com

mun

ity

educ

atio

n•

Form

ulat

e su

ppor

t gro

ups

for

patie

nts

with

can

cer

• La

ck o

f can

cer

info

rmat

ion.

• La

te p

rese

ntat

ion

for

care

and

tr

eatm

ent

• Ve

ry

few

ge

t ca

ncer

ca

re

serv

ices

• W

eak

patie

nt in

volv

emen

t•

Patie

nts

are

sile

nt

and

stig

mat

ized

HH

Very

su

ppor

tive

VH

Rel

igio

us le

ader

s•

Dis

sem

inat

ion

of c

ance

r in

form

atio

n•

Psyc

ho-s

ocia

l sup

port

• R

efer

ral o

f pat

ient

s to

faci

litie

s

• N

o aw

aren

ess

on c

ance

rH

HSu

ppor

tive

H

Inte

rnat

iona

l or

gani

zatio

ns a

nd

fund

ers

• Fi

nanc

ial a

nd t

echn

ical

sup

port

• Te

chni

cal a

nd fi

nanc

ial s

uppo

rt

HH

Supp

ortiv

eH

Com

mun

ity•

Dis

sem

inat

ion

and

enfo

rcem

ent

of

canc

er

awar

enes

s, an

d pr

ovis

ion

of i

nfor

mat

ion

and

refe

rral

to

faci

litie

s

• W

eak

awar

enes

s on

can

cer

HH

Supp

ortiv

eH

NA

TIO

NA

L C

AN

CE

R C

ON

TR

OL

PL

AN

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22

Hea

lth c

are

prov

ider

sD

irec

tly In

volv

ed in

can

cer

prev

entio

n,

care

and

con

trol

, acc

ordi

ng t

o th

eir

leve

l of

expe

rtis

e

• In

adeq

uate

kno

wle

dge

and

skill

on

prev

entio

n, c

are

and

cont

rol o

f can

cer

HH

Very

Su

ppor

tive

VH

Priv

ate

Hea

lth

Inst

itutio

ns

Dir

ectly

invo

lved

in c

ance

r pr

even

tion,

ca

re a

nd c

ontr

ol, a

ccor

ding

to

thei

r le

vel o

f ex

pert

ise

• N

o co

ordi

natio

n•

Lack

of p

ublic

-pri

vate

par

tner

ship

on

canc

er c

ontr

ol•

Man

y ar

e no

t re

ady

to h

andl

e ca

ncer

ca

ses

• La

ck o

f tra

ined

sta

ff

HH

Supp

ortiv

eH

igh

Faith

-bas

ed h

ealth

se

ctor

Dir

ectly

invo

lved

in c

ance

r pr

even

tion,

ca

re a

nd c

ontr

ol, a

ccor

ding

to

thei

r le

vel o

f ex

pert

ise

• M

ost

do n

ot p

rior

itize

can

cer

• M

any

are

not

read

y to

han

dle

canc

er

case

s H

igh

Low

Supp

ortiv

eH

igh

Trad

ition

al h

eale

rs a

nd

herb

alis

ts

• H

ave

good

acc

ess

to c

ance

r pa

tient

s•

Dis

sem

inat

ion

of c

ance

r in

form

atio

n an

d ea

rly

refe

rral

of c

hron

ic p

atie

nts

• R

ecog

nitio

n of

ear

ly-w

arni

ng s

ympt

oms

Wor

k w

ith H

ealth

Ext

ensi

on W

orke

rs

(HEW

s) a

nd H

ealth

Dev

elop

men

t Age

nts.

• N

o ad

equa

te in

form

atio

n on

the

C

ontr

ol o

f can

cer

• Fi

nanc

ial c

onfl i

ct-o

f-int

eres

t•

Patie

nt d

elay

at

this

leve

l

LL

Less

su

ppor

tive

M

Med

icin

es&

med

-ic

al-e

quip

men

t su

pplie

rs

• M

ake

good

-qua

lity

med

icin

es a

nd m

edic

al

equi

pmen

t av

aila

ble

at a

fair

and

affo

rdab

le

pric

e

• W

eak

publ

ic-p

riva

te c

oord

inat

ion

in im

port

ing

canc

er m

edic

ines

and

su

pplie

s.•

Supp

liers

not

inte

rest

ed in

bul

k im

port

atio

n.•

Ethi

opia

n Es

sent

ial M

edic

ines

Lis

t ne

eds

revi

sion

reg

ular

ly.

HH

Supp

ortiv

eH

igh

NA

TIO

NA

L C

AN

CE

R C

ON

TR

OL

PL

AN

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1.4

SWO

T A

naly

sis

OF

TH

E N

atio

nal C

ance

r C

ontr

ol A

ctiv

itie

s

Tab

le 2

: SW

OT

ana

lysi

s of

nat

iona

l can

cer

cont

rol a

ctiv

itie

s in

Eth

iopi

a

I. Pr

imar

y Pr

even

tion

of C

ance

r

Stre

ngth

Wea

knes

sO

ppor

tuni

ties

Thr

eats

• A

vaila

bilit

y of

pol

icy

on

dise

ase

Con

trol

• A

vaila

bilit

y of

Nat

iona

l A

ctio

n Pl

an o

n N

CD

s•

Cer

vica

l can

cer

Con

trol

gu

idel

ines

ava

ilabl

e an

d H

PV d

emon

stra

tion

in

prog

ress

• H

epat

itis

B va

ccin

atio

n in

corp

orat

ed in

chi

ldho

od

imm

uniz

atio

n•

Expa

nsio

n of

pri

mar

y he

alth

car

e (P

HC

) se

rvic

es a

ll ov

er t

he

coun

try

• A

vaila

bilit

y of

com

mun

ity

conv

ersa

tion

stru

ctur

e•

Ava

ilabi

lity

of lo

cal s

ocia

l st

ruct

ures

like

“ED

IR”1

• La

ck o

f com

mun

icat

ion

stra

tegy

on

canc

er•

Lack

of a

war

enes

s of

ris

k fa

ctor

s•

Lack

of c

oord

inat

ed p

reve

ntio

n ac

tiviti

es a

nd o

wne

rshi

p•

Lack

of I

EC/B

CC

mat

eria

ls o

n ca

ncer

• A

dult

risk

gro

up H

BV im

mun

izat

ion

not

impl

emen

ted

• H

ealth

Ext

ensi

on P

rogr

am is

an

asse

t to

re

ach

the

rura

l com

mun

ity•

GA

VI s

uppo

rts

child

hood

imm

uniz

atio

n (t

he c

urre

nt d

emon

stra

tion

proj

ect

will

su

ppor

t si

ngle

coh

orts

in t

wo

dist

rict

s fo

r tw

o ye

ars,

but

once

the

cou

ntry

app

lies

for

a na

tiona

l pro

gram

the

y co

uld

rece

ive

GA

VI s

uppo

rt fo

r 5

year

s—so

5 c

ohor

ts

of g

irls

nat

ionw

ide.

• A

vaila

bilit

y of

FM

rad

io s

ervi

ces

in lo

cal

lang

uage

s.

• W

orkl

oad

on H

EWs

and

Hea

lth D

evel

opm

ent A

rmy.

• C

ance

r m

yths

pro

mot

ed

by t

radi

tiona

l hea

lers

an

d ca

ncer

pre

vent

ion

coun

tera

cts

belie

fs b

y lo

cal

com

mun

ities

• R

esis

tanc

e fr

om t

obac

co,

alco

hol,

and,

pac

ked-

food

-pr

oces

sing

indu

stri

es.

• Lo

ng-t

erm

fund

ing

com

mitm

ent

from

don

ors

is n

ot a

ssur

ed

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II. E

arly

Det

ectio

n an

d Sc

reen

ing

• A

vaila

bilit

y of

low

-cos

t ap

proa

ches

like

VIA

for

cerv

ical

can

cer

• G

over

nmen

t co

mm

itmen

t to

sca

le

up n

atio

nal s

cree

ning

se

rvic

es fo

r ce

rvic

al

canc

er

• Lo

w a

war

enes

s ab

out

canc

er

scre

enin

g an

d pr

even

tion

• In

adeq

uate

and

uns

kille

d st

aff

• La

ck o

f pat

holo

gy la

b an

d ex

pert

ise

• Se

rvic

e in

adeq

uate

and

cen

tral

ized

• La

ck o

f par

tner

s w

orki

ng o

n th

is

area

of w

ork

• A

vaila

bilit

y of

tel

ecom

infr

astr

uctu

re a

ll ov

er t

he c

ount

ry t

o pr

actic

e te

lem

edic

ine

and

e-he

alth

app

licat

ions

• Po

ssib

ility

of u

sing

new

tec

hnol

ogie

s, su

ch a

s H

PV D

NA

tes

ting,

and

outr

each

ap

proa

ches

to

reac

h m

ore

wom

en m

ore

effi c

ient

ly•

Part

ners

ava

ilabl

e to

Fi

nanc

ially

and

tec

hnic

ally

sup

port

can

cer

initi

ativ

es (

e.g.

the

PRR

R s

uppo

rt)

• Ex

pens

ive

but

cost

-ef

fect

ive

inte

rven

tion

• La

ck o

f bud

get

• Su

stai

nabi

lity

not

assu

red

• C

ompe

ting

heal

th

prio

ritie

s

3. C

ance

r D

iagn

osis

&Tr

eatm

ent

• A

vaila

bilit

y of

the

th

ree-

tiere

d he

alth

car

e de

liver

y sy

stem

• Ex

pans

ion

of h

ealth

car

e se

rvic

es a

ll ov

er t

he

coun

try

• A

vaila

bilit

y of

Can

cer

plan

and

str

ateg

y•

Phar

mac

eutic

als

and

med

ical

sup

plie

s co

ntro

l an

d re

gula

tion

auth

ority

av

aila

ble

• M

edic

ines

pro

cure

men

t an

d lo

gist

ic s

yste

m

avai

labl

e

• La

ck o

f exp

ertis

e on

can

cer

diag

nosi

s an

d tr

eatm

ent

• La

ck o

f dia

gnos

tic a

nd t

reat

men

t fa

cilit

ies

• T

he s

ervi

ce is

lim

ited

in t

ertia

ry

hosp

itals

and

cen

tral

ized

• In

adeq

uate

dia

gnos

tic a

nd t

reat

men

t eq

uipm

ent

(Rad

ioth

erap

y, M

RI,

CT

sc

an, m

amm

ogra

m, b

one

scan

, etc

.)•

No

func

tiona

l pub

lic–p

riva

te

part

ners

hip

• C

ance

r m

edic

ine

and

supp

lies

are

not

avai

labl

e, if

ava

ilabl

e no

t af

ford

able

• N

o ne

twor

king

of i

nstit

utio

ns

in c

apac

ity-

build

ing

and

shar

ing

reso

urce

s

• A

vaila

bilit

y of

mid

-leve

l pro

fess

iona

ls a

ll ov

er t

he c

ount

ry fo

r po

ssib

le t

ask-

shift

ing

• C

an b

e in

tegr

ated

in h

ealth

car

e de

liver

y sy

stem

• A

vaila

bilit

y of

tel

ecom

infr

astr

uctu

re

wid

ely

give

s op

port

unity

for

capa

city

bu

ildin

g th

roug

h e-

lear

ning

.•

Part

ners

will

ing

to p

artic

ipat

e in

tra

inin

g of

hea

lth w

orke

rs•

Inte

rnat

iona

l int

eres

t to

sup

port

can

cer

initi

ativ

es (

e.g.

IAEA

)•

Poss

ibili

ty o

f “tw

inni

ng”

rela

tions

hips

with

in

tern

atio

nally

kno

wn

canc

er-t

reat

men

t ce

nter

s

• In

terv

entio

ns a

re

expe

nsiv

e.•

Sust

aina

bilit

y no

t as

sure

d•

Rad

ioth

erap

y eq

uipm

ent

stat

us r

elat

ive

to

popu

latio

n ne

ed is

gro

ssly

in

adeq

uate

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4. C

ance

r pa

lliat

ive

care

• In

clud

ed in

Nat

iona

l C

ance

r C

ontr

ol a

nd

Prev

entio

n St

rate

gic

Plan

.•

Ava

ilabi

lity

of t

he

thre

e-tie

red

heal

th c

are

deliv

ery

syst

em.

• M

inim

al p

allia

tive

care

kno

wle

dge

and

prac

tice

by h

ealth

wor

kers

.•

No

palli

ativ

e-ca

re s

truc

ture

in

heal

th c

are

syst

em.

• C

omm

unity

con

vers

atio

n st

ruct

ure,

loca

l so

cial

str

uctu

res

like

“ED

IR”,”

• W

HO

gui

delin

es o

n pa

lliat

ive

care

av

aila

ble

• A

ssoc

iatio

ns a

nd lo

cal N

GO

s w

orki

ng o

n pa

lliat

ive

care

ava

ilabl

e.

• La

ck o

f bud

get

& fu

ndin

g•

Sust

aina

bilit

y no

t as

sure

d

5. C

ance

r Su

rvei

llanc

e an

d R

esea

rch

• H

ealth

info

rmat

ion

tech

nici

ans

wid

ely

avai

labl

e in

the

cou

ntry

• R

esea

rch

inst

itutio

ns a

nd

univ

ersi

ties

avai

labl

e •

Dem

ogra

phic

and

Hea

lth

Surv

ey (

DH

S) c

ondu

cted

re

gula

rly

• N

o na

tiona

lly r

epre

sent

ativ

e ca

ncer

da

ta•

Nat

iona

l can

cer

regi

stry

una

vaila

ble.

• In

form

atio

n of

fi cer

s no

t tr

aine

d in

ca

ncer

-spe

cifi c

dat

a.•

Lack

of a

ccur

ate

mor

talit

y su

rvei

llanc

e

• H

ospi

tal-b

ased

can

cer

regi

stry

initi

ativ

es

avai

labl

e.•

Part

ners

will

ing

to p

artic

ipat

e in

impl

emen

ting

canc

er r

egis

try

stre

ngth

enin

g an

d re

sear

ch w

ork.

• Po

pula

tion-

base

d ca

ncer

reg

istr

y in

A

ddis

Aba

ba p

rovi

des

a fo

unda

tion

for

exte

ndin

g to

a n

atio

nal r

egis

try

thro

ugh

the

deve

lopm

ent

of s

ever

al s

atel

lite

cent

ers

• H

MIS

pol

icy

not

acco

mm

odat

ing

canc

er

regi

stry

as

an in

depe

nden

t re

gist

ry.

• C

urre

nt P

BCR

in A

ddis

A

baba

dep

ende

nt o

n ou

tsid

e do

nors


26

1.5 The National Cancer Control StrategyThis plan is based on the World Health Organization’s global cancer control strategy. It aims to build on the existing health system in Ethiopia to strengthen cancer control capacities in both the public and private sectors through control of risk factors associated with cancer, investment in cancer care workforce, equipment and research. This is the fi rst cancer control plan document to be developed in the country. It describes aspects of cancer prevention, screening, diagnosis, treatment and care for the population as well as the investment needed to deliver these services.

The plan particularly reinforces the need for action to prevent cancer, especially related to smoking and other modifi able risk factors. Enhanced health promotion, education and advocacy will enable the government and other partners to improve public understanding of cancer. It will empower the public in general, to adopt healthier lifestyles and healthcare professionals in particular to recognize the symptoms of cancer and identify people at risk of or living with cancer.

It seeks to:

• Introduce and expand coverage of HBV and HPV vaccination for those cancers that are vaccine-preventable;

• Improve early detection of cancer by introducing or expanding the available screening programmes and putting in place mechanisms and services that are proven to save lives;

• Shorten the time taken to diagnose and treat cancer by streamlining the diagnosis and referral systems, the process of care and investing in more cancer treatment equipment as well as cancer specialists and other staff;

• Improve access to cancer medicinesin line with the WHO Model Essential Medicines Listand other aspects of care for cancer patients;

• Harmonize and coordinate cancer care, national cancer registration, sharing of resources and information among health facilities;

• Ensure patients and their families have better support and access to quality treatment including palliative care;

• Introduce innovations in technology and approach that will make the prevention and treatment of cancer more effective and effi cient; and

• Enable the country to improve services through education and research in the fi eld of cancer control ensuring a culture of evidence-based and resource appropriate practice.

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1.6

Link

age

wit

h ot

her

exis

ting

str

ateg

ies

The

Can

cer

Con

trol

Pla

n ha

s br

oad-

base

d cr

ossc

uttin

g in

terv

entio

ns. A

num

ber

of p

ropo

sed

inte

rven

tions

are

als

o ad

dres

sed

in o

ther

rel

evan

t st

rate

gies

and

pla

ns w

ithin

the

FM

oH. T

he fo

llow

ing

mat

rix

outli

nes

the

othe

r ke

y re

leva

nt s

trat

egie

s an

d pl

ans

and

thei

r lin

k w

ith t

he p

lan

for

Con

trol

of c

ance

r.

Tab

le 3

: Lin

kage

of

NC

CP

wit

h ot

her

stra

tegi

es o

f FM

OH

SNEx

istin

g St

rate

gies

and

pla

nsIn

terf

ace

with

the

Nat

iona

l Can

cer

Con

trol

Pla

n

1H

ealth

Sec

tor T

rans

form

atio

n Pl

an o

f

Ethi

opia

201

5/16

-201

9/20

• T

he p

lan

reco

gniz

es c

ance

r as

one

of t

he k

ey p

rior

ity a

reas

for

inte

rven

tion

• T

he N

atio

nal C

ance

r C

ontr

olPl

an (

NC

CP)

alig

ns w

ith H

STP

2

Nat

iona

l Str

ateg

ic A

ctio

n Pl

an (

NSA

P)

for

Con

trol

of n

on-c

omm

unic

able

dise

ases

in E

thio

pia

2014

-201

6

• A

ddre

sses

can

cer

as a

maj

or N

CD

• D

efi n

es s

trat

egic

act

ions

add

ress

ing

the

risk

fact

ors

for

canc

er a

nd o

ther

NC

Ds

• T

he c

ance

r co

ntro

l pla

n se

eks

to p

rom

ote

impl

emen

tatio

n of

the

nat

iona

l act

ion

plan

on

NC

Ds

3G

uide

line

for

Cer

vica

l Can

cer

Prev

entio

n an

d C

ontr

ol

• Pr

ovid

es c

lear

gui

danc

e on

scr

eeni

ng a

nd t

reat

men

t of

cer

vica

l can

cer

in E

thio

pia

• T

he N

CC

P ca

pita

lizes

on

the

deta

ils o

f int

erve

ntio

ns a

s de

fi ned

in t

he n

atio

nal c

ervi

cal c

ance

r

guid

elin

e

4N

atio

nal N

utri

tion

Stra

tegy

• M

akes

ref

eren

ce t

o a

life-

styl

e re

late

d ri

sks

to c

ance

r in

clud

ing

unhe

alth

y di

et a

nd p

hysi

cal

inac

tivity

• T

he N

CC

P ca

pita

lizes

on

the

deta

ils o

f int

erve

ntio

ns a

s de

fi ned

in t

he n

atio

nal n

utri

tion

stra

tegy

5St

rate

gy o

n V

iral

Hep

atiti

s (b

eing

deve

lope

d)

• T

he N

CC

P co

nsid

ers

infe

ctio

us d

isea

ses

caus

ally

ass

ocia

ted

with

can

cer

and

mak

es r

efer

ence

to

inte

rven

tions

out

lined

in t

he n

atio

nal s

trat

egy

on v

iral

hep

atiti

s

6N

atio

nal R

epro

duct

ive

Hea

lth S

trat

egy

• R

epro

duct

ive

orga

n ca

ncer

s ar

e am

ong

the

maj

or c

ance

rs a

ffect

ing

wom

en

NA

TIO

NA

L C

AN

CE

R C

ON

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7H

IV S

trat

egy

• H

IV in

crea

ses

the

risk

of c

ance

rs a

mon

gst

HIV

sur

vivo

rs -

as

surv

ival

rat

es im

prov

e so

doe

s th

e

need

for

plan

s to

man

age

a po

tent

ial r

ise

in c

ance

r bu

rden

.

8N

atio

nal M

enta

l Hea

lth S

trat

egy

2012

/13-

2015

/16

• H

arm

ful c

onsu

mpt

ion

of a

lcoh

ol a

ddre

ssed

as

one

of t

he k

ey r

isk

fact

ors

for

canc

er

9To

bacc

o C

ontr

ol D

irec

tive

• R

ecog

nize

s to

bacc

o as

one

the

key

ris

k fa

ctor

s fo

r ca

ncer

• O

utlin

e ke

y in

terv

entio

ns t

o co

ntro

l tob

acco

use

• T

he N

CC

P se

eks

to p

rom

ote

impl

emen

tatio

n of

the

dir

ectiv

es o

n to

bacc

o co

ntro

l

10N

atio

nal P

allia

tive

Car

e G

uide

line

• T

he n

atio

nal p

allia

tive

care

gui

delin

e de

fi nes

way

s of

sta

ndar

dizi

ng p

allia

tive

care

for

maj

or li

fe

thre

aten

ing

chro

nic

dise

ase

incl

udin

g ca

ncer

• T

he N

CC

P de

velo

ped

inte

rven

tions

as

defi n

ed in

the

nat

iona

l pal

liativ

e ca

re g

uide

line

11

Stra

tegi

c Pl

an fo

r th

e N

atio

nal B

lood

Tran

sfus

ion

Serv

ices

• Pr

ovid

e ac

cess

, and

pro

per

use

of a

dequ

ate

and

safe

blo

od a

nd b

lood

pro

duct

s

• T

he N

CC

P re

cogn

izes

bio

logi

cal r

isk

fact

ors

incl

udin

g he

patit

is B

infe

ctio

n as

a c

ause

of c

ance

r

and

prom

ote

avai

labi

lity

of s

afe

bloo

d an

d bl

ood

prod

ucts


29

1.7 Justifi cation for the National Cancer control Plan:The rapid increase in non-communicable diseases is attributed to social and demographic factors, which include economic development, globalization of markets and urbanization. These factors lead to increased exposure to modifi able life-style risk factors for cancer. Most developing countries such as Ethiopia are undergoing rapid urbanization, economic development and increased globalization of markets for unhealthy foods and consumer products all of which contribute to risk factor prevalence in the population.

To mitigate the health impact of these socio-economic transformations and safeguard the gains made in economic development, the country must prioritize the Control of chronic non-communicable diseases. Development of a national cancer control plan is recommended wherever the burden of the disease is signifi cant. Unfortunately, Ethiopia still has a developing health system that is not fully capable of tackling all of the key areas that form the ‘continuum of cancer control’. In addition, the country is classifi ed as a low-income country, with a heavy burden of communicable diseases. There is, therefore, an urgent need to make the most effi cient use of available limited resources for maximum impact through the identifi cation and implementation of cost-effective strategies and innovations in cancer Control.

The NCCP comprises an integrated set of interventions covering all aspects of cancer Control including cancer management. It operates with an appropriate allocation of available resources among the various interventions with an equitable coverage of the population. This is done through systematic and equitable implementation of evidence-based interventions for prevention, early detection, treatment, and palliation. Proper planning will ensure effi cient use of resources for cancer Control.


30

PART 1I

THE NATIONAL CANCERCONTROL PLAN

OF ETHIOPIA


31

2. STRATEGIC FRAMEWORK:2.1 VisionEthiopia will have a system of cancer prevention and control that will reduce cancer incidence, morbidity and mortality through the adoption of a multi-sectoral approach, implementation of concrete and sustainable actions, according to the priorities, taking the greatest advantage of available resources.

2.2 MissionAn Ethiopian public health care system that is equipped, staffed, trained, and empowered to provide a full range of cancer prevention, screening, diagnostic, treatment, and care options to cancer patients

2.3 GoalTo reduce cancer incidence and mortality in Ethiopia by 15%by 2020

2.4 General ObjectivesI. To promote cancer prevention and early detection.

II. To improve diagnosis and treatment including palliative care

III. To promote cancer surveillance, registration and research

IV. To foster partnership, collaboration and innovation in cancer control.

V. To integrate Cancer Control activities into the National Health Sector Transformation Plan

VI. To promote community involvement and participation in cancer prevention, control and care

2.5 Guiding Principles of the Cancer control Plan:The Ethiopian National Cancer Control Plan is guided by the following key principles:

• Ownership, leadership and fairness in the implementation of the national plan

• Equity and accessibility of services.

• Partnership, team building and coordination, with the involvement of partners at various levels in the development, planning and implementation of interventions. The coordination will be based on clear defi nition and understanding of roles, responsibilities and mandates.

• Innovation, creativity and accountability, with the involvement of all stakeholders including cancer patients, civil society, partners and community at all stages of decision-making, planning, implementation and evaluation.


32

• Systematic and integrated approach to implementation of priority interventions as part of a national cancer action plan.

• Sustainability-identify and avail adequate resources required for long-term implementation within the national health systems.

• Evidence-based approach focusing on best practice.

2.6 Service delivery level and startegieS2.6.1 Health service delivery organization

Health Systems consists of all organizations, product, people and actions whose primary intent is to promote, restore or maintain health. The health care delivery system in Ethiopia is structured in three-tier. The primary level health care delivery system includes Health Posts (per 3,000 – 5,000 population), Health Centers (15,000 – 25,000 Population) and primary hospitals (60,000 – 100,000 population); secondary level health care delivery system includes general hospital which serves about 1-1.5 million people and Tertiary level health care delivery system includes tertiary hospital which serves 3.5 to 5 million people.

The Ethiopian health care delivery system is augmented by the rapid growth of the private-for-profi t and NGOs sector that are playing signifi cant role in expanding the health service coverage and utilization. To strengthen the engagement of the private sector in health service delivery and foster partnership between the public and private sectors the FMOH launched the Public Private Partnership (PPP) strategy. Forums of private sectors are established focusing on quality improvement and regulatory schemes. The PPP strategy will be an opportunity to promote and strengthen local manufacturing of essential medicines and commodities for cancer care in the country. This will ensure sustained availability of those commodities and signifi cantly reduce the lead-time between their production and use. The private sector and NGOs also play key role in ensuring access to health services and products through engaging in community engagement and social marketing.

Types of cancer control interventions vary depending on the level of cancer control continuum. This document describes in detail what kind of strategic interventions are given at various levels of care.

2.6.1.1 Primary Level Health CareThe PHCU provides basic promotive, preventive and curative health care services to its catchment population through participation of communities in the planning and implementation of the health care services1.

With rapid expansion of the physical infrastructure and equipping the primary level health care (health posts, health centers and primary hospitals) throughout the country and training and deployment at health care workers the primary level health care structure and function

1 FMOH: Health Sector Development Plan IV 2010/11 – 2014/15, October 2010


33

was revitalized and health posts were made to administratively and technically link with the health centers. The mandate of the woreda health offi ces remained to be management and coordination of the operation of all PHCUs within their woredas including planning, fi nancing, monitoring and evaluation of health programs and services deliveries. To guide the revitalization of the PHCU in 2012 a guideline on ‘Primary Health Care Unit Linkage and Referral2’ was prepared by FMOH and distributed to regions.

Expansion of the coverage of primary level care across the country has improved access to basic information and referral for cancer patients, particularly for cervical and breast cancers with a highly effective screening and early detection potential.

2.6.1.2 Community Empowerment, Engagement and Participation

The Federal Ministry of Health along with health development partners has been implementing different models of engaging community members in the plan and implementation of health programs. Following the launch of the Health Extension Program (HEP) in 2005 the engagement of community members in the health service program planning and implementation became more systematic and organized3. However, the types, roles and levels of engagement of the community health workers were not consistent throughout the country. Cognizant of these challenges and with the aim of standardizing the community health workers’ types, roles and level of engagement and to ensure scale up of key positive family and community health practices in 2011 the government of Ethiopia launched the Health Development Army (HAD).

Health Development Army: is a network of women that are led by women who have adopted better health behavior through completing the 16 packages of HEP. Leaders of the network of women infl uence women under their leadership to practice a healthy life style. Five of such 1-to-5 networks of women form a health development team. The leaders of the networks are selected by the members of the network with the key criteria including being a model family in the community through completing implementation of the 16 packages of HEP and getting trust and respect by the members in mobilizing the community. The formation of the health development teams and the 1-to-5 networks is facilitated by HEWs and the Kebele administration4.

So far a total of 2.3 million women were organized into 442,773 health development teams voluntarily mobilized to lead 1-to-5 networks of women throughout the country, the plan is to mobilize up to 3 million one-to-fi ve networks of women to work alongside the HEWs in supporting families to adopt a healthy behavior5.

2 Primary Health Care Unit Linkage and Referral, 20123 Health Extension Program in Ethiopia: Profi le. Health and Education Center, FMOH, June 20074 Federal Democratic Republic of Ethiopia Ministry of Health: EFY 2005 (2012/13) HSDP IV Annual

Performance Report Version I5 HSDP IV Annual Performance Report (2013/14)


34

2.6.1.3 SECONDARY AND TERTIARY LEVEL HEALTH CARE

According to the recent Service Provision Assessment (SPA) in 2014 in Ethiopia there were total of 163, 73 and 35 primary, general and referral hospitals, respectively, of which 40, 71 and 30 respectively are fully functional.

Table 4: Number, types and functional status of health facilities and health posts in Ethiopia, SPA 2014

Health facility type Fully FunctionalPartially

FunctionalNot

FunctionalTotal based on

SPA

Health Post 15,526 15,526

Health Center 3,269 46 227 3,542

Primary Hospital 40 4 119 163

General Hospital 71 1 1 73

Referral Hospital 30 1 4 35

According to the 2013/2014 HSDP IV annual performance report the total number of health posts reached 16,048 making functional health posts to population ratio at 1:5,264 and to date the total number of health centers constructed reached 3,245, reaching a functional health center to population ratio of 1: 26,858.6.

2.6.2 The cancer control ContinuumOwing to its nature, cancer is diffi cult to treat, and often takes a long time to progress in to a full stage disease. Some cancers like cervical and breast can benefi t from early screening and detection and treating the disease before it grows into an advanced stage. However, due to lack of information, inadequate availability of diagnostic and screening facilities and lack of skilled health care providers, most of the cancer patients present with an advanced disease and often diffi cult and too late to treat and require a long time care.

Cancer control requires a coordinated range of interventions from preventing the disease before it occurs, through availing early screening and detection facilities, providing diagnostic and treatment services and providing palliative and pain management for terminally ill patients. This spectrum of interventions constitutes a continuum of cancer

care. Continuous research and surveillance of cancer control programme and systematic monitoring of progress are key to the coordination of the national cancer control programme. The following fi gure depicts the model of continuum of cancer care.

6 FMOH: 2005 EFY ARM performance report


35

Figure 2: The Continuum of Cancer Control

Cancer Research &Surveillanc e

NationalCoordinatio n

Monitoringand

Evaluation

Cancer Research &Surveillanc e

NationalCoordinatio n

Monitoringand

Evaluation

PrimaryPrevention

EarlyDetection

Diagnosisand

TreatmentPalliative

Care

PrimaryPrevention

EarlyDetection

Diagnosisand

TreatmentPalliative

Care

2.7 intervention strategies by service delivery level2.7.1 Primary Prevention of Cancer

Primary prevention interventions are cost-effective approaches to reduce exposure to the modifi able risk factors at individual and community levels. Prevention of cancer especially when integrated with other programmes, such as the Expanded Programme on Immunization, reproductive health, HIV/AIDs, occupational and environmental health, offers the greatest public health potential and most cost-effective long-term method of cancer control. Approximately 40% of cancers are preventable through interventions such as tobacco control, promotion of healthy diets, physical activity, vaccination and protection against exposure to environmental carcinogens .In Ethiopia, the innovative Health Extension Workers programme and the Health Development Army have huge potential, and could be instrumental for the successful implementation of cancer preventive activities in the country.

Strategy 1: Promote public awareness on cancer prevention and care

Information is very crucial throughout the continuum of cancer care. The health system of Ethiopia offers broad community-based services through a well-established structure of information delivery network using the HEWs and the Health Development Army (HDA).Tested and culturally acceptable messages will be developed and channeled through these existing systems.


36

Objective 1: To reach 50% of THE population with cancer prevention awareness information by 2020

Objective 2: to integrate cancer prevention activities at primary health care level by 2020

Key Interventions:• Train health workers, HEWs, media and HDA on cancer prevention and advocacy

• Use opportunities like commemoration days to disseminate cancer prevention information to the community

• Create networking with other relevant sectors to intensify cancer awareness

• Develop and test cancer awareness messages and channel them through HEW and HDA programmes

Table 5: Primary prevention of cancer by service delivery level: Strategy 1-Public Awareness

Service delivery

levelInterventions/Activities

Specifi c Inputs

Medicines and Supplies

HWs Capacity

Community/HP

• Train health workers, HEWs, media and HDA on cancer prevention and advocacy, referrals

• Jobaids for HEWs• Media briefi ng

packs on cancer control

• IEC/BCC materials (posters, audio)

• 20% of health workers receive training every year (100% in fi ve years)

• 7,600 HEWs receive training on cancer every year ( target to reach 38,000 HEWs)

• 50% of HDA will get training on cancer control by 2020

• Develop and test cancer awareness messages and channel them through HEW and HDA programmes

• Cancer awareness messages

• Culturally acceptable and socially sound IEC/BCC materials

Health Center

• Train health workers (Nurses, health offi cers, doctors,) on basic cancer awareness creation skill, referrals


• 20% of health workers trained every year (100% in fi ve years)

General Hospital

• Provide health education to patients on prevention and control of cancer




37

Tertiary Hospital

• Provide health education to patients on prevention and control of cancer



Regional/

National

level

• Design, develop and disseminate information package on prevention and control of cancer

• IEC materials• Compilation and

processing of facts and fi gures on cancer

• Printings

• Prepare and conduct trainings

Strategy 2:Tobacco controlTobacco smoking causes many types of cancer, including cancers of the lung, esophagus, larynx (voice box), mouth, throat, kidney, bladder, pancreas, stomach and cervix. About 70% of the lung cancer burden can be attributed to smoking alone. Second-hand smoke (SHS), also known as environmental tobacco smoke, has been proven to cause lung cancer in non-smoking adults. Smokeless tobacco (also called oral tobacco, chewing tobacco or snuff) causes oral, esophageal and pancreatic cancer.

Objective:To reduce the prevalence of tobacco smoking by 30% in 2020

Key Interventions:• Promote implementation of a comprehensive tobacco control bill/law by parliament

• Incorporate tobacco health risks in school health program

• Require by law and enforce 100% smoke-free environments in workplaces and public places

• Ban all advertising, promotion and sponsorship of tobacco products

• Put health warnings boldly on all tobacco packaging

• Establish a national pilot cessation program in health-care facilities

• Build media awareness of both the addictive nature of tobacco use and treatment options


38

Table 6: Primary prevention of cancer by service delivery level: Strategy 2-Tobacco Control

Service delivery


Specifi c Inputs

Medicines and Supplies HWs Capacity

Community/HP

• Educate the public about the risk of smoking and cancer by HEWs

• Brochures, leafl ets and posters (

• Media spots (TV, Radio) every year

• Train health workers on Interpersonal Communication skills and key approaches and communication skills as per FMOH standard training guidelines

• Disseminate the concept of healthy and smoke-free life style through the HDA programme

Health Center

• Educate the public about the risk of smoking and cancer

• Brochures, leafl ets and posters


General Hospital

• Integrate public awareness raising into routine health education in hospitals



• Designated rooms for cessation

• Train health workers on cessation

Tertiary Hospital

• Integrate public awareness raising into routine health education in hospitals



• Designated rooms for cessation

• Train health workers on tobacco cessation


39

Regional/National

level

• Promote implementation of a comprehensive tobacco control bill/law by parliament

• Incorporate tobacco health risks in school health program

• Require by law and enforce 100% smoke-free environments in workplaces and public places

• Ban all advertising, promotion and sponsorship of tobacco products

• Build media awareness

• Tobacco control proclamation


Strategy 3: Promotion of healthy diet and physical activityDietary modifi cation is another important approach to cancer control. There is a link between overweight and obesity to many types of cancer such as esophagus, colorectum, breast, endometrium and kidney. Diets high in fruits and vegetables may have a protective effect against many cancers. Healthy eating habits that prevent the development of diet-associated cancers will also lower the risk of cardiovascular disease.

Regular physical activity and the maintenance of a healthy body weight, along with a healthy diet, will considerably reduce cancer risk. National policies and programmes should be implemented to raise awareness and reduce exposure to cancer risk factors, and to ensure that people are provided with the information and support they need to adopt healthy lifestyles.

Objective 1: A15 % relative increase in mean population intake of fruits and vegetables at least twice per week by 2020.

Objective 2: A10% relative reduction in prevalence of insuffi cient physical activity BY 2020.

Objective 3:To reduce overweight and obesity by 5% BY 2020

Key Interventions:• Promote public awareness on risks of overweight, obesity unhealthy diet and physical

inactivity.

• Control the import of processed foods having high fat, sugar and salt.

• Promote physical activity in workplaces


40

• Promote healthy diet and physical activities around schools

• Develop and implement national guidelines on physical activity.

• Promote the availability of play grounds per vicinity

Table 7: Primary prevention of cancer by service delivery level: Strategy 3- healthy diet and physical activity

Service delivery level

Interventions/Activities

Specifi c Inputs


Community/HP

• Promote public awareness on risks of overweight, obesity unhealthy diet and physical inactivity.

• IEC/BCC materials (leafl ets, brochures, posters, recorded audio-video tapes)

• 38,000 HEWs trained on communication skills with specifi c information on promotion of healthy diet and physical activity

• At least 50% of HDA trained on the risk of unhealthy diet and physical inactivity

Health Center



• All HWs trained on communication skills with specifi c information on promotion of healthy diet and physical activity

General Hospital



Tertiary Hospital




41

Regional/National level

• Control the import of processed foods having high fat, sugar and salt.

• Promote healthy diet and physical activities around schools

• Develop and implement national guidelines on physical activity.

• Promote physical activity in workplaces

• Promote the availability of play grounds per vicinity

• Media spots (TV, radio)- (a 30 second twice yearly promotion every year for 5 years)

• A consultant cost to develop a guideline on physical activity

Strategy4: Controlof harmful use of alcohol Alcohol use is a risk factor for many cancer types including cancer of the oral cavity, pharynx, larynx, esophagus, liver, colorectum and breast. Risk of cancer increases with the amount of alcohol consumed.

Objective: To reduce the prevalence of harmful use of alcohol by 5% BY 2020

key Interventions:• Adopt the NCD Global Strategy on harmful use of alcohol

• Raise public awareness, especially among young people, about alcohol-related health risks, including cancer

• Incorporate information on the risks of alcohol consumption into the school health programme

• Work and link interventions with other relevant sectors to reduce alcohol-related problems.

• Promote the implementation of legislation on production and consumption of alcohol.

• Ban alcohol trade in the vicinity of school.


42

Table 8: Primary prevention of cancer by service delivery level: Strategy 4- Control of harmful use of alcohol

Service delivery


Specifi c Inputs


Community/HP


• Conduct regular information sharing to the community using pre-organized messages

• Avail Jobaids• Avail IEC/BCC

materials

• Train HEWs and HDAs

Health Center


• Conduct regular information sharing to the community using pre-organized messages

• Jobaids• IEC/BCC materials

• Train nurses and health offi cers

General Hospital

• Integrate information on harmful use of alcohol into routine health education



Tertiary Hospital

• Integrate information on harmful use of alcohol into routine health education

• Provide treatment of substance abuses including alcoholics



• Training on treatment of alcoholics


43

Regional/National

level

• Adopt the NCD Global Strategy on harmful use of alcohol

• Incorporate information on the risks of alcohol consumption into the school health programme

• Work and link interventions with other relevant sectors to reduce alcohol-related problems.

• Promote implementation of legislation on production and consumption of alcohol.

• Ban alcohol trade around schools

• Develop awareness creation materials

• Media spots (TV, radio)- (a 30 second twice yearly promotion every year for 5 years)

• Organize awareness creation workshop with schools on the health risk of alcohol and effect of alcohol trade around school (1 workshop per year)

• A team of experts trained on early prevention of cancer focusing on major risk factors

Strategy 5: Control of Biological Agents Causing Cancer There are infections that either directly cause cancers or increase the risk of cancer. These infections include Hepatitis B or C (liver cancer), human papillomavirus - HPV (cervical cancer), human immunodefi ciency virus –HIV (Kaposi sarcoma, lymphomas), helicobacter pylori (cancer of stomach). It is estimated that 20% of all cancers in developing countries and 6% in developed countries are caused by viral and bacterial infections. Prevention through vaccination, early detection and treatment of these infections will reduce the risk of these cancers.

Objective 1: Achieve 80% coverage of each year’s target cohort of girls aged 9 to 13 with vaccination against HPV BY 2020.

Objective 2: To reduce the burden of cancer-causing infections

key Interventions:• Strengthen health promotion on infectious disease-related cancers

• Develop effective targeted screening and control of pathological agents such as HPV, HIV and hepatitis B, especially in high-prevalence populations.

• Provide vaccination against viral infections associated with cancers particularly HPV and Hepatitis B

• Treat infectious diseases causally-associated with cancers (HPV, Hepatitis B, HIV)

• Promote healthy sexual behavior

• Develop or strengthen prevention strategies on specifi c infectious diseases that contribute to cancer


44

Table 9: Primary prevention of cancer by service delivery level: Strategy 5- Control of Biological Agents Causing Cancer



Specifi c Inputs


HWs Capacity

Community/HP

• Promote healthy sexual behavior• Raise public awareness on

infectious diseases that contribute to cancer

• Jobaids for HEWs

• IEC/BCC materials

• Train Hews, HDAs

Health Center

• Strengthen health promotion on infectious disease-related cancers


• Develop targeted screening and control of pathological agents such as HPV, HIV and hepatitis B


• Adequate supply of medicine to treat common infectious agents associated with cancer

• Adequate vaccines (HB, HPV)

• Train nurses, Health Offi cers, Doctors

General Hospital





• Vaccines ( HB, HPV)

• Trained doctors and nurses

Tertiary Hospital





• Vaccines ( HB, HPV)

• Trained doctors and nurses

Regional/National

level

• Develop or strengthen prevention strategies on specifi c infectious diseases that contribute to cancer

• HPV, HB vaccination strategy

• Trained experts


45

Strategy 6: Control of Environmental and Occupational HazardsEnvironmental pollution of air, water and soil with carcinogenic chemicals accounts for 1-4% of all cancers. Exposure to carcinogenic chemicals in the environment can occur through drinking water or pollution of indoor ambient air. Exposure to carcinogens also occurs via the contamination of food and water by chemicals such as afl atoxins, dioxins and asbestos. Indoor air pollution from coal (charcoal) fi res doubles the risk of lung cancer. Occupational carcinogens are causally related to cancer of the lung, bladder, larynx, skin, esophagus and leukemia. Ionizing radiation can cause almost any type of cancer particularly leukemia, lung, thyroid and breast cancer.

Objective:To reduce exposure to environmental hazards causally associated to cancer

key Interventions: • Enforcement and strengthen the legal framework to protect workers and general

population from environmental carcinogens.

• Regulate the disposal of toxic wastes such as industrial, nuclear and electronic wastes.

• Promote protection of work place exposure to hazards.

• Promote stopping the use of all forms of asbestos.

• Develop regulatory standards on the use of known carcinogens in the work place.

• Enforce the national radiation protection guidelines.

Table 10: Primary prevention of cancer by service delivery level: Strategy 6- reduce exposure to environmental hazards



Specifi c Inputs


Community/HP

• Educate the public about potential link between environmental hazards and cancer

• IEC materials• Audio-video

materials

• Train HEWS, HDAs

Health Center



materials

• Train nurses, health offi cers, doctors

General Hospital



materials

• Train nurses, health offi cers, doctors


46

Tertiary Hospital

• Provide diagnostic facilities for detection of environmental carcinogens

• Diagnostic laboratory

• Trained lab technicians

Regional/National

level

• Enforcement and strengthen the legal framework to protect workers and general population from environmental carcinogens.

• Regulate the disposal of toxic wastes such as industrial, nuclear and electronic wastes.

• Promote protection of work place exposure to hazards.

• Promote stopping the use of all forms of asbestos.

• Develop regulatory standards on the use of known carcinogens in the work place.

• Strengthen inter-sectoral collaboration

• Enforce the national radiation protection guidelines

• Diagnostic laboratory

• Guidelines• Multi-sectoral

team of experts

2.7.2 Early Detection of CancerEarly detection comprises early diagnosis of cancer in symptomatic populations and screening in asymptomatic high-risk and vulnerable populations. It is an approach that promotes vigilance for early signs and symptoms of disease. Early detection and treatment of cancer is known to reduce greatly the burden of cancers such as cancer of the cervix. Because of the burden and high mortality of breast and cervical cancers, accounting for a total of 34% of the total cancer incidence and combined mortality of 58%, the two cancer types are considered priority cancers for intervention in Ethiopia. Moreover, these two cancers are the ones with proven strategies for early diagnosis and screening.

Strategy 1: Promote breast self-awarenessEarly diagnosis remains an important early-detection strategy; particularly in low- and middle-income countries where the disease is diagnosed in late stages and resources are very limited. There is some evidence that this strategy can produce “down-staging” (increase in proportion of breast cancers detected at an early stage) of the disease to stages that are more amenable to curative treatment. The practice of breast self-awareness (BSA) has been seen to empower women, taking responsibility for their own health. Therefore, BSA is recommended for raising awareness among women at risk rather than as a screening method.


47

Objective:To improve early detection of breast cancer

Key Interventions:• Develop IEC/BCC materials for breast self-awareness

• Create public awareness using targeted IEC/BCC materials

• Develop a job-aid for HEWs on breast self awareness

• Integrate health education on breast self-awareness in all health facilities

• Develop guideline for breast self-awareness

Table 11: Early detection of cancer by service delivery level: Strategy 1- Promote breast self-awareness

Service delivery


Specifi c Inputs


Community/HP

• Create public awareness using targeted IEC/BCC materials

• Provide integrated sensitization while doing other health community health activities



Health Center

• Integrate health education on breast self-awareness in the health facilities

• Integrate routine breast examination with other maternal and family health services

• BSE guideline

• Train health workers on clinical breast examination and how to train women to do breast self-examination

General Hospital


• Provide individual breast self-awareness training


• Train health workers on clinical breast examination and how to train women to do breast self-examination

Tertiary Hospital


• Provide individual breast self-awareness training


• Expert team to produce high quality video clips to teach the public on breast self-examination


48

Regional/National

level

• Develop IEC/BCC materials for breast self-awareness

• Develop a job-aid for HEWs on breast self-awareness

• Develop guideline for breast self-awareness

• Materials to teach the public

• Guidelines on breast self-awareness

• Communication experts

• Technical and programme experts

Strategy 2: Clinical Breast examination for all women above age 18 coming to health institutions for other complaintsObjective: To improve early detection of breast cancer by health professionals

key Interventions:• Training all level of health workers on clinical breast examination

• Develop manual for clinical breast examinations for health workers

• Train health care professionals (nurses, HOs, doctors) on early symptoms and signs of breast cancer

• Conduct community awareness on the availability and importance of breast examination services

• Improve the pathology and imaging services at heath facilities

• Assure regional facilities to obtain reliable cytology/histology service of breast tumours

Table 12: early detection of cancer by service delivery level: Strategy 2- Clinical Breast examination

Service delivery


Specifi c Inputs


HWs Capacity

Community/HP


• Facilitate referral of women who need further investigation


• Train HEWs, HDAs

Health Center




• Train nurses, health offi cers and doctors


49

General Hospital

• Training all level of health workers on clinical breast examination



• Diagnostic and screening services (US, mammography)

• Train team of health workers (nurses, HOs, doctors)

Tertiary Hospital

• Training all level of health workers on clinical breast examination

• Develop manual for clinical breast examinations for health workers



• Diagnostic and screening services (US, mammography)

• Train team of health workers (nurses, Hos, doctors)

• Develop and share guidelines on CBE

Regional/National

level

• Assure facilities to get reliable cytology/histology service of breast tumours

• Ensure availability of diagnostic and screening services (US, mammography) at least at general and tertiary hospitals

• Guideline of CBE

• Trained technical and programme experts

Strategy 3: Population-based cervical cancer screening using VIA (visual screening using acetic acid) for all women aged 30-49 every 5 yearsCervical cancer is one of the cancers for which early detection and screening are most effective.

Objective: 1. To Achieve 80-percent coverage of via to detect pre-cancerous cervical lesions among non-symptomatic women aged 30-49

key Interventions:• Conduct community awareness on the availability and importance of VIA and

cryotherapy

• Avail VIA and cryotherapy services at all health facilities from health center level

• Build human-resource capacity to conduct VIA and cryotherapy

• Equip health facilities with VIA and cryotherapy machines, accessories and supplies

• Develop referral system for LEEP and more-advanced treatment


50

• Introduce and adopt innovative approaches to rapidly screen large numbers of women, such as HPV DNA testing, in pilot demonstration programs

• Prepare for a demonstration of HPV DNA technology integrated with VIA screening and cryotherapy in a single-visit approach

Table 13: Early detection of cancer by service delivery level: Strategy 3- cervical cancer screening using via


Interventions/ActivitiesSpecifi c Inputs


Community/HP

• Create public awareness using targeted IEC/BCC materials in local languages

• Train HEWs on the symptoms of cervical cancer, and to refer suspicious cases for rapid follow up.



Health Center

• Create public awareness using targeted IEC/BCC materials in local languages

• Conduct cervical cancer screening using VIA and provide cryotherapy for those who are positive


• Integrate health education on cervical cancer in the health facilities


• Cryotherapy machines with C02 gas supply (detail list annexed)

• 10 days training to nurses, HOs, and doctors using a standard training package prepared by the FMOH

General Hospital

• Train health care professionals (nurses, HOs, doctors) on early symptoms and signs of cervical cancer

• Training of nurses, health offi cers and doctors on cervical cancer screening and treatment by Cryotherapy

• Cryotherapy machines with C02

gas supplies (detail list annexed)

10 days training to nurses, HOs, and doctors using a standard training package prepared by the FMOH


51

Tertiary Hospital

• Train health care professionals (nurses, HOs, doctors) on early symptoms and signs of cervical cancer

• Training of nurses, health offi cers and doctors on cervical cancer VIA screening and treatment by Cryotherapy

• Provide treatment (LEEEP, Surgery, chemo and radiation) for advanced cervical cancer

• Cryotherapy machines with C02

gas supplies (detail list annexed)

• LEEP surgery

10 days training to nurses, HOs, and doctors using a standard training package prepared by the FMOH


• Develop a job-aid for HEWs on cervical cancer awareness and early detection

• Provide guideline Review a guidelines

• Guidelines• Jobaids

• Technical and programme experts

2.7.3 Diagnosis and Treatment of CancerThe purpose of diagnosis and treatment is to cure or considerably prolong the life of cancer patients and ensure the best possible quality of life for cancer survivors. The most effective and effi cient treatment is linked to early detection programmes and follows evidence-based quality of care using a multidisciplinary approach.

The target population for diagnosis and treatment according to the WHO’s estimate for Ethiopia is 60,000 new cancer patients. There are 5 regional oncology centers under construction in fi ve teaching hospitals located in different regions: Jimma, Hawassa, Haromaya, Mekelle and Gondar. There is ongoing specialty training on Oncology (Adult, Pediatrics, and gynecology) and hematology at School of Medicine, Addis Ababa University. Training of health professionals like Oncology Nurses and Radiotherapists will start next year. This will improve access to early diagnosis and treatment of cancer.

a. Primary care level

Strategy 1: Early DiagnosisObjective: To Increase awareness to 50% among the general population and health care providers of early signs and symptoms AND OPPORTUNITIES FOR EARLY DETECTION of the top two cancers

key Interventions:• Early identifi cation and referral of patients suspected of breast and cervical cancer

• Training of health professionals on clinical breast examination, VIA and cryotherapy

• Conduct awareness campaigns


52

Strategy 2: Community support for cancer patientsOBJECTIVE:TO IMPROVE COMMUNITY-BASED CANCER CARE SERVICES

key Interventions:• Provide education and community support materials for patients with cancer

• Integrate basic cancer care activities within existing community health workers’ scope of work

b. Secondary care level

Strategy 1: Improve and increase access to diagnostic and treatment facilitiesObjectives:To achieve adequate diagnosis and TREATMENT FOR 20% of patients, identifi ed by the early-detection strategy

key Interventions:• Develop action plan for phased introduction of cancer care

• Develop a standard set of equipment required for supplying health facilities with diagnostic equipment

• Train medical doctors and nurses on the chemotherapy protocols identifi ed as standard.

• Develop a staffi ng plan for optimal use of the radiotherapy unit and develop an education and in/service training plan to implement radiotherapy treatment.

Strategy 2: Provide surgical treatment Objectives:To increase access to surgical care by eligible patients by 50% by 2020

key Interventions:• Instigate an assessment of current work force capacity and the gap needed to fi ll the

projected number of cancer cases by 2020.

• Develop a health workforce plan for cancer that addresses education as well as in-service capacity building opportunities, harnessing international, regional and national virtual as well as in-person training platforms

• Task the professional societies to adapt international guidelines for diagnosis and treatment of cancer for Ethiopia

• Train different levels of health professionals for cancer diagnosis and treatment

• Supply personal protective equipment for health professionals who prepare or administer chemotherapy, and train them in its use.


53

c. Tertiary care level

Strategy 1: Capacity-buildingObjective:To obtain 50% of the required health workforce to effectively diagnose and treat cancer in Ethiopia by 2020

key Interventions:• Develop guidelines for diagnosis and treatment of cancer


• Supply personal protective equipment for nurses that prepare or administer chemotherapy, and train them in its use.

Strategy 2: Improve access to advanced diagnostic and treatment servicesObjective: to avail access to cancer diagnosis and treatment to 30% of new cancer patients by 2020

key Interventions:• Provide pathology services including immunohistochemistry, fl ow cytometry, and

PCR

• Expand computerized tomography, magnetic resonance imaging, endoscopy and bone scan services

• Open xxx new sites for the administration of chemotherapy and hormonal therapy

• Expand radiotherapy services to 5 regional teaching hospitals

• Provide complex oncology surgery for cancer patients

• Improve availability of blood and blood products

• Improve rehabilitation services

Strategy 3: Improve availability of required medicines and medical equipmentObjectives:to achieve UNINTERRUPTED AND STANDARD cancer diagnosis and treatment SERVICES by 2020

key Interventions:• Defi ne a list of national essential cancer medicines for Ethiopia and secure

procurement commitment for annual projected numbers of cases

• Ensure availability of cancer treatment equipment, medicine and supplies

• Strengthen inventory of required equipment, medicine and supplies with scientifi c quantifi cations and forecast


54

Table 14: diagnosis and treatment OF cancer by service delivery level



Specifi c Inputs


HWs Capacity

Community/HP

• Provide education and community support materials for patients with cancer


• Early identifi cation and referral of patients suspected of breast and cervical cancer



• Jobaids

• Train 38,000 HEWs

• Train at least 50% of HDAs

Health Center

• Provide education and community support materials for patients with cancer


• Early identifi cation and referral of patients suspected of breast and cervical cancer



• Jobaids

• Train 38,000 HEWs

• Train at least 50% of HDAs

General Hospital

• Training of health professionals on clinical breast examination, VIA and cryotherapy


• Supply personal protective equipment for health professionals who prepare or administer chemotherapy, and train them in its use.

• Provide cancer care for patients diagnosed and on treatment

• Training guideline

• Cancer medicine as per the standard list of drugs

• Personal protective equipment

• Trained oncologist, radiotherapist, medical physicist, pathologist, clinical oncology nurses


55

Tertiary Hospital

• Develop guidelines for diagnosis and treatment of cancer

• Develop a staffi ng plan for optimal use of the radiotherapy unit and develop an education and in/service training plan to implement radiotherapy treatment.

• Train medical doctors and nurses on cancer diagnosis and treatment

• Supply personal protective equipment for nurses that prepare or administer chemotherapy, and train them in its use.

• Provide pathology services including immunohistochemistry, fl ow cytometry, and PCR

• Expand computerized tomography, magnetic resonance imaging, endoscopy and bone scan services

• Provide complex oncology surgery for cancer patients

• Improve availability of blood and blood products

• Improve rehabilitation services

• Defi ne a list of national essential cancer medicines for Ethiopia and secure procurement commitment for annual projected numbers of cases

• Ensure availability of cancer treatment equipment, medicine and supplies

• Strengthen inventory of required equipment, medicine and supplies with scientifi c quantifi cations and forecast

• Training guideline

• Cancer medicine as per the standard list of drugs

• Personal protective equipment

• Radiotherapy machines (5)

(LINAC, Brachytherapy, CT simulator, treatment planning)

• Trained oncologist, radiotherapist, medical physicist, pathologist, clinical oncology nurses


56


• Develop a standard set of equipment required for supplying health facilities with diagnostic equipment

• Develop action plan for phased introduction of cancer care in Ethiopia

• Instigate an assessment of current work force capacity and the gap needed to fi ll the projected number of cancer cases by 2020.

• Develop a health workforce plan for cancer that addresses education as well as in-service capacity building opportunities, harnessing international, regional and national virtual as well as in-person training platforms

• Task the professional societies to adapt international guidelines for diagnosis and treatment of cancer for Ethiopia

• Open 27 new sites for the administration of chemotherapy and hormonal therapy

• Expand radiotherapy services to 5 regional teaching hospitals

• Human resource plan for cancer care

• Radiotherapy machines

• Adequate supply of chemotherapy

• Trained technical and programme staff

2.7.4 Palliati ve Care and Pain ManagementPalliative care improves the quality of life of patients and families who face life-threatening illness, by providing pain- and symptom-management, spiritual and psychosocial support from diagnosis to the end of life and bereavement. Effective palliative care services should be integrated into the existing healthcare system at all levels of care, including home-based care. These should be adapted to the specifi c cultural, social and economic setting. Palliative care should be strategically linked to cancer prevention, early detection and treatment services.


57

Strategy 1: Capacity-Building for Health Facilities and CommunityObjective: To build both institutional and community capacity on palliative care

key Interventions: • Conduct an assessment of current palliative care services, including community-

based services via religious organisations and civil society organisations

• Defi ne a basic package of palliative care services

• Develop implementation plan to fi ll gap in a phased manner

• Conduct awareness campaigns on palliative care that target policy-makers, the public, media, health care personnel and regulators

• Provide skills training in palliative care to HEWs for the identifi cation, assessment and treatment of distressing symptoms in cancer patients

• Build capacity of the health care providers and care givers on palliative care

Table 15: palliative care and pain management OF cancer by service delivery level: Strategy 1- capacity building for health facilities and community




HWs Capacity

Community/HP

• Conduct awareness campaigns on palliative care that target policy-makers, the public, media, health care personnel and regulators

• Provide skills training in palliative care to HEWs for the identifi cation, assessment and treatment of distressing symptoms in cancer patients

• Jobaids,• IEC/BCC

materials


Health Center

• Build capacity of the health care providers and care givers on palliative care.

• Palliative care guideline and training materials

• Train nurses, HO, doctors on palliative care

General Hospital


Palliative care guideline and training materials

• Train nurses, HO, doctors on palliative care


58

Tertiary Hospital


• Palliative care guideline and training materials

Train nurses, HO, doctors on palliative care

Regional/National

level

• Conduct an assessment of current palliative care services, including community-based services via religious organisations and civil society organisations

• Defi ne a basic package of palliative care services

• Develop implementation plan to fi ll gap in a phased manner

• National palliative care guideline

• Trained technical and programme experts

Strategy 2: Integrate palliative-care serviceS at all levels oF health-delivery outlets Objective: To ensure at least 50% of health facilities provide palliative care services by 2020

key Interventions: • Develop an essential palliative-care medicines list, with special provision of controlled

medicines such as opioids for pain relief and integrate it into the national Ethiopian Essential Medicines List.

• Integrate palliative care services into the national health services.

• Work with the drug regulatory agency to ensure access and availability of pain relief medications to essential medication and supplies

• Support health professionals to incorporate palliative care skills into their daily and routine services

• Strengthen referral and networking between facilities and community-based care

• Promote patient & family-centered care through training and education


59

Table 16: palliative care and pain management OF cancer by service delivery level: Strategy 2- Integrated palliative care services




HWs Capacity

Community/HP

• Strengthen referral and networking between facilities and community-based care

• Promote patient & family-centered care through training and education

• Referral guide


Health Center


• PC guideline• Essential PC

medicine

• Train all categories of health workers

General Hospital



medicine


Tertiary Hospital



medicine

Train all categories of health workers


• Develop an essential palliative-care medicines list,

• Integrate palliative care • Ensure access and availability of

pain relief medications to essential medication and supplies


medicine

Strategy 3: Strengthen Home-Based Care and Volunteerism Objective: To create a strong patient- and family-centered approach that encourages early reporting and prompt management of cancer patients living in the community

key Interventions:• Mobilize communities through awareness-raising, training and recognition

• Strengthen community- and home-based palliative care services including establishment of nutritional support services for cancer patients.

• Establish social support services for cancer patients and provide palliative care services for groups with special needs, children and the elderly.

• Maintain frequent and early contact with patients through HEWs and volunteer community workers


60

Table 17: palliative care and pain management OF cancer by service delivery level: Strategy 3- STRENGTHEN home-based care

Service delivery


Specifi c Inputs

Medicines and

Supplies

HWs Capacity

Community/HP

• Mobilize communities through awareness-raising, training and recognition



• Train HEWs and HDAs on palliative care

Health Center

• Mobilize communities through awareness-raising, training and recognition



• Essential palliative care medicine


General Hospital

• Provide regular supervision to home based palliative care services

• Provide expert techncial support


• Train all categories of HWs

Tertiary Hospital

• Provide regular supervision to home based services

• Provide expert techncial support


• Train all categories of HWs

Regional/National

level

• Strengthen community- and home-based palliative care services including establishment of nutritional support services for cancer patients.

• Establish social support services

• National PC guideline

• Trained technical experts

Strategy 4: Incorporate Palliative Care as Part of Health Sciences Studies CurriculumObjective: Develop curricula and training materials for palliative care.

key Interventions:• Raise awareness on the relevance of palliative care in the continuum of cancer care

• Recognize palliative care specialization in the health workforce

• Design and implement curricula on palliative care for physicians,health offi cers,nurses and pharmacists and other relevant members of the multidsciplinary team


61

Table 18: Palliative care and pain management OF cancer by service delivery level: Strategy 4- integrate palliative care in curriculum




HWs Capacity

Community/HP

• Incorporate palliative care into HEWs package

• PC guideline• jobaids

• Orientation and training to HEWs and the HDAs

Health Center

• Implement PC in the routine health service delivery


• Orientation and training to HWs

General Hospital

• Design and implement curricula on palliative care for physicians, health offi cers, nurses and pharmacists and


• Orientation and training to HWs

Tertiary Hospital

• Design and implement curricula on palliative care for physicians, health offi cers, nurses and pharmacists and


• Orientation and training to HEWs and the HDAs

Regional/National

level

• Raise awareness on the relevance of palliative care in the continuum of cancer care

• Recognize palliative care specialization in the health workforce

• Curriculum• Train PC

experts widely

Strategy 5: Networking, partnership and collaboration among public health care system, non–state actors and the communityObjective: Develop networks, partnerships and collaboration with local and international partners.

key Interventions:• Map all stakeholders working on palliative care and prepare directory

• Facilitate national partnership on palliative care for cancer

• Develop and implement national palliative-care guideline and harmonize national efforts


62

Table 19: palliative care and pain management of cancer by service delivery level: Strategy 5- networking and partnership




HWs Capacity

Community/HP

• Strengthen community level partnership through engagement using existing structures like the HDA network

• Palliative care guideline

• Trained and informed HEWs, HDAs

Health Center

• Map all stakeholders working on palliative care and engage them


• Directory of all stakeholders working on PC

• Train HWs

General Hospital

• Map all stakeholders working on palliative care and engage


• Train HWs

Tertiary Hospital

• Map all stakeholders working on palliative care and engage


Train HWs

Regional/National

level

• Map all stakeholders working on palliative care and prepare directory

• Facilitate national partnership on palliative care for cancer

• Develop and implement national palliative-care guideline and harmonize national efforts



• Trained health workers on PC

2.7.5 Cancer Surveillance and Research

Strategy 1: Enhancing surveillance for cancer and its risk factorsObjective 1: To establish national and regional cancer registries.

Interventions:• Develop guidelines, tools and standards for cancer registries in collaboration with

the African Cancer Registry Network• Conduct regional needs assessment for establishing cancer registries.• Establish a 5-year plan for a national approach to cancer surveillance in Ethiopia


63

• Generate and publish annual cancer status reports• Adopt and customize the IARC/GICR curriculum for training cancer registrars.• Develop a capacity building program for cancer registration personnel and sensitize

health personnel on cancer registration.• Defi ne a standard list and procure equipment for new cancer services as

appropropriate

Objective 2: To improve cancer surveillance system.

Interventions:• Review existing cancer surveillance and registration tools and extent of integration

into the health information system• Develop a plan for optimal integration of cancer data for public health • Train personnel on the use of the cancer registration and surveillance tools.

Objective 3: To disseminate cancer information to relevant stakeholders

Interventions:• Establish guidelines for dissemination and utility of surveillance/registry data. • Hold an annual cancer conference. • Generate and publish annual cancer status reports.

Strategy 2: Improve research capacity and establish collaboration Objective: To advance Ethiopian cancer diagnosis and treatment center to a networked center of excellence by 2020

Interventions:• Develop networks, partnerships and collaboration with local and international

partners• Conduct research on diagnostic tests and treatment of cancers • Establish population or facility-based cancer registry

2.7.6 Monitoring and Evaluation

Strategy: StrengthenING monitoring and evaluation of cancer Control activities. Objective: To monitor and evaluate cancer Control interventions

Interventions:• Carry out a baseline cancer situational analysis.• Develop monitoring and evaluation guidelines and tools. • Develop a monitoring and evaluation framework for cancer Control• Conduct a mid-cycle (year 2-3) assessment of plan implementation


64

3. COORDINATION OF CANCER CONTROL ACTIVITIES

Currently, the NCD Case Team within the Disease Control Directorate manages the cancer Control programme with external support from multi-sectoral national cancer Control committee. In order to have better cancer Control programme, there is a dire need to strengthen the current structure and establish similar mechanisms at all levels of the health system. As part of the effort to strengthen the cancer Control programme and in line with the national and global NCD plan of action, there is a need to have an established system of data management that includes routine nationwide cancer registry, operational research on priority areas, and the use of data for decision-making.

The following matrix summarizes the strategies, objectives and activities related to program management (coordination and data-management) during the implementation of the national cancer control plan in the period of 2015/16 to 2019/20.

Strategies Objectives Interventions

Coordination

Strengthen

cancer

Control

coordination

mechanisms

at all levels

Establish a cancer Control focal point under disease prevention control in all levels of health system by the end of 2020

• Conduct regional consultation on the importance of the focal point

• Develop program-management manual

• Build capacity-building of focal persons on programme management

• Conduct program managers review meeting and periodic follow up

Establish a functional multi-sectoral NCD Control committee at national and regional levels by the end of 2020 (this includes cancer control as well)

• Develop terms of reference for cancer Control committee

• Organize orientation meeting on cancer Control for committee and subcommittee members

• Establish subcommittees on resource mobilization and partnership, communication and advocacy, technical and program implementation

• Develop plan of action with monitoring and accountability indicators

• Develop reporting mechanism to ensure functionality of committees and subcommittees at different levels

• Conduct national consultation of committee and sub-committees


65

Data management

Strengthen

data

management

for Control

of cancer.

Establish regional

Population-based

cancer registries by

the end of 2020.

• Identify cancer registry facilities

• Assign personnel and provide training

• Avail the necessary logistics for the cancer registry.

• Establish an e-based national data centre by networking the CRs. Will this be the registry based at Black Lion or elsewhere?

• Use data from the national data centre for evidence-based decision during annual action planning

• Conduct meetings and annual scientifi c forums to improve data quality and management.

• Conduct review meeting of CRs

Strengthen use of

evidence-based data

for decision-making.

• Build capacity of program managers and service providers in operational research.

• Conduct operational research (OR) on identifi ed priority cancer Control issues.

• Produce publications and present at international and national forums to contribute to global knowledge.

• Disseminate and utilize OR results for improvement of programme.

• Revise the HMIS/IDS tools to include priority cancer indicators.

NA

TIO

NA

L C

AN

CE

R C

ON

TR

OL

PL

AN

OF

ET

HIO

PIA

- 2

01

6-2

02

0

66

4. IM

PLE

MEN

TAT

ION

FR

AM

EWO

RK

4.1

Pri

mar

y P

reve

ntio

n of

Can

cer

Out

put

Indi

cato

r: %

of p

opul

atio

n re

ache

d w

ith a

war

enes

s in

form

atio

n on

can

cer

prev

entio

n

Stra

tegy

Obj

ectiv

eIn

terv

entio

nsM

onito

ring

indi

cato

rsR

espo

nsib

le

Bodi

es

Tim

e fr

ame

Y1

Y2

Y3

Y4

Y5

Stra

tegy

1:

Prom

ote

publ

ic

awar

enes

s on

ca

ncer

pre

vent

ion

and

care

Obj

ecti

ve 1

: To

rea

ch 5

0%

of p

opul

atio

n w

ith c

ance

r pr

even

tion

awar

enes

s in

form

atio

n by

20

20

Obj

ecti

ve 2

: To

inte

grat

e ca

ncer

pr

even

tion

activ

ities

at

prim

ary

heal

th

care

leve

l by

2020

• Tr

ain

heal

th w

orke

rs,

HEW

, med

ia a

nd H

DA

on

can

cer

prev

entio

n an

d ad

voca

cy

• #

of p

eopl

e tr

aine

d on

ca

ncer

pre

vent

ion

and

care

FMoH

, RH

Bs

• C

reat

e ne

twor

king

with

ot

her

rele

vant

sec

tors

to

inte

nsify

can

cer

awar

enes

s

• M

ulti-

sect

oral

foru

m

crea

ted

on c

ance

r C

ontr

olFM

oH

• D

evel

op a

nd t

est

canc

er

awar

enes

s m

essa

ges

and

chan

nel t

hem

th

roug

h H

EW a

nd H

AD

pr

ogra

mm

es

• #

of m

essa

ges

deve

lope

d an

d di

ssem

inat

edFM

oH, R

HBs

NA

TIO

NA

L C

AN

CE

R C

ON

TR

OL

PL

AN

OF

ET

HIO

PIA

- 2

01

6-2

02

0

67

Stra

tegy

Obj

ectiv

eIn

terv

entio

nsM

onito

ring

indi

cato

rsR

espo

nsib

leBo

dies

Tim

e fr

ame

Y1

Y2

Y3

Y4

Y5

Stra

tegy

2:

Toba

cco

cont

rol

Obj

ecti

ve:

To r

educ

e th

e pr

eval

ence

of

tob

acco

sm

okin

g by

30

% b

y 20

20

• Pr

omot

e ad

optio

n an

d im

plem

enta

tion

of a

co

mpr

ehen

sive

tob

acco

con

trol

bi

ll/la

w b

y pa

rlia

men

t

• Pr

ocla

mat

ion

pass

ed a

nd

impl

emen

ted

on t

obac

co

cont

rol

EFM

HA

CA

• In

corp

orat

e to

bacc

o he

alth

ri

sks

in s

choo

l hea

lth p

rogr

am

• %

of s

choo

ls w

ith t

obac

co

cont

rol i

nitia

tives

FMoH

, EF

MH

AC

A,

MoE

• R

equi

re b

y la

w a

nd e

nfor

ce

100%

sm

oke-

free

env

iron

men

ts

in w

orkp

lace

s an

d pu

blic

pla

ces

• A

vaila

bilit

y of

law

s re

quir

ing

smok

e fr

ee e

nvir

onm

ent

in

wor

k an

d pu

blic

pla

ces

EFM

HA

CA

• Ba

n al

l adv

ertis

ing,

prom

otio

n an

d sp

onso

rshi

p of

tob

acco

pr

oduc

ts

• %

red

uctio

n of

pro

mot

iona

l w

orks

on

toba

cco

use

EFM

HA

CA

• Pu

t he

alth

war

ning

s bo

ldly

on

all t

obac

co p

acka

ging

• %

of t

obac

co p

rodu

cts

with

he

alth

war

ning

sEF

MH

AC

A

• Es

tabl

ish

a na

tiona

l pilo

t ce

ssat

ion

prog

ram

in h

ealth

-ca

re fa

cilit

ies

• #

of h

ealth

faci

litie

s us

ing

the

cess

atio

n gu

idel

ines

FMoH

, EF

MH

AC

A

• Bu

ild m

edia

aw

aren

ess

of b

oth

the

addi

ctiv

e na

ture

of t

obac

co

use

and

trea

tmen

t op

tions

.

• #

pro

gram

mes

spe

cifi c

to

toba

cco

heal

th-r

isk

on m

edia

FMoH

, EF

MH

AC

A

NA

TIO

NA

L C

AN

CE

R C

ON

TR

OL

PL

AN

OF

ET

HIO

PIA

- 2

01

6-2

02

0

68

Stra

tegy

Obj

ectiv

eIn

terv

entio

nsM

onito

ring

indi

cato

rsR

espo

nsib

le

Bodi

esT

ime

fram

e

Y1

Y2

Y3

Y4

Y5

Stra

tegy

3:

Prom

otio

n of

hea

lthy

diet

, and

ph

ysic

al

activ

ity

Obj

ecti

ve 1

: A

15

% r

elat

ive

incr

ease

in

mea

n po

pula

tion

inta

ke o

f fru

its

and

vege

tabl

es

at le

ast

twic

e pe

r w

eek

by

2020

.

Obj

ecti

ve 2

: A

10%

rel

ativ

e re

duct

ion

in

prev

alen

ce o

f in

suffi

cien

t ph

ysic

al a

ctiv

ity

in 2

020.

Obj

ecti

ve

3: T

o re

duce

ov

erw

eigh

t an

d ob

esity

by

5% in

20

20

• Pr

omot

e pu

blic

aw

aren

ess

on r

isks

of

over

wei

ght,

obes

ity

unhe

alth

y di

et a

nd

phys

ical

inac

tivity

.

• %

of p

ublic

with

the

cor

rect

kn

owle

dge

of c

ance

r ri

sks

FMoH

, FM

oA,

MO

UD

C,

EFM

HA

CA

• C

ontr

ol t

he im

port

of

proc

esse

d fo

ods

havi

ng

high

fat,

suga

r an

d sa

lt

• R

egul

atio

n on

impo

rtat

ion

of

unhe

alth

y fo

od d

evel

oped

and

im

plem

ente

d•

Num

ber

of R

egio

ns t

hat

have

ad

opte

d an

d im

plem

ente

d th

e re

gula

tion

EFM

HA

CA

• Pr

omot

e ph

ysic

al a

ctiv

ity

in w

orkp

lace

s•

% o

f wor

kpla

ces

with

faci

lity

for

phys

ical

exe

rcis

e

MoL

SA,

FMoH

, M

oUD

C

• Pr

omot

e he

alth

y di

ets

and

phys

ical

act

iviti

es

arou

nd s

choo

ls

• #

of s

choo

ls a

dopt

ing

regu

lar

phys

ical

act

iviti

es•

# o

f sch

ools

hav

ing

a sy

stem

in p

lace

to

dis

allo

w e

ntra

nce

of u

nhea

lthy

food

into

the

ir s

choo

ls

MoE

, M

oYSC

, EF

MH

AC

A,

FMoH

• D

evel

op a

nd im

plem

ent

natio

nal g

uide

lines

on

phys

ical

act

ivity

.•

Gui

delin

es o

n ph

ysic

al a

ctiv

ityFM

oH,

MoY

SC,

MoU

DC

• Pr

omot

e th

e av

aila

bilit

y of

pla

y gr

ound

s pe

r vi

cini

ty

• Pr

opor

tion

of t

he g

ener

al p

ublic

en

gagi

ng in

phy

sica

l act

ivity

MoY

SC,

FMoH

, M

oUD

C

NA

TIO

NA

L C

AN

CE

R C

ON

TR

OL

PL

AN

OF

ET

HIO

PIA

- 2

01

6-2

02

0

69

Stra

tegy

Obj

ectiv

eIn

terv

entio

nsM

onito

ring

indi

cato

rsR

espo

nsib

le

Bodi

esT

ime

fram

e

Y1

Y2

Y3

Y4

Y5

Stra

tegy

4:

Con

trol

of

harm

ful u

se

of a

lcoh

ol

Ob

ject

ive:

To

red

uce

the

prev

alen

ce o

f ha

rmfu

l use

of

alco

hol b

y 5%

by

202

0

• A

dopt

the

NC

D G

loba

l St

rate

gy o

n ha

rmfu

l use

of

alco

hol

• St

rate

gy a

dopt

edFM

oH,

EFM

HA

CA

• R

aise

pub

lic a

war

enes

s, es

peci

ally

am

ong

youn

g pe

ople

, abo

ut a

lcoh

ol-r

elat

ed

heal

th r

isks

, inc

ludi

ng c

ance

r

• %

of y

oung

peo

ple

with

co

rrec

t kn

owle

dge

of

alco

hol-r

elat

ed h

ealth

ri

sks

FMoH

, EF

MH

AC

A

• In

corp

orat

e in

form

atio

n on

the

ris

ks o

f alc

ohol

co

nsum

ptio

n in

to t

he s

choo

l he

alth

pro

gram

me

• %

of s

choo

ls w

ith

prog

ram

mes

on

harm

ful

use

of a

lcoh

ol

FMoH

, EF

MH

AC

A,

MoE

• W

ork

and

link

inte

rven

tions

w

ith o

ther

rel

evan

t se

ctor

s to

red

uce

alco

hol-r

elat

ed

prob

lem

s.

• A

vaila

bilit

y of

mul

ti-se

ctor

al fo

rum

on

alco

hol

FMoH

, EF

MH

AC

A

• Pr

omot

e th

e im

plem

enta

tion

of le

gisl

atio

n on

pro

duct

ion

and

cons

umpt

ion

of a

lcoh

ol.

• N

umbe

r of

Reg

ions

ad

optin

g an

d im

plem

entin

g th

e le

gisl

atio

n on

pro

duct

ion

and

cons

umpt

ion

of

alco

hol

FMoH

, EF

MH

AC

A

• Ba

nnin

g of

alc

ohol

tra

de in

the

vi

cini

ty o

f sch

ool.

• %

of s

choo

ls w

ith

alco

hol-f

ree

envi

ronm

ent

NA

TIO

NA

L C

AN

CE

R C

ON

TR

OL

PL

AN

OF

ET

HIO

PIA

- 2

01

6-2

02

0

70

Stra

tegy

Obj

ectiv

eIn

terv

entio

nsM

onito

ring

indi

cato

rsR

espo

nsib

le

Bodi

es

Tim

e fr

ame

Y1

Y2

Y3

Y4

Y5

Stra

tegy

5:

Con

trol

of

biol

ogic

al

agen

ts

caus

ing

canc

er

Ob

ject

ive:

To

red

uce

the

burd

en

of c

ance

r ca

usin

g in

fect

ions

• St

reng

then

hea

lth p

rom

otio

n on

in

fect

ious

dis

ease

-rel

ated

can

cers

• %

incr

ease

in K

AP

on c

ance

r in

the

com

mun

ityFM

oH, R

HB

• D

evel

op e

ffect

ive

targ

eted

sc

reen

ing

and

cont

rol o

f pa

thol

ogic

al a

gent

s su

ch a

s H

PV,

HIV

and

hep

atiti

s B

espe

cial

ly in

hi

gh-p

reva

lenc

e po

pula

tions

.

• %

cov

erag

e of

tar

get

popu

latio

n sc

reen

ed fo

r in

fect

ions

cau

sing

can

cer

FMoH

, RH

B

• Pr

ovid

e va

ccin

atio

n ag

ains

t vi

ral

infe

ctio

ns a

ssoc

iate

d w

ith c

ance

rs

e.g.

HPV

and

Hep

atiti

s B

• %

cov

erag

e of

tar

get

popu

latio

n va

ccin

ated

ag

ains

t in

fect

ions

cau

sing

ca

ncer

FMoH

, RH

B

• Tr

eatm

ent

of in

fect

ious

dis

ease

s ca

usal

ly a

ssoc

iate

d w

ith c

ance

rs

(HPV

, HBV

, HIV

)

• %

of h

ealth

faci

litie

s ef

fect

ivel

y tr

eatin

g in

fect

ious

di

seas

es a

ssoc

iate

d w

ith

canc

er

FMoH

, RH

B

• Pr

omot

ion

of h

ealth

y se

xual

be

havi

or

• %

incr

ease

in K

AP

abou

t he

alth

y se

xual

beh

avio

r in

th

e co

mm

unity

FMoH

, RH

B

• D

evel

op o

r st

reng

then

pr

even

tion

stra

tegi

es o

n sp

ecifi

c in

fect

ious

dis

ease

s th

at

cont

ribu

te t

o ca

ncer

• #

of p

reve

ntio

n st

rate

gies

de

velo

ped

FMoH

, RH

B

NA

TIO

NA

L C

AN

CE

R C

ON

TR

OL

PL

AN

OF

ET

HIO

PIA

- 2

01

6-2

02

0

71

Stra

tegy

Obj

ectiv

eIn

terv

entio

nsM

onito

ring

indi

cato

rsR

espo

nsib

le

Bodi

es

Tim

e fr

ame

Y1

Y2

Y3

Y4

Y5

Stra

tegy

6:

Con

trol

of

Envi

ronm

enta

l an

d O

ccup

atio

nal

Haz

ards

Ob

ject

ive:

To

red

uce

expo

sure

to

envir

onm

enta

l ha

zard

s ca

usal

ly as

soci

ated

w

ith c

ance

r

• Pr

omot

e en

forc

emen

t an

d st

reng

then

ing

of

the

lega

l fra

mew

ork

to

prot

ect

wor

kers

and

ge

nera

l pop

ulat

ion

from

en

viro

nmen

tal c

arci

noge

ns.

• A

vaila

bilit

y of

lega

l fr

amew

ork

to p

rote

ct a

gain

st

envi

ronm

enta

l car

cino

gens

MoL

SA,

FMoH

• R

egul

ate

the

disp

osal

of

tox

ic w

aste

s su

ch a

s in

dust

rial

, nuc

lear

and

el

ectr

onic

was

tes

• A

vaila

bilit

y of

was

te d

ispo

sal

site

s an

d di

spos

al m

echa

nism

s fo

r va

riou

s w

aste

sM

oLSA

, ES

A, F

MoH

• Pr

omot

e pr

otec

tion

of w

ork

plac

e ex

posu

re t

o ha

zard

s.

• %

of w

orkp

lace

with

cle

ar

com

mun

icat

ion

on r

isks

to

haza

rds

MoL

SA,

FMoH

• Pr

omot

esto

ppin

g th

e us

e of

al

l for

ms

of a

sbes

tos

• • Le

gisl

atio

n de

velo

ped

and

impl

emen

ted

on c

essa

tion

of

asbe

stos

use

•

# o

f ind

ustr

ies

that

hav

e ad

opte

d al

tern

ativ

es t

o as

best

os p

rodu

ctio

n an

d us

e.

MoU

DC

, FM

oH

• D

evel

op r

egul

ator

y st

anda

rds

on t

he u

se o

f kn

own

carc

inog

ens

in t

he

wor

k pl

ace

• #

ofw

orkp

lace

s ap

plyi

ng t

he

regu

lato

ry s

tand

ards

M

oLSA

, FM

oH

NA

TIO

NA

L C

AN

CE

R C

ON

TR

OL

PL

AN

OF

ET

HIO

PIA

- 2

01

6-2

02

0

72

4.2

Earl

y D

etec

tion

of

Can

cer

O

utpu

t In

dica

tor:

• To

tal #

& %

(of

tar

get

popu

latio

n) o

f clie

nts

scre

ened

with

VIA

• To

tal #

& %

of w

omen

scr

eeni

ng p

ositi

ve o

n V

IA t

reat

ed w

ith c

ryot

hera

py/L

EEP

• %

Det

ectio

n of

bre

ast

canc

er a

t ea

rly

stag

e

Stra

tegy

Obj

ectiv

eIn

terv

entio

nsM

onito

ring

indi

cato

rsR

espo

nsib

le

Bodi

esT

ime

fram

e

Y1

Y2

Y3

Y4

Y5

Stra

tegy

1:

Prom

ote

brea

st s

elf-

awar

enes

s

Ob

ject

ive:

To

impr

ove

early

det

ectio

n of

bre

ast

canc

er

• D

evel

op IE

C/B

CC

mat

eria

ls

for

brea

st s

elf-

awar

enes

s•

Ava

ilabi

lity

of IE

C/B

CC

m

ater

ials

FMoH

• C

reat

e pu

blic

aw

aren

ess

usin

g ta

rget

ed IE

C/B

CC

mat

eria

ls

• Pr

opor

tion

of t

he g

ener

al

publ

ic a

war

e of

the

be

nefi t

s of

BSA

FMoH

, RH

B

• D

evel

op a

job-

aid

for

HEW

s on

bre

ast

self-

awar

enes

s•

Job-

aid

on B

SA u

sed

by

HEW

sFM

oH

• In

tegr

ate

heal

th e

duca

tion

on

brea

st s

elf-a

war

enes

s in

all

heal

th fa

cilit

ies

• %

of h

ealth

faci

litie

s pr

ovid

ing

regu

lar

heal

th

educ

atio

n on

BSA

FMoH

, RH

B

• D

evel

op g

uide

line

for

brea

st

self-

awar

enes

s •

Ava

ilabi

lity

of g

uide

lines

on

BSA

FMoH

NA

TIO

NA

L C

AN

CE

R C

ON

TR

OL

PL

AN

OF

ET

HIO

PIA

- 2

01

6-2

02

0

73

Stra

tegy

Obj

ectiv

eIn

terv

entio

nsM

onito

ring

indi

cato

rsR

espo

nsib

le

Bodi

esT

ime

fram

e

Y1

Y2

Y3

Y4

Y5

Stra

tegy

2:

Bre

ast

exam

inat

ion

for

all w

omen

ab

ove

age

18 c

omin

g to

hea

lth

inst

itutio

ns

for

othe

r co

mpl

aint

s

Ob

ject

ive:

To

impr

ove

early

det

ectio

n of

bre

ast

canc

er

by h

ealth

pr

ofes

siona

ls

• Tr

ain

all l

evel

s of

hea

lth w

orke

rs o

n cl

inic

al b

reas

t ex

amin

atio

n (C

BE)

• %

of h

ealth

wor

kers

tr

aine

dFM

oH, R

HB,

U

nive

rsiti

es

• D

evel

op m

anua

ls a

nd jo

b ai

ds fo

r cl

inic

al b

reas

t ex

amin

atio

ns fo

r he

alth

wor

kers

• A

vaila

bilit

y of

HW

s m

anua

ls a

nd jo

b ai

ds in

he

alth

faci

litie

s

FMoH

, RH

B,

Uni

vers

ities

• Tr

ain

heal

th c

are

prof

essi

onal

s (n

urse

s, H

Os,

doct

ors)

on

earl

y sy

mpt

oms

and

sign

s of

bre

ast

canc

er

• %

of h

ealth

wor

kers

w

ith c

orre

ct k

now

ledg

e of

ear

ly s

ympt

oms

and

sign

s of

bre

ast

canc

er

FMoH

, RH

B,

Uni

vers

ities

• C

ondu

ct c

omm

unity

aw

aren

ess

on

the

avai

labi

lity

and

impo

rtan

ce o

f cl

inic

al b

reas

t ex

amin

atio

n se

rvic

e

• %

of e

ligib

le w

omen

w

ho a

re a

war

e of

clin

ical

bre

ast

exam

inat

ion

serv

ices

FMoH

, RH

B

• Im

prov

e pa

thol

ogy

and

imag

ing

serv

ices

at

heat

h fa

cilit

ies

• Pr

opor

tion

of

seco

ndar

y an

d te

rtia

ry

leve

l HF

with

can

cer

diag

nost

ic s

ervi

ces

FMoH

, U

nive

rsiti

es

NA

TIO

NA

L C

AN

CE

R C

ON

TR

OL

PL

AN

OF

ET

HIO

PIA

- 2

01

6-2

02

0

74

Stra

tegy

Obj

ectiv

eIn

terv

entio

nsM

onito

ring

indi

cato

rsR

espo

nsib

le

Bodi

esT

ime

fram

e

Y1

Y2

Y3

Y4

Y5

Stra

tegy

3:

Popu

latio

n ba

sed

cerv

ical

ca

ncer

sc

reen

ing

,suc

h as

usi

ng

VIA

(vi

sual

sc

reen

ing

usin

g ac

etic

ac

id)

for

all

wom

en a

ged

30-4

9 ev

ery

5 ye

ars

Ob

ject

ive:

1. T

o im

prov

e de

tect

ion

of

prec

ance

rous

ce

rvic

al le

sions

• C

ondu

ct c

omm

unity

aw

aren

ess

on

the

avai

labi

lity

and

impo

rtan

ce o

f V

IA a

nd c

ryot

hera

py

• #

of c

omm

unity

aw

aren

ess

sess

ions

FMoH

, R

HB

• A

vail V

IA a

nd c

ryot

hera

py s

ervi

ces

at a

ll he

alth

faci

litie

s fr

om h

ealth

ce

nter

leve

l

• %

of H

F pr

ovid

ing

VIA

and

cr

yoth

erap

y se

rvic

esFM

oH,

RH

B

• Bu

ild h

uman

res

ourc

e ca

paci

ty t

o co

nduc

t VIA

and

cry

othe

rapy

• #

of h

ealth

wor

kers

tra

ined

on

VIA

and

cry

othe

rapy

• To

tal #

and

% (

of t

arge

t po

pula

tion)

of c

lient

s sc

reen

ed w

ith V

IA

FMoH

, R

HB

• Eq

uip

heal

th fa

cilit

ies

with

VIA

and

cr

yoth

erap

y m

achi

nes

• #

of h

ealth

faci

litie

s w

ith

func

tiona

l VIA

/cry

othe

rapy

eq

uipm

ent

and

supp

lies

• To

tal #

and

% o

f wom

en

scre

enin

g po

sitiv

e on

V

IA a

nd t

reat

ed w

ith

cryo

ther

apy/

LEEP

FMO

H,

PFSA

• D

evel

op r

efer

ral s

yste

m fo

r ad

vanc

ed t

reat

men

t•

Ref

erra

l sys

tem

in p

lace

FM

oH, R

HB

• In

trod

uce

and

adop

t in

nova

tive

appr

oach

es t

o ra

pidl

y sc

reen

larg

e nu

mbe

rs o

f wom

en

• #

of i

nnov

ativ

e ap

proa

ches

ad

opte

dFM

oH, R

HB

NA

TIO

NA

L C

AN

CE

R C

ON

TR

OL

PL

AN

OF

ET

HIO

PIA

- 2

01

6-2

02

0

75

4.3

Dia

gnos

is a

nd T

reat

men

t of

Can

cer

Out

put

Indi

cato

r: #

of f

ully

equ

ippe

d an

d fu

nctio

nal c

ance

r di

agno

sis

and

trea

tmen

t ce

nter

s

Stra

tegy

Obj

ectiv

eA

ctiv

ities

Mon

itori

ng in

dica

tors

Res

pons

ible

Bo

dies

Tim

e fr

ame

Y1

Y2

Y3

Y4

Y5

a. Pr

imar

y ca

re le

vel

Stra

tegy

1:

Ear

ly

Dia

gnos

is

Obj

ecti

ve:

To In

crea

se

awar

enes

s to

50

% a

mon

g th

e ge

nera

l po

pula

tion

and

heal

th

care

pro

vider

s of

ear

ly sig

ns a

nd

sym

ptom

s an

d op

port

uniti

es

for

early

de

tect

ion

of

the

top

two

canc

ers

• Id

entif

y an

d pr

ompt

ly r

efer

pa

tient

s su

spec

ted

of b

reas

t an

d ce

rvic

al c

ance

r

• %

of t

arge

t po

pula

tion

iden

tifi e

d an

d pr

ompt

ly r

efer

red

for

susp

ecte

d br

east

and

cer

vica

l ca

ncer

• T

ime

it ta

kes

to r

ecei

ve d

iagn

osis

an

d tr

eatm

ent

for

cerv

ical

/bre

ast

canc

er

FMoH

, RH

B

• Tr

ain

heal

th p

rofe

ssio

nals

on

clin

ical

bre

ast

exam

inat

ion

• %

of t

rain

ed h

ealth

wor

kers

abl

e to

cor

rect

ly c

ondu

ct c

linic

al

brea

st e

xam

inat

ion

• %

of t

rain

ed h

ealth

wor

kers

w

ith c

orre

ct k

now

ledg

e of

ear

ly

sym

ptom

s an

d si

gns

of b

reas

t ca

ncer

FMoH

, RH

B,

Uni

vers

ities

• C

ondu

ct a

war

enes

s ca

mpa

igns

• #

of w

omen

rea

ched

with

aw

aren

ess

mes

sage

s on

cer

vica

l an

d br

east

can

cer

FMoH

, RH

B

Stra

tegy

2:

Com

mun

ity

supp

ort

for

canc

er

patie

nts

Obj

ecti

ve:

To im

prov

e co

mm

unity

ba

sed

canc

er

care

ser

vices

• Pr

ovid

e ed

ucat

ion

and

com

mun

ity s

uppo

rt fo

r pa

tient

s w

ith c

ance

r

• #

of c

ance

r pa

tient

s w

ho r

ecei

ve

adeq

uate

edu

catio

n, c

are

and

su

ppor

t FM

oH, R

HB

• In

tegr

ate

basi

c ca

ncer

car

e ac

tiviti

es w

ithin

exi

stin

g co

mm

unity

hea

lth w

orke

rs’

scop

e of

wor

k

• #

Com

mun

ity h

ealth

wor

kers

FM

oH, R

HB

NA

TIO

NA

L C

AN

CE

R C

ON

TR

OL

PL

AN

OF

ET

HIO

PIA

- 2

01

6-2

02

0

76

Stra

tegy

Obj

ectiv

eIn

terv

entio

nsM

onito

ring

indi

cato

rsR

espo

nsib

le

Bodi

esT

ime

fram

e

Y1

Y2

Y3

Y4

Y5

b.

Seco

ndar

y ca

re le

vel

Stra

tegy

1:

Impr

ove

and

incr

ease

ac

cess

to

diag

nost

ic

and

trea

tmen

t se

rvic

es

Obj

ecti

ves:

To

ach

ieve

ad

equa

te

diag

nosis

and

tr

eatm

ent f

or

20%

of p

atie

nts,

iden

tifi e

d by

the

early

det

ectio

n st

rate

gy

• D

evel

op a

sta

ndar

d se

t of

equ

ipm

ent

requ

ired

for

supp

lyin

g he

alth

faci

litie

s w

ith d

iagn

ostic

equ

ipm

ent

(to

incl

ude

ultr

asou

nd, X

-ray

, mam

mog

raph

y, cy

tolo

gy, h

emat

olog

y se

rvic

es)

and

secu

re c

omm

itmen

t to

fi na

nce

this

in

in a

pha

sed

man

ner

• %

of h

ealth

faci

litie

s eq

uipp

ed w

ith b

asic

can

cer

diag

nost

ic e

quip

men

t

FMoH

, PF

SA

• Tr

ain

med

ical

doc

tors

and

nur

ses

on

chem

othe

rapy

tre

atm

ent

• #

of m

edic

al d

octo

rs t

rain

ed

on c

hem

othe

rapy

for

canc

er•

# o

f tra

ined

med

ical

doc

tors

pr

ovid

ing

chem

othe

rapy

ap

prop

riat

ely

FMoH

, U

nive

rsiti

es

Stra

tegy

2:

Pro

vide

su

rgic

al

trea

tmen

t

Obj

ecti

ves:

To

incr

ease

ac

cess

to

surg

ical

car

e by

el

igib

le p

atie

nts

by 5

0% b

y 20

20

• Ex

pand

sur

gica

l tre

atm

ent

of b

reas

t ca

ncer

•

% o

f bre

ast

canc

er p

atie

nts

(elig

ible

for

surg

ery)

who

re

ceiv

ed s

urgi

cal t

reat

men

t

FMoH

, RH

B,

Uni

vers

ity

Hos

pita

ls

• R

efer

to

tert

iary

leve

l pat

ient

s w

ho

requ

ire

radi

othe

rapy

and

com

plex

su

rger

y•

% r

efer

red

for

adva

nced

car

eFM

oH, R

HB,

U

nive

rsity

H

ospi

tals

• St

reng

then

sur

gica

l tre

atm

ent

of

cerv

ical

can

cer

• %

of c

ervi

cal c

ance

r pa

tient

s (e

ligib

le fo

r su

rger

y) w

ho

rece

ived

sur

gica

l tre

atm

ent

FMoH

, RH

B,

Uni

vers

ity

Hos

pita

ls

• O

rgan

ize

peri

odic

rot

atio

n of

sur

gica

l se

rvic

es a

t se

cond

ary

hosp

itals

•

Rou

nds

of c

ampa

igns

co

nduc

ted

FMoH

, RH

B,

Uni

vers

ity

Hos

pita

ls

NA

TIO

NA

L C

AN

CE

R C

ON

TR

OL

PL

AN

OF

ET

HIO

PIA

- 2

01

6-2

02

0

77

Stra

tegy

Obj

ectiv

eIn

terv

entio

nsM

onito

ring

indi

cato

rsR

espo

nsib

le

Bodi

es

Tim

e fr

ame

Y1

Y2

Y3

Y4

Y5

c. Tert

iary

ca

re le

vel

Stra

tegy

1:

Cap

acity

bu

ildin

g

Obj

ecti

ves:

To

obt

ain

50%

of t

he

requ

ired

heal

th

wor

kfor

ce

to e

ffect

ively

diag

nose

and

tr

eat c

ance

r in

Eth

iopi

a by

20

20

• D

evel

op a

hea

lth w

orkf

orce

pla

n fo

r ca

ncer

• #

ofh

ealth

wor

kers

tr

aine

dFM

oH,

Uni

vers

ities

, Pa

rtne

rs

• Ta

sk t

he p

rofe

ssio

nal s

ocie

ties

to a

dapt

inte

rnat

iona

l gui

delin

es

for

diag

nosi

s an

d tr

eatm

ent

of

canc

er fo

r Et

hiop

ia

• #

of p

rofe

ssio

nal s

ocie

ties

enga

ged

FMoH

• Tr

ain

diffe

rent

leve

ls o

f hea

lth

prof

essi

onal

s on

can

cer

diag

nosi

s an

d tr

eatm

ent

• %

of h

ealth

wor

kers

with

co

rrec

t kn

owle

dge

of

earl

y sy

mpt

oms

and

sign

s of

bre

ast

canc

er

FMoH

, U

nive

rsiti

es,

Part

ners

• Su

pply

per

sona

l pro

tect

ive

equi

pmen

t fo

r he

alth

pr

ofes

sion

als

who

pre

pare

or

adm

inis

ter

chem

othe

rapy

, and

tr

ain

them

in it

s us

e

• %

of h

ealth

wor

kers

in

volv

ed in

can

cer

trea

tmen

t pr

ovid

ed w

ith

PPE

FMoH

NA

TIO

NA

L C

AN

CE

R C

ON

TR

OL

PL

AN

OF

ET

HIO

PIA

- 2

01

6-2

02

0

78

Stra

tegy

2:

Impr

ove

acce

ss t

o ad

vanc

ed

diag

nost

ic

and

trea

tmen

t

Obj

ecti

ves:

To

ava

il ac

cess

to

can

cer

diag

nosis

and

tr

eatm

ent t

o 30

% o

f new

ca

ncer

pat

ient

s by

202

0

• A

vail

diag

nosi

s w

ith

imm

unoh

isto

chem

istr

y, C

T,

MR

I, en

dosc

opy,

bone

sca

n fl o

cyto

met

ry, a

nd P

CR

• R

ange

of d

iagn

ostic

fa

cilit

ies

avai

labl

e•

# o

f equ

ippe

d te

rtia

ry

cent

ers

corr

ectly

and

pr

ompt

ly d

iagn

osin

g ca

ncer

• %

of t

ime

with

equ

ipm

ent

brea

kdow

n

FMoH

, PFS

A

• Bu

ild c

apac

ity fo

r ad

min

istr

atio

n of

che

mot

hera

py a

nd h

orm

onal

th

erap

y

• %

of h

ealth

faci

litie

s pr

ovid

ing

chem

othe

rapy

an

d ho

rmon

al t

hera

py•

% o

f tim

e w

ith s

tock

-out

s of

che

mo

and

horm

ones

fo

r tr

eatm

ent

FMoH

, RH

B,

Uni

vers

ities

• Ex

pand

rad

ioth

erap

y se

rvic

es t

o 5

regi

onal

tea

chin

g ho

spita

ls

• #

of n

ewly

est

ablis

hed

ra

diot

hera

py c

ente

rs•

% o

f tim

e w

ith e

quip

men

t br

eakd

own

• #

of t

rain

ed s

taff

to

corr

ectly

adm

inis

ter

radi

othe

rapy

FMO

H, M

OST

, PF

SA

• Pr

ovid

e co

mpl

ex o

ncol

ogy

surg

ery

for

canc

er p

atie

nts

• #

of h

ealth

faci

litie

s pr

ovid

ing

canc

er s

urge

ryFM

oH,

Uni

vers

ities

• Im

prov

e av

aila

bilit

y of

blo

od a

nd

bloo

d pr

oduc

t

• #

of f

acili

ties

with

blo

od

and

bloo

d pr

oduc

ts fo

r ca

ncer

tre

atm

ent

ERC

S, FM

oH,

• Im

prov

e re

habi

litat

ion

serv

ices

• #

of c

ance

r re

habi

litat

ion

cent

ers

offe

ring

un

inte

rrup

ted

serv

ices

FM

oH, P

artn

ers

NA

TIO

NA

L C

AN

CE

R C

ON

TR

OL

PL

AN

OF

ET

HIO

PIA

- 2

01

6-2

02

0

79

Stra

tegy

3:

Impr

ove

avai

labi

lity

of r

equi

red

med

icin

es

and

med

ical

eq

uipm

ent

Obj

ectiv

es: T

o ac

hiev

e ca

ncer

di

agno

sis a

nd

trea

tmen

t ce

nter

with

un

inte

rrup

ted

and

up to

the

stan

dard

car

e by

20

20

• En

sure

ava

ilabi

lity

of c

ance

r tr

eatm

ent

equi

pmen

t, m

edic

ine

and

supp

lies

• %

of h

ealth

faci

litie

s w

ith

unin

terr

upte

d su

pply

of

med

icin

e an

d eq

uipm

ent

FMoH

, PFS

A

• In

vent

ory

of r

equi

red

equi

pmen

t, m

edic

ine

and

supp

lies

with

sc

ient

ifi c

quan

tifi c

atio

ns a

nd

fore

cast

• #

of i

nven

tori

es

cond

ucte

d pe

r ye

arFM

oH, P

FSA

NA

TIO

NA

L C

AN

CE

R C

ON

TR

OL

PL

AN

OF

ET

HIO

PIA

- 2

01

6-2

02

0

80

4.4

Palli

ativ

e C

are

and

Pain

Rel

ief

Out

put

Indi

cato

r: %

of e

ligib

le c

ance

r pa

tient

s re

ceiv

ing

PC

Stra

tegy

Obj

ectiv

eIn

terv

entio

nsM

onito

ring

indi

cato

rsR

espo

nsib

le

Bodi

esT

ime

fram

e

Y1

Y2

Y3

Y4

Y5

Stra

tegy

2:

Inte

grat

e pa

lliat

ive

care

ser

vice

at

all

leve

ls

heal

th

deliv

ery

outle

ts

Obj

ecti

ve:

To e

nsur

e at

le

ast 5

0% o

f he

alth

faci

litie

s pr

ovid

e pa

lliativ

e ca

re

serv

ices

by

2020

• D

evel

op a

n es

sent

ial p

allia

tive-

care

m

edic

ines

list

•

A n

atio

nal e

ssen

tial

med

icin

es li

st w

ith

palli

ativ

e ca

re m

edic

ines

in

clud

ed

EFM

HA

CA

, FM

oH, P

FSA

• In

tegr

ate

palli

ativ

e ca

re s

ervi

ces

into

the

nat

iona

l hea

lth s

ervi

ces

• %

of h

ealth

faci

litie

s pr

ovid

ing

palli

ativ

e ca

reFM

oH, R

HB

• En

sure

ava

ilabi

lity

and

acce

ss t

o m

edic

atio

n an

d su

pplie

s•

% o

f pat

ient

s in

nee

d of

PC

rec

eivi

ng t

he s

ervi

ceEF

MH

AC

A,

FMoH

, PFS

A

• Su

ppor

t he

alth

pro

fess

iona

ls t

o in

corp

orat

e pa

lliat

ive

care

ski

lls in

to

thei

r da

ily a

nd r

outin

e se

rvic

es

• %

of H

Ws

with

bas

ic

know

ledg

e an

d sk

ills

on

PCFM

oH, R

HB

• St

reng

then

ref

erra

l and

net

wor

king

be

twee

n fa

cilit

ies

and

com

mun

ity-

base

d ca

re

• #

of c

omm

uniti

es w

ith

func

tiona

l ref

erra

l sy

stem

on

PCFM

oH, R

HB

• Pr

omot

e pa

tient

& fa

mily

-cen

tere

d ca

re t

hrou

gh t

rain

ing

and

educ

atio

n •

# o

f PC

cen

ters

su

ppor

ted

FMoH

, RH

B,

Part

ners

NA

TIO

NA

L C

AN

CE

R C

ON

TR

OL

PL

AN

OF

ET

HIO

PIA

- 2

01

6-2

02

0

81

Stra

tegy

Obj

ectiv

eIn

terv

entio

nsM

onito

ring

indi

cato

rsR

espo

nsib

le

Bodi

esT

ime

fram

e

Y1

Y2

Y3

Y4

Y5

Stra

tegy

1:

Cap

acity

Bu

ildin

g fo

r H

ealth

Fa

cilit

ies

and

Com

mun

ity

Obj

ecti

ve:

To b

uild

bot

h in

stitu

tiona

l an

d co

mm

unity

ca

paci

ty o

n pa

lliativ

e ca

re

• C

ondu

ct a

war

enes

s ca

mpa

igns

on

palli

ativ

e ca

re t

hat

targ

et p

olic

y-m

aker

s, th

e pu

blic

, med

ia, h

ealth

car

e pe

rson

nel a

nd r

egul

ator

s.

• #

of a

war

enes

s cr

eatio

n se

ssio

ns c

ondu

cted

per

ye

arFM

oH, R

HB,

Pa

rtne

rs,

• Tr

ain

heat

h ex

tens

ion

wor

kers

on

PC

ski

lls fo

r id

entifi

cat

ion,

as

sess

men

t an

d tr

eatm

ent

of

dist

ress

ing

sym

ptom

s in

can

cer

patie

nts

• %

of H

EW t

rain

ed o

n PC

FMoH

, RH

B,

Part

ners

,

• Bu

ild c

apac

ity o

f hea

lth c

are

prov

ider

s an

d ca

re g

iver

s on

pa

lliat

ive

care

.

• %

of H

W a

nd c

are

give

rs w

ith t

he c

orre

ct

know

ledg

e on

bas

ic

prin

cipl

es o

f PC

FMoH

, RH

B,

Part

ners

,

NA

TIO

NA

L C

AN

CE

R C

ON

TR

OL

PL

AN

OF

ET

HIO

PIA

- 2

01

6-2

02

0

82

Stra

tegy

Obj

ectiv

eIn

terv

entio

nsM

onito

ring

indi

cato

rsR

espo

nsib

le

Bodi

esT

ime

fram

e

Y1

Y2

Y3

Y4

Y5

Stra

tegy

3:

Stre

ngth

en

Hom

e Ba

sed

Car

e an

d Vo

lunt

eeri

sm

Obj

ecti

ve: T

o cr

eate

a s

tron

g pa

tient

and

fa

mily

-cen

tere

d ap

proa

ch th

at

enco

urag

es

early

rep

ortin

g an

d pr

ompt

m

anag

emen

t of

canc

er p

atie

nts

livin

g in

the

com

mun

ity

• M

obili

ze c

omm

uniti

es t

hrou

gh

awar

enes

s-ra

isin

g, tr

aini

ng a

nd

reco

gniti

on o

f pro

blem

s

• #

of c

omm

unity

m

obili

zatio

n se

ssio

ns

FMoH

, RH

B

• St

reng

then

com

mun

ity a

nd

hom

e-ba

sed

palli

ativ

e ca

re

serv

ices

incl

udin

g es

tabl

ishm

ent

of n

utri

tiona

l sup

port

ser

vice

s fo

r ca

ncer

pat

ient

s.

• #

of a

ctiv

e co

mm

unity

and

ho

me-

base

d PC

cen

ters

FMoH

, RH

B,

Part

ners

• Es

tabl

ish

soci

al s

uppo

rt s

ervi

ces

for

canc

er p

atie

nts

and

prov

ide

palli

ativ

e ca

re s

ervi

ces

for

grou

ps

with

spe

cial

nee

ds, c

hild

ren

and

elde

rly

• #

of c

ente

rs e

stab

lishe

d•

# o

f est

ablis

hed

cent

ers

that

pro

vide

soc

ial s

uppo

rt

to fa

mili

es a

nd p

atie

nts

FMoH

, RH

B,

Part

ners

• M

aint

ain

freq

uent

and

ear

ly

cont

act

with

pat

ient

s th

roug

h H

EW a

nd v

olun

teer

com

mun

ity

wor

kers

• %

of p

atie

nts

in n

eed

of P

C

cont

acte

d by

HEW

sFM

oH, R

HB,

Pa

rtne

rs

NA

TIO

NA

L C

AN

CE

R C

ON

TR

OL

PL

AN

OF

ET

HIO

PIA

- 2

01

6-2

02

0

83

Stra

tegy

4:

Inco

rpor

ate

Palli

ativ

e C

are

as P

art

of H

ealth

Sc

ienc

es

Stud

ies

Cur

ricu

lum

Obj

ectiv

e:

Dev

elop

cur

ricul

a an

d tr

aini

ng

mat

eria

ls fo

r pa

lliativ

e ca

re.

• R

aise

aw

aren

ess

on t

he r

elev

ance

of

PC

in t

he c

ontin

uum

of c

ance

r ca

re

• #

of d

ecis

ion-

mak

ers

reac

hed

with

in

form

atio

n on

PC

as

a pa

rt o

f the

con

tinuu

m o

f ca

ncer

car

e

FMoH

, R

HB

• R

ecog

nize

pal

liativ

e ca

re

spec

ializ

atio

n in

the

hea

lth

wor

kfor

ce•

Esta

blis

h PC

as

a sp

ecia

lized

tra

inin

gFM

oH,

Uni

vers

ities

• D

esig

n an

d im

plem

ent

PC

curr

icul

um fo

r ph

ysic

ians

,hea

lth

offi c

ers,

nurs

es a

nd p

harm

acis

ts

and

othe

r re

leva

nt m

embe

rs o

f the

m

ultid

scip

linar

y te

am

• #

of P

C c

urri

cula

de

velo

ped

• #

of i

nstit

utio

ns u

sing

th

e PC

cur

ricu

lum

•

# o

f hea

lth w

orke

rs

FMoH

, U

nive

rsiti

es

NA

TIO

NA

L C

AN

CE

R C

ON

TR

OL

PL

AN

OF

ET

HIO

PIA

- 2

01

6-2

02

0

84

Stra

tegy

Obj

ectiv

eIn

terv

entio

nsM

onito

ring

indi

cato

rsR

espo

nsib

le

Bodi

es

Tim

e fr

ame

Y1

Y2

Y3

Y4

Y5

Stra

tegy

5:

Net

wor

king

, pa

rtne

rshi

p an

d co

llabo

ratio

n am

ong

publ

ic

heal

th c

are

syst

em, n

on–

stat

e ac

tors

an

d th

e co

mm

unity

Obj

ecti

ve:

Dev

elop

ne

twor

ks,

part

ners

hips

and

co

llabo

ratio

n w

ith lo

cal a

nd

inte

rnat

iona

l pa

rtne

rs.

• M

ap a

ll st

akeh

olde

rs w

orki

ng

on P

C a

nd p

repa

re d

irec

tory

• A

vaila

bilit

y of

a n

atio

nal

dire

ctor

y on

PC

FMoH

• Fa

cilit

ate

natio

nal p

artn

ersh

ip

on P

C fo

r ca

ncer

• #

of n

atio

nal f

orum

on

PC

esta

blis

hed

FMoH

• D

evel

op a

nd im

plem

ent

natio

nal p

allia

tive

care

gu

idel

ine

and

harm

oniz

e na

tiona

l effo

rts

• N

atio

nal P

C g

uide

line

avai

labl

e an

d di

ssem

inat

ed•

# o

ffaci

litie

s th

at u

se t

he

PC g

uide

lines

•

FMoH

NA

TIO

NA

L C

AN

CE

R C

ON

TR

OL

PL

AN

OF

ET

HIO

PIA

- 2

01

6-2

02

0

85

4.5

Can

cer

Surv

eilla

nce

and

Res

earc

hO

utpu

t In

dica

tor:

# o

f CR

est

ablis

hed

and

func

tioni

ng

Stra

tegy

Obj

ectiv

eIn

terv

entio

nsM

onito

ring

indi

cato

rsR

espo

nsib

le

Bodi

esT

ime

fram

e

Y1

Y2

Y3

Y4

Y5

Stra

tegy

1:

Enha

ncin

g su

rvei

llanc

e fo

r ca

ncer

an

d its

ris

k fa

ctor

s

Obj

ecti

ve

1: T

o es

tabl

ish

natio

nal

and

regi

onal

ca

ncer

re

gist

ries.

• D

evel

op g

uide

lines

, too

ls a

nd s

tand

ards

fo

r ca

ncer

reg

istr

ies

in c

olla

bora

tion

with

the

Afr

ican

Can

cer

Reg

istr

y N

etw

ork

• A

vaila

bilit

y of

too

ls a

nd

guid

elin

es

FMoH

, RH

B

• C

ondu

ct r

egio

nal n

eeds

ass

essm

ent

for

esta

blis

hing

can

cer

regi

stri

es

• A

sses

smen

t re

port

ava

ilabl

e an

d us

ed fo

r ca

ncer

re

gist

ries

FMoH

, RH

B

• Es

tabl

ish

popu

latio

n-ba

sed

and

regi

onal

ca

ncer

reg

istr

ies

• #

of C

R e

stab

lishe

d•

# o

f est

ablis

hed

CR

s th

at

are

func

tiona

lFM

oH, R

HB

• A

dopt

and

cus

tom

ize

the

IAR

C/G

ICR

cu

rric

ulum

for

trai

ning

can

cer

regi

stra

rs•

Trai

ning

cur

ricu

lum

ava

ilabl

e an

d us

edFM

oH, R

HB

• Bu

ild c

apac

ity o

f can

cer

regi

stra

tion

pers

onne

l and

sen

sitiz

e he

alth

pe

rson

nel o

n ca

ncer

reg

istr

atio

n.

• #

of t

rain

ed p

erso

nnel

on

CR

FMoH

, RH

B

• D

efi n

e a

stan

dard

list

and

pro

cure

eq

uipm

ent

for

new

can

cer

serv

ices

as

appr

opro

pria

te

• %

of c

ance

r re

gist

ry

cent

ers

supp

lied

with

bas

ic

equi

pmen

t an

d fu

nctio

nal

FMoH

, RH

B

• G

ener

ate

and

publ

ish

annu

al c

ance

r st

atus

rep

orts

• #

of r

epor

ts p

rodu

ced

FMoH

, RH

B

NA

TIO

NA

L C

AN

CE

R C

ON

TR

OL

PL

AN

OF

ET

HIO

PIA

- 2

01

6-2

02

0

86

Stra

tegy

Obj

ectiv

eIn

terv

entio

nsM

onito

ring

indi

cato

rsR

espo

nsib

le

Bodi

esT

ime

fram

e

Y1

Y2

Y3

Y4

Y5

Stra

tegy

1:

Enha

ncin

g su

rvei

llanc

e fo

r ca

ncer

an

d its

ris

k fa

ctor

s

Obj

ecti

ve 2

: To

impr

ove

canc

er

surv

eilla

nce

syst

em.

• R

evie

w a

nd r

evis

e ex

istin

g ca

ncer

sur

veill

ance

and

re

gist

ratio

n to

ols.

• #

of t

ools

rev

ised

FMoH

, RH

B

• D

evel

op a

nd h

arm

oniz

e ca

ncer

sur

veill

ance

too

ls•

Ava

ilabi

lity

of c

ance

r su

rvei

llanc

e to

ols

FMoH

, RH

B

• Tr

ain

pers

onne

l on

the

use

of t

he c

ance

r re

gist

ratio

n an

d su

rvei

llanc

e to

ols.

• %

of p

erso

nnel

tra

ined

FMoH

, RH

B,

Uni

vers

ities

Obj

ecti

ve 3

: To

diss

emin

ate

canc

er

info

rmat

ion

to r

elev

ant

stak

ehol

ders

• Es

tabl

ish

guid

elin

es fo

r di

ssem

inat

ion

and

utili

ty o

f su

rvei

llanc

e/re

gist

ry d

ata.

• G

uide

lines

for

diss

emin

atio

n de

velo

ped

FMoH

, U

nive

rsiti

es

• H

old

an a

nnua

l can

cer

conf

eren

ce.

• C

ance

r co

nfer

ence

rep

ort

• R

ecom

men

datio

ns fr

om t

he

conf

eren

ce im

plem

ente

d to

im

prov

e ca

ncer

reg

istr

atio

n

FMoH

, U

nive

rsiti

es

• G

ener

ate

and

publ

ish

annu

al c

ance

r st

atus

re

port

s.

• #

of c

ance

r-sp

ecifi

c re

port

s pu

blis

hed

and

diss

emin

ated

• D

ata

from

the

ann

ual c

ance

r st

atus

rep

ort

used

for

deci

sion

-mak

ing;

qual

ity o

f dat

a in

the

se r

epor

ts.

FMoH

, RH

B,

Uni

vers

ities

NA

TIO

NA

L C

AN

CE

R C

ON

TR

OL

PL

AN

OF

ET

HIO

PIA

- 2

01

6-2

02

0

87

Stra

tegy

Obj

ectiv

eIn

terv

entio

nsM

onito

ring

indi

cato

rsR

espo

nsib

le

Bodi

esT

ime

fram

e

Y1

Y2

Y3

Y4

Y5

Stra

tegy

2:

Impr

ove

rese

arch

ca

paci

ty a

nd

esta

blis

h co

llabo

ratio

n

Obj

ecti

ve: T

o ad

vanc

e Et

hiop

ian

canc

er d

iagn

osis

and

trea

tmen

t ce

nter

to a

ne

twor

ked

cent

er o

f ex

celle

nce

by 2

020

• D

evel

op n

etw

orks

, par

tner

ship

s an

d co

llabo

ratio

n w

ith lo

cal a

nd

inte

rnat

iona

l par

tner

s

• #

of n

etw

orks

•

# o

f fun

ctio

nal n

etw

orks

FMoH

, U

nive

rsiti

es,

Part

ners

• C

ondu

ct r

esea

rch

on d

iagn

ostic

te

sts

and

trea

tmen

t of

can

cers

•

# o

f res

earc

h pa

pers

on

canc

er p

ublis

hed

FMoH

, U

nive

rsiti

es,

Part

ners

• Es

tabl

ish

popu

latio

n or

faci

lity-

base

d ca

ncer

reg

istr

y

• #

of C

R e

stab

lishe

d•

# o

f CR

tha

t ar

e fu

nctio

nal

FMoH

, U

nive

rsiti

es,

4.6

Mon

itor

ing

and

Eval

uati

on

Stra

tegy

Obj

ectiv

eIn

terv

entio

nsM

onito

ring

indi

cato

rsR

espo

nsib

le

Bodi

esT

ime

fram

e

Y1

Y2

Y3

Y4

Y5

Stra

tegy

: St

reng

then

m

onito

ring

an

d ev

alua

tion

of c

ance

r C

ontr

ol

activ

ities

.

Obj

ecti

ve:

To m

onito

r an

d ev

alua

te c

ance

r Co

ntro

l int

erve

ntio

ns

• C

arry

out

a b

asel

ine

canc

er

situ

atio

nal a

naly

sis

• Ba

selin

e re

port

• R

esul

ts o

f bas

elin

e as

sess

men

t us

ed fo

r pl

anni

ng/r

epla

nnin

g

FMoH

, RH

B

• D

evel

op m

onito

ring

and

ev

alua

tion

guid

elin

es a

nd t

ools

.

• M

onito

ring

and

eva

luat

ion

guid

elin

es d

evel

oped

and

us

ed a

t al

l lev

els

of h

ealth

ca

re s

yste

m

FMoH

, RH

B

• D

evel

op a

mon

itori

ng a

nd

eval

uatio

n fr

amew

ork

for

canc

er

Con

trol

• M

& E

fram

ewor

k fo

r ca

ncer

dev

elop

ed a

nd

diss

emin

ated

• qu

arte

rly

repo

rts

on

canc

er a

vaila

ble

FMoH

, RH

B

NA

TIO

NA

L C

AN

CE

R C

ON

TR

OL

PL

AN

OF

ET

HIO

PIA

- 2

01

6-2

02

0

88

5. T

HE

CO

ST O

F N

AT

ION

AL

CA

NC

ER C

ON

TR

OL

PLA

N O

F ET

HIO

PIA

Tabl

e 1:

Pro

ject

ed c

ost o

f the

Nat

iona

l Can

cer

Cont

rol P

lan

by a

str

ateg

y (

X 1

000

USD

)

Stra

tegy

2016

2017

2018

2019

2020

Tota

l cos

t%

Prim

ary

Prev

entio

n of

C

ance

r 3

,220

.98

2,5

85.8

2 2

,657

.60

2,7

43.9

6 2

,837

.23

14,

045.

59

19.2

Earl

y D

etec

tion

of

Can

cer

1,1

88.2

7 1,

066.

711,

113.

301,

105.

351,

142.

385,

616.

007.

7

Dia

gnos

is a

nd T

reat

men

t of

Can

cer

33,3

97.5

0 7

,649

.05

7,8

93.1

7 8

,150

.27

8,4

21.0

5 6

5,51

1.04

62

.2

Palli

ativ

e C

are

1,4

40.3

1 1

,467

.24

1,4

95.6

1 1

,528

.74

1,5

39.6

4 7

,471

.54

10.2

Can

cer

Surv

eilla

nce

and

Res

earc

h 9

0.07

8

2.10

8

3.23

9

4.93

8

5.76

4

36.0

9 0.

6

Mon

itori

ng a

nd

Eval

uatio

n 2

7.14

2

7.44

2

7.77

2

8.13

2

8.52

1

39.0

1 0.

2

Tota

l39

,364

.27

12,8

78.3

613

,270

.68

13,6

51.3

714

,054

.58

93,2

19.2

610

0.0

NA

TIO

NA

L C

AN

CE

R C

ON

TR

OL

PL

AN

OF

ET

HIO

PIA

- 2

01

6-2

02

0

89

Tabl

e 2:

Det

aile

d bu

dget

by

cate

gory

of c

ostin

g fo

r th

e Et

hiop

ian

Nat

iona

l Can

cer

cont

rol P

lan

(X10

00 U

SD)

Cos

t C

ateg

ory

2016

20

17

2018

20

19

2020

T

otal

cos

t %

Trai

ning

4,2

47.8

7 4

,263

.23

4,2

85.7

9 4

,310

.15

4,3

36.4

6 2

1,44

3.50

29

.3

Stra

tegy

dev

elop

men

t 4

4.16

1

1.12

1

1.24

1

1.36

1

1.49

8

9.37

0.

1

Wor

ksho

p 8

60.7

7 8

67.1

0 8

73.9

6 8

81.3

6 8

89.3

6 4

,372

.55

6.0

Med

icin

e 4

,368

.48

4,3

68.4

8 4

,586

.90

4,8

16.2

5 5

,057

.06

23,

197.

16

31.7

Vacc

ine

- -

- -

- -

0.0

Med

ical

sup

plie

s -

- -

- -

- 0.

0

Med

ical

Equ

ipm

ent

21,1

21.6

4 1

,448

.45

1,4

48.4

5 1

,448

.45

1,4

48.4

5 26

,915

.45

9.4

Infr

astr

uctu

re 6

,000

.00

- -

- -

6,0

00.0

0 8.

2

Hum

an R

esou

rce

256

.80

271

.64

293

.37

316

.84

342

.19

1,4

80.8

6 2.

0

Aw

aren

ess

Rai

sing

2,3

00.8

1 1

,585

.16

1,7

05.7

8 1

,789

.13

1,8

99.8

6 9

,280

.74

12.7

Res

earc

h an

d pu

blic

atio

ns 3

8.00

3

8.00

3

8.00

3

8.00

3

8.00

1

90.0

0 0.

3

M&

E 1

1.36

1

1.36

1

1.36

1

1.36

1

1.36

5

6.80

0.

1

Man

ual D

evel

opm

ent

116

.75

25.

17

27.

18

29.

36

31.

71

230

.16

0.3

Oth

ers

- -

- -

- -

0.0

Tota

l 3

9,36

6.63

12

,889

.72

13,2

82.0

4 13

,652

.26

14,0

65.9

4 93

,256

.58

100.

0


90

6. REFERENCES

1. GLOBOCAN (IACR) 2012

2. WHO Global Health Observatory Data Repository (2010)

3. HSDP-IV Woreda-Based Health Sector Annual Core plan, Federal Ministry of Health of Ethiopia (2013/2014)

4. Health Sector Transformation Plan, Federal Ministry of Health of Ethiopia (2015/2016-2019/20)

5. Tikur Anbessa Specialized Hospital, Oncology Centre (Unpublished Report)

6. Addis Ababa Cancer Registry Data (2012-2014)


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