MINISTRY OF HEALTH

KINGDOM OF ESWATINI

NATIONAL CANCER PREVENTION &

CONTROL STRATEGY
2019
FOREWORD

The World Health Organization (WHO) describes cancer as the second leading cause
of death globally and is estimated to account for 9.6 million deaths in 2018. These
are premature deaths that can be prevented by enabling health systems to respond
more effectively and equitably to health care needs of people with cancer. According
to current evidence, between 30% and 50% of cancer deaths could be prevented by
modifying or avoiding key risk factors, including avoiding tobacco products,
reducing alcohol consumption, maintaining a healthy body weight, exercising
regularly and addressing infection-related risk factors. Tackling these risk factors
involves influencing public policy outside health.

Eswatini is not spared from the increasing burden of cancer. To respond to this
situation, the Ministry of Health (MoH) established the National Cancer Prevention
and Control Unit which coordinates the implementation of interventions aimed at
reducing cancer morbidity and mortality. To facilitate the implementation these
interventions the same Ministry has developed of the National Cancer Prevention
and Control Strategic Plan.

Since most of cancer determinants are outside the scope of the health sector, the
Strategic Plan proposes to extend cancer prevention and control interventions to all
government sectors and other relevant sectors with active participation of civil
society, NGOs, local associations and the community. This inter-sectoral approach
that is considered as “a must”, allows a better coordination of cancer prevention and
control interventions at all levels. The strategy is indeed a product of joint efforts
and an intensive consultation process between governmental institutions and
development partners and I have no doubt they will continue providing the
technical and financial support for the success of its implementation.

Finally, I would like to request all health workers to support the implementation of
all interventions defined in this document so that the MoH plays its role and
assumes its responsibilities as a leader and coordinator of cancer prevention and
control interventions in the country.

Dr. Vusi Magagula

Director of Health Services, Ministry of Health

National Cancer Prevention and Control Strategy 2019 2

ACKNOWLEDGEMENTS

The development of the National Cancer Prevention and Control Strategic Plan is a
product of joint efforts. In this regard, the Ministry of Health would like to take this
opportunity to thank all those who participated in the development of this valuable
document that include Government institutions, Non-Governmental Organizations
(NGOs), the World Health Organization (WHO) and Development Partners. Their
contribution is highly appreciated.

The valuable technical support received from other Government institutions and
public health programmes and units in the Ministry of Health was also a
determining contribution. The invaluable input from different health cadres
particularly doctors and nurses from different levels of the health system through
their participation in several consultative meetings are here distinctly recognised.

Finally, the Ministry of Health highly appreciates the dedication and technical know-
how of the members of the Cancer Task Force for demonstrating their
determination throughout the entire process.

Dr Velephi Okello
Deputy Director Health Services – Clinical, Ministry of Health

National Cancer Prevention and Control Strategy 2019 3

ACRONYMS

AIDS Acquired Immune Deficiency Syndrome

CHAI Clinton Health Access Initiative
EHCP Essential Health Care Packages
EBCCN Eswatini Breast And Cervical Cancer Network
ENCR Eswatini National Cancer Registry
HIV Human Immune Deficiency
MOH Ministry Of Health
M&E Monitoring And Evaluation
NCD Non Communicable Diseases
NHSSP National Health Sector Strategic Plan
SAM Service Availability Mapping
STEPS Stepwise Approach To Surveillance (Steps) Survey
SWOT Strengths, Weaknesses, Opportunities, and Threats
TB Tuberculoisis
TWG Technical Working Group
WHO World Health Organization

National Cancer Prevention and Control Strategy 2019 4

TABLE OF CONTENTS

FOREWARD ................................................................................................................................. 2
ACKNOWLEDGEMENTS........................................................................................................... 3
ACRONYMS .................................................................................................................................. 4
TABLE OF CONTENTS .............................................................................................................. 5
EXECUTIVE SUMMARY ............................................................................................................ 6
CHAPTER 1.................................................................................................................................. 7
1.1 INTRODUCTION .................................................................................................................................................................7
1.2 THE NATIONAL CANCER PREVENTION AND CONTROL STRATEGY ..........................................................................7
1.3 THE COUNTRY PROFILE ..................................................................................................................................................8
1.3.1 Demographic Data ......................................................................................................................................8
1.3.2 Health System ...............................................................................................................................................9
1.3.3 Health System Analysis ......................................................................................................................... 10
1.4 CANCER PREVENTION AND CONTROL SITUATION ANALYSIS................................................................................ 10
1.4.1 Epidemiology ............................................................................................................................................. 10
1.4.2 The Leading Cancers............................................................................................................................... 11
1.4.3 The NCPC Programme Performance ............................................................................................... 12
CHAPTER 2................................................................................................................................ 14
2.1 VISION ............................................................................................................................................................................. 14
2.2 MISSION .......................................................................................................................................................................... 14
2.3 GUIDING PRINCIPLES .................................................................................................................................................... 14
CHAPTER 3................................................................................................................................ 15
3.1 SITUATIONAL ANALYSIS (SWOT) ............................................................................................................................. 15
3.2 STAKEHOLDER ANALYSIS ............................................................................................................................................ 16
CHAPTER 4................................................................................................................................ 17
4.1 GOAL................................................................................................................................................................................ 17
4.2 STRATEGIC OBJECTIVES ............................................................................................................................................... 17
4.2.1 Strategic Objective 1 ............................................................................................................................... 17
4.2.2 Strategic Objective 2 ............................................................................................................................... 18
4.2.3 Strategic Objective 3 ............................................................................................................................... 19
4.2.4 Strategic Objective 4 ............................................................................................................................... 20
4.2.5 Strategic Objective 5 ............................................................................................................................... 21
4.2.6 Strategic Objective 6 ............................................................................................................................... 21
CHAPTER 5................................................................................................................................ 24
5.1 MONITORING AND EVALUATION................................................................................................................................. 24
5.2 PROGRAMME MANAGEMENT ...................................................................................................................................... 24
5.3 FUNDING ARRANGEMENT ............................................................................................................................................ 24
5.4 STRATEGY IMPLEMENTATION REVIEW ..................................................................................................................... 25

APPENDIX A: THE IMPLEMENTATION PLAN................................................................ .26

REFERENCES............................................................................................................................. 36

National Cancer Prevention and Control Strategy 2019 5

EXECUTIVE SUMMARY

Cancer is a class of diseases in which a group of cells display uncontrolled growth, with
intrusion on and destruction of adjacent tissues and sometimes spread to other
locations in the body via lymph or blood. Most cancers form a tumor (growth) but some,
like leukemia, do not. Cancer is now recognised globally as one of the leading
noncommunicable diseases. Second to cardiovascular diseases, cancers contribute to
over 7.9 million deaths (13% of total global mortality) each year and this figure is
projected to rise to nearly 10 million unless the problem is addressed urgently.

The National Cancer Prevention and Control Strategy is a response by the Ministries of
Health and stakeholders to the obvious need to prioritise cancer prevention and control
in Eswatini. It recognises that the disease cannot be eradicated, but that its effects can
be significantly 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 2019 to 2022 and explains the scientific basis for cancer
control and prevention; outlines a vision and mission; suggests objectives as well as
interventions to prevent and control cancer in Eswatini. The strategy draws from
experiences gained in various countries that have similar programmes, and also
includes technical advice provided by relevant bodies.

National Cancer Prevention and Control Strategy 2019 6

CHAPTER 1

1.1 Introduction

Cancer poses a major threat to public health in Eswatini and the incidence rates have
increased over the past years. The number of cancer cases and related deaths nationally
is expected to double over the next 20-30 years and the country is least capable to cope
with the challenges cancer presents. Due to lack of a well-organised and comprehensive
cancer programme, the coordination mechanisms result in service duplication or
inequity in service provision. Therefore, it is very important to build the capacities for
cancer prevention and control. This will lead to more standardised cancer management
through the whole continuum of care including guidelines, cancer policies, and action
plans thus reducing the late stage diagnosis and improving prompt appropriate action
particularly at the peripheral health facility level.

Cancer is a generic term for a large group of diseases that can affect any part of the
body. There are over 100 types of cancers, each classified according to the type of cells
initially affected. One defining feature of cancer is the rapid creation and replication of
abnormal cells that grow beyond their usual boundaries which can lead to metastasis
where the cancer invades adjoining parts of the body and spreads to other organs.
Metastases are the major cause of death from cancer (WHO, 2014).

1.2 The National Cancer Prevention and Control Strategy

The National Cancer Prevention and Control Strategy aims to build on the existing
health system in Eswatini in order to strengthen cancer prevention and control
capacities both in public and private sectors through the control of risk factors
associated with cancer, investment in cancer control workforce, use of equipment, and
cancer research. This is the first cancer control strategy document to be developed in
Eswatini. It consolidates aspects in cancer prevention, screening, diagnosis, treatments
and care for cancer patients as well as the investment required to deliver these services.

The strategy particularly reinforces the need for action to prevent cancer, especially
those related to smoking and other modifiable risk factors. Enhanced health promotion,
education, and advocacy will enable the government and other partners to improve the
public understanding of cancer. In particular, the strategy will empower the public to
adopt healthier lifestyles and help healthcare professionals to recognise the symptoms
of cancer and identify people at risk or living with cancer. The strategy seeks to improve
early detection of cancer by expanding the available screening programmes and
introducing mechanisms and services that are proven to save lives. It seeks to shorten
the time taken to diagnose and treat cancer by streamlining the diagnosis,referral
systems, and process of care as well as investing in more cancer treatment equipment,
cancer specialists, and other staff. The strategy also seeks to improve access to cancer
drugs and other aspects of care for cancer patients.

This strategy seeks to harmonise and coordinate cancer care, national cancer
registration, sharing of resources, and information among health facilities. It will ensure
patients and their families have better support and access to quality treatment
National Cancer Prevention and Control Strategy 2019 7
including palliative care. Lastly, the strategy will enable the country to improve services
through education and research in the field of cancer prevention and control ensuring a
culture of evidence based practice. The strategy is based on the WHO’s global cancer
control strategy.

The rapid increase in NCDs can be attributed to social and demographic factors which
include economic development, globalization of markets and urbanization. These
factors lead to increased exposure to modifiable lifestyle risk factors for cancer. These
changes, coupled with an increase in globalization of markets for unhealthy foods and
consumer products, elevate the risk factor prevalence in the population. To mitigate the
health impact of these socio-economic transformations, the country must brace for the
challenge in the prevalence of cancers. The prevention and control of this disease
therefore is a high priority in order to safeguard the gains made in economic
development and establishment of a national cancer prevention and control unit is
recommended since the burden of the disease is significant.

Consequently, there is an urgent need to make the most efficient use of the limited
resources available to make an impact in cancer prevention and control which is only
possible if the most efficient and cost-effective strategies are applied. The National
Cancer Prevention and Control Unit is a public health initiative designed to reduce the
incidence and mortality of cancer and improve the quality of life for cancer patients in
Eswatini which is done through systematic and equitable implementation of evidence-
based interventions for prevention, early detection, treatment, and palliation, making
the best use of available resources. Proper planning will ensure efficient use of
resources for cancer prevention and control.

The development of the cancer prevention and control strategy is necessitated by:
 the growing burden of cancer, including an increasing number of new patients every
year,
 the high impact of cancer mortality—cancer is among the leading causes of death in
Eswatini,
 increased costs of cancer care,
 uneven uptake of knowledge and innovation,
 limited availability of tools and resources and lack of collaboration among cancer
stakeholders

1.3 Country Profile

1.3.1 Demographic Data

The results of the 2017 population census show that the total population of the
Kingdom of Eswatini is 1,093,238 comprising of 531,111 males and 562,127 females. An
increase of 74,789 persons was registered during 2007-2017 (Central Statistical Office).
Out of this total addition, 49,683 additions were in the category of males and 25,106
were added among females (Central Statistical Office). The country’s population had
consistently shown an annual exponential growth rate of about 2 per cent or more
during the period 1936-1997 with maximum growth of 4.9 per cent recorded during
1956-1966 (Central Statistical Office). Women of childbearing age (15-49 years) make
National Cancer Prevention and Control Strategy 2019 8
up 26.1% of the population while all females account for 51.4% (Central Statistical
Office). An estimated 4.6% of the population is 60 years of age and above (Central
Statistical Office). It is significant to note that maximum population has been recorded
in the age-group 0-4 closely followed by 5-9, 10-14 and 15-19 age-groups (Central
Statistical Office). The median age is 21.7 years and it indicates that Eswatini is a
country with a very young population. 56 percent of the population is below 25 years of
age (Central Statistical Office).

The percentage of males is higher in the younger age groups but it is higher for females
in all age groups after 45 which indicates higher life expectancy of females. As a result of
HIV and AIDS, the life expectancy dropped to 32 in 2011 (Central Statistical Office). HIV
prevalence is 26%, the highest in the world, and TB prevalence is 707/100,000, also one
of the highest in the world (Central Statistical Office). Mortality rates are relatively high
for the Eswatini population. The Eswatini Annual Health Statistics Report (2011)
indicates that infant mortality rate is 100.5 deaths per 1,000 live births, and under-five
mortality rate is 146.3 deaths per 1,000 live births; 70% of all child deaths were
reported to have taken place during the first year of life. The crude death rate is 17.6
per 1,000.

1.3.2 Health System

The Eswatini health system is based on the concept of Primary Health Care and consists
of three main levels of prevention: primary, secondary and tertiary. At the primary
level, there are community based health workers, clinics, and outreach services. The
secondary level comprises of health care centres which offer both outpatient and
inpatient services and serve as referral points for the primary level facilities. The
tertiary level comprises of regional hospitals, specialised hospitals and the National
referral hospital and rehabilitation services.

The service delivery system of the Eswatini Health Sector is organised in a four-tier
system:

1. National (referral) Hospitals;

2. Regional Hospitals;
3. Primary Health Care facilities including Health Centres, Public Health Units, Rural
Clinics and a network of outreach sites;
4. Community Based Care where Rural Health Motivators (RHM), Faith-based Health
care Providers, Volunteers and Traditional Practitioners provide care, support and
treatment according to EHCP11.

The health care delivery system relies on both formal and informal sectors. In the
formal health service sector, there are both public and private health services providers
including NGOs, mission, industrial, and private practitioners. The informal sector
consists mainly of traditional and other alternative health care providers.Whilst the
Essential Health Package (EHP) has been developed to provide guidance in the
treatment of all ailments at all health care levels, the Task Shifting Strategy focuses on
the rational use of scarce human resources in the health sector.

National Cancer Prevention and Control Strategy 2019 9

1.3.3 Health System Analysis

The accessibility to health services is generally defined by availability, affordability,

accessibility and utilization. Eswatini has made substantial efforts to ensure that these
criteria are met. For the availability criterion, Eswatini has developed an Essential
Health Care Package that defines health care provision at each level for all conditions
including for NCDs. At the same time, an Essential Medicine List has been developed and
drugs that must be available at each level has been determined. Health workers at
various levels have been trained through a number of programmes in order to improve
the quality of services offered to patients. As needs rise, the use of in-service training
will continue.

Regarding affordability, all health care offered through public services are free in
principle. This is the case for ART, TB, Mental Illnesses, and Sexual Reproductive Health
(SRH) as well as for other key health programmes. However, symbolic fees may be
required for some specific health care services which unfortunately imposes a barrier
for access to essential care.

In terms of accessibility, Eswatini has made tangible progress to bring health care closer
to those in need through decentralization of health services. According to the Service
Availability and Readiness Assessment Report (2017), Eswatini has about 327 health
facilities. With comparison to other countries in Africa and consideration of the size of
the country, the quantity of health facilities is more than satisfactory. The adoption of
outreach approach by some health programmes (ART, EPI, Mental Health, and others),
has contributed to accessibility to health services particularly for people living and
located in rural areas far from health facilities. Furthermore, the development of the
Task Shifting Strategy constitutes an important step in accelerating the access to health
care services at all levels including in communities.

There has been no formal survey on health service utilization within Eswatini although
anecdotal evidence suggests it is obtainable. Further investigation and additional effort
is required in order to optimise the situation.

The key areas where specific actions are needed include:

 Acceleration of health services decentralization including using outreach approach
and giving priority to the population residing in remote areas that still have
difficulties in accessing health facilities because of geographical barriers.
 Combating stigma and discrimination.
 Health promotion and education particularly with the overarching objective of
inculcating health seeking behavior among the populace.

1.4 Cancer Prevention and Control Situation Analysis

1.4.1 Epidemiology

According to the International Agency for Research on Cancer, there were 14.1 million
new cancer cases, 8.2 million cancer deaths and 32.6 million people living with cancer
(within 5 years of diagnosis) in 2012 worldwide(Globocan 2012). 57% (8 million) of

National Cancer Prevention and Control Strategy 2019 10

new cancer cases, 65% (5.3 million) of cancer deaths and 48% (15.6 million) of the 5-
year prevalent cancer cases occurred in the less developed regions (Globocan 2012).
Many of these deaths due to cancer can be avoided with greater public awareness,
increased government support and funding for prevention, detection and treatment
(World Health Organization, 2014). Worth noting is that cancer is not a disease
affecting the affluent and elderly people and developed countries alone, but it is a global
epidemic, affecting all ages, from all socio-economic levels.

Cancers were previously considered more pervasive in affluent countries; however, the
highest burden now is heaviest on poor and disadvantaged populations. According to
the World Health Organization (WHO), more than two thirds of new cases and cancer
deaths occur in low and middle-income countries, where such numbers are increasing
at alarming rates. In some low-income countries, less than 15% of breast and cervical
cancer patients survive longer than five years following diagnosis, despite both being
highly curable diseases elsewhere in the world.

1.4.2 The Leading Cancers

The most commonly occurring cancers in Eswatini are shown in Figure 1 below. For
females, cervical cancer was the most commonly diagnosed cancer during the period
2014-2015 (age-standardized rate (ASR)): 75.3 per 100,000), followed by breast cancer
(ASR: 15.5 per 100,000), Kaposi Sarcoma (ASR: 6.2 per 100,000) and Non-Hodgkin
Lymphoma (4.2 per 100,000). Prostate cancer was the most commonly diagnosed
cancer among men (ASR: 34.2 per 100,000) followed by Kaposi Sarcoma (ASR: 11.1 per
100,000), Non –Hodgkin lymphoma (ASR: 5.0 per 100,000) and liver cancer (5.0 per
100,000). Apart from KS, the greatest cancer burdens on both males and females were
cancers of the reproductive system (prostate and cervical cancers).

Figure 1: Age-Standardized Incidence Rates per Sex of Top Ten Leading Cancers
(2014-2015)
Males Females

Cervix Uteri 75.3

Prostate 34.2
Karposi Sarcoma 11.1 6.2
Breast 15.5
Non-Hodgkin Lymphoma 5.0 4.2
Liver 5.0 3.2
Colorectum 4.6 2.9
Lung 4.3 2.9
Oesophagus 4.9 1.1
Leukaemia 3.0 2.1
80
-80 60
-60 40
-40 20
-20 0 20
20 40 60
60 80
80
ASR (World) per 100,000

Source: Eswatini National Cancer Registry

National Cancer Prevention and Control Strategy 2019 11

1.4.3 The NCPC Programme Performance

Of the 2,077 new cancer cases recorded among EmaSwatis in 2016-2017, the majority
(52.6%) were diagnosed in the Mbabane Government Hospital which is the national
referral hospital capacitated with an oncologist, the most surgeons, and the national
referral laboratory which links with Lancet for further diagnosis. The apparent rising
trend in cancer incidence can be attributed to many factors, including HIV prevalence,
population aging, and exposure to risk factors, such as smoking, unhealthy diet, physical
inactivity, and environmental pollution. It is estimated that 40% of cancers can be
prevented by risk factor modification (WHO, 2009).

The sharp increase in the number of new cancer cases between 2014 and 2015 may also
reflect an increase in cancer awareness. Unfortunately, most cancers are diagnosed at
advanced stages, largely because of late health seeking behavior, unavailability of
diagnostic equipment, and low uptake of cancer screening especially cervical cancer as
noted in Stepwise approach to surveillance (STEPS) survey done in the country in
2014[1, 5]. The survey reported that only 13.4% of sexually active women were
reported to have had cervical cancer screening, whereas the Service Availability
Mapping (SAM) report also revealed that the incidence of cancers associated with HIV,
such as KS, may decrease with increased availability of and access to antiretroviral
drugs. Early diagnosis and treatment are essential to reduce cancer-related mortality.
However, according to SAM (2014) a majority of cancer patients are diagnosed at very
late stages when the prognosis is poor.

Some years ago, the Kingdom of Eswatini initiated the Phalala Referral Fund, which
assists financially deserving Eswatini citizens who would otherwise not have access to
specialist medical care within or, in special circumstances, outside the Kingdom of
Eswatini. Through the Phalala Fund, the MOH refer cancer patient to local private
hospitals like the Eswatini Cancer Care and in South Africa. In the year 2017, out of all
referred cases, 37% was the oncology cases (NB. Referral visits refers to the number of
times that each patient travels back to South Africa to receive treatment i.e. each unique
care-seeking episode). Most such cancer patients are referred to South Africa for
surgery, radiation therapy and/or chemotherapy.

Figure 2: Proportion of cancer patients referred to South Africa through

Phalala Fund in 2017- mid 2018
Total Oncology Referral Visits
Compared with Total Referral Visits
800 633 male 5.2%, females 3.2%
600 Total Oncology
400 Referrals
235 232 Total Referrals
200 105
0
2017 2018

Source: Phalala Office Database

National Cancer Prevention and Control Strategy 2019 12

The policy of referring cancer cases diagnosed locally to SA for further management
requires expenditures for treatment, transportation, admission and lodging, as well as
care and rehabilitation related to the illness. Indirect costs include the loss of economic
output due to missed work (morbidity costs) and premature death (mortality costs). In
addition to the human toll of cancer, the financial cost is substantial. Cancer also has
hidden costs, such as health insurance premiums and nonmedical expenses
(transportation, child or elder care, housekeeping assistance, meals, etc.) (Lambe & all,
1994)

National Cancer Prevention and Control Strategy 2019 13

CHAPTER 2

2.1 Vision
The vision is for Eswatini to have comprehensive national cancer prevention and
control systems to reduce cancer morbidity and mortality.

2.2 Mission
The mission is to increase awareness on all cancer related issues and the creation of an
enabling environment for adoption and practice of evidence-based cancer prevention,
early detection, diagnosis, treatment, palliative care, rehabilitation, surveillance, and
research.

2.3 Guiding Principles

The implementation of the National Cancer Control Strategic Framework will be guided
by the following principles:

 Universal Access and Equity – All people should have full access to health care and
opportunities for prevention and control of cancer based on need regardless of age,
gender, religion, social status, presence of disabilities and the ability to pay

 Ethics – Confidentiality of intended beneficiaries will be maintained at all levels of

service delivery

 Evidence-Based Practices – All interventions and strategies for prevention and

control of cancer need to be based on scientific evidence and public health
principles.

 Holistic – Cancer services assess and support the physical, emotional, social and
spiritual needs of the patients and their families

 Partnership – Multidisciplinary and multi-sectoral collaboration and coordination

on NCD control interventions will always be promoted and supported

 Accountability – Service providers, organizations and government are held

responsible for upholding sound and ethical practice

 Human Rights – Respect for human dignity, with specific focus on ensuring that the
rights of the beneficiaries are guaranteed. NCD prevention and control strategies
must be formulated and implemented in accordance with international human
rights conventions and agreements

 Compassion – Cancer services are provided with genuine care and empathy for the
patients and their families

National Cancer Prevention and Control Strategy 2019 14

CHAPTER 3

3.1 Situational Analysis (SWOT)

Strengths Weaknesses
 Ongoing campaigns to raise  Screening services currently limited
awareness, community engagement to breast and cervical cancers
and social mobilisation activities
 Cancer survivors’ network  Stock out of chemotherapy drugs
 Cancer education proposed to be  Inadequate health care workers’
integrated into the school curriculum knowledge and limited availability of
and teachers to provide cancer dedicated healthcare workers to
education during lifeskills lessons provide screening services
 Decentralization and integration of  Limited intersectoral response to
screening services cancer control
 Availability of health care workers  Limited Monitoring and Evaluation
and staff trained in palliative care system with poor ownership
 High political commitment  Non availability of paediatric screening
and diagnosis
 Availability of diagnostic technologies  Inadequate peer support systems
 Availability of Pathologist, Cytologist,  Lack of follow-up on patients on
and other specialists treatment
 Availability of funds for referrals  Lack of structural referral system and
long waiting time for referral
Availability of Palliative Care system  Poor implementation of PC services in
(health facility and community health facilities
based)
 Availability of guidelines  Inadequate nutritional impact/support
for palliative patients
 Availability of PC medicines  Lack of HPV vaccine
 Availability of Chemotherapy Unit  Inadequate HPV genotyping screenings
 Chemotherapy drugs included in the  Poor control on risk factors (tobacco,
Government’s medicines tender alcohol, radiation)
system

National Cancer Prevention and Control Strategy 2019 15

 Opportunities Threats
 Presence of a decentralised health  Global and local financial instability
care system

 Availability of international donors to  Political interference

fund and support cancer initiatives
 Availability of local oncologist at the  Inadequate infrastructure
national hospital to train and mentor
health care workers
 Availability of funds for specialist  No cancer wards
training
 Existence of public private  Referral infrastructure challenges
partnerships
 Big companies can support  Cancer services not decentralised
establishment of cancer management
centres
 Existence of a well-established  Human resources deficient on skilled
decentralised HIV and TB personnel
management
 Availability of research unit and the  Deficiency of medical supplies and
Royal Technology Park to encourage drugs
and support research initiatives

3.2 Stakeholer Analysis

Primary Secondary Tertiary

 Cancer patients  Health workers  Politicians
 Cancer survivors  Pharmaceutical  Community leaders
corporations
 Caregivers  Private sector in  Training institutions
terms of provision
of drugs,
diagnostics
 Collaborating NGOs  International agencies:
WHO, CDC, PEPFAR,
USAID, UN, CHAI, etc.
 Rural Health  International and Local
Motivators / Private Sector Funding
community care Partners
workers
 Peer educators  Academicians and
Research Institutions
 Other public health  Mass Media
programmes
 Multi Sectoral
Collaborating
Ministries
National Cancer Prevention and Control Strategy 2019 16
CHAPTER 4

4.1 Goal

As stated in the WHO Global Framework for NCDs, the goal is to reduce cancer
morbidity and mortality by 25% by 2022.

4.2 Strategic Objectives

1. To reduce the number of new cancer cases attributable to modifiable risk factors by
2022 by 10%.
2. To increase the number of facilities providing screening, early detection, and
linkages to care to 60%.
3. To expand the number of level 3-5 facilities offering basic cancer diagnosis,
treatment, and palliative care to 80%.
4. To strengthen cancer surveillance, research and strategic information systems.
5. To improve the institutional and technical capacity for cancer prevention and
control.
6. To establish a high level mechanisms for multi-sectoral coordination and
partnership for prevention, treatment, care and rehabilitation of cancer.

4.2.1 Strategic Objective 1: To reduce the number of new cancer cases

attributable to modifiable risk factors by 2022 by 10%.

Prevention of cancer is a key element in cancer control. It offers the greatest public
health potential and the most cost-effective long-term cancer control as more than 40%
of cancers could be prevented by modifying or avoiding key risk factors (WHO, 2009).
The primary prevention of cancer aims at reducing the number of people who develop
the disease. It involves eliminating or minimising exposure to the risk factors
incriminated in its causation. Prevention services include the use of health protection,
health promotion, and disease prevention strategies. These services will alert the
population of cancer risk factors, promote healthier lifestyles, and create healthier
environments that aim to reduce potential risk factors. Some of these risk factors
include tobacco use, unhealthy diets,physical inactivity, harmful use of alcohol, sexually
transmitted HPV-infection, HIV infection, urban air pollution, and indoor smoke from
household use of solid fuels.

Strategic Activities
1. Create awareness in the general population on modifiable risk factors that pre-
dispose to cancer
 Create dialogue with at-risk populations to enhance community participation
in cancer prevention
 Develop and disseminate health education messages aimed at preventing
risky behaviours and adopting healthier lifestyles (Tobacco use, harmful use
of alcohol, unhealthy diet, physical inactivity and sexual behaviour)
 Advocate for the incorporation of risk factors reduction strategies into
educational curriculum

National Cancer Prevention and Control Strategy 2019 17

2. Control tobacco use and address alcohol abuse, unhealthy diet, physical inactivity
and sexual and reproductive factors
 Promote tobacco cessation programmes
 Advocate for physical environments that support safe active commuting, and
create space for recreational activity.
 Adapt and implement national guidelines on diet and physical activity.
 Advocate for the implementation of legislation on production and
consumption of alcohol
 Provide cessation and support services for smokers and develop tobacco
cessation guidelines
 Incorporate tobacco and alcohol control into school health programme
including in school curriculum
 Advocate for increased taxation of cigarette and alcohol and re-allocation of
collected funds to health services
 Provide cessation and support services for smokers and develop tobacco
cessation guidelines
 Incorporate tobacco and alcohol control into school health programme
including in school curriculum
3. Control of biological agents that cause cancer including prevention through vaccine
introduction
 Conduct awareness campaigns on screening for infectious diseases related to
cancer (HIV, helicobacter pylori, HPV, hepatitis B and C and Epstein Barr
virus)
 Educate parents on safety and need for universal infant immunization with
the aim of increasing uptake and coverage
 Support and promote the introduction of HPV vaccine
4. Control of environmental exposure to carcinogens
 Promote policy to minimise occupational related cancers and known
environmental carcinogens
 Conduct awareness campaigns on reducing exposure to air pollution and
other carcinogens via contamination of food (aflatoxins or dioxins)
 Engage with employers to reduce exposure to occupational carcinogens
 Conduct awareness campaigns on the dangers of exposure to ionizing
radiation

4.2.2 Strategic Objective 2: To increase to 60% the number of facilities providing

screening, early detection and linkages to care.

Early detection comprises early diagnosis of cancer in symptomatic populations and

screening in asymptomatic but at-risk populations. The aim is to detect the cancer when
it is localised (before metastasis). Early detection of cancer is based on the observation
that treatment is more effective when disease is detected early as there is a greater
chance that curative treatment will be successful, particularly for cancers of the breast,
cervix, mouth, larynx, colon and rectum, and skin. Early detection is therefore successful
when linked to effective treatment as 30% of treatable cancers can be cured if detected
early (WHO, 2009).

National Cancer Prevention and Control Strategy 2019 18

Strategic Activities
1. Expand screening, early detection, and linkages to care services.
 Develop and rollout basic screening, early detection and linkage to care
package for different levels of the health system.
 Capacitate facilities to implement the minimum package.
2. Screening of asymptomatic and apparently healthy individuals
 Develop guidelines for screening for specific cancers.
 Conduct awareness campaigns among communities on early warning signs
and symptoms of cancer, self screening methods and participation in
screening programmes
 Conduct cancer screening outreach campaigns by trained teams at all levels.
3. Enhance early detection of cancer in symptomatic individuals
 Create awareness on the early warning signs and symptoms of cancer among
at risk populations and health workers
 Integrate early detection of cancer into existing health programs.
4. Streamlining the referral and linkages system for cancer patients
 Strengthen and implement the use of guidelines and standard tools for
referral and linkages system
 Strengthen/ orientation on the referral and linkages pathway.

4.2.3 Strategic Objective 3: To expand the number of level 3-5 facilities offering
basic cancer diagnosis, treatment and palliative care to 80% by 2022

Cancer diagnosis is the first step to cancer management. This calls for a combination of
careful clinical assessment and diagnostic investigations including endoscopy, imaging,
biochemistry, histopathology, cytopathology, and other laboratory studies. Once a
diagnosis is confirmed, it is necessary to ascertain cancer staging, where the main goals
are to assist in the choice of therapy. The primary objective of cancer treatment is to
cure, prolong, and improve the quality of life whichinvolves a multidisciplinary
treatment including surgery, radiation therapy, chemotherapy, hormonal therapy, or
some combination of these.

Palliative care is an approach that improves the quality of life of patients and their
families facing the problems associated with life-threatnening illness. Palliative care
works through the prevention and relief of suffering by means of early identification
and impeccable assessment and treatment of pain as well as any other physical,
psychosocial, and spiritual challenges. Pain relief and palliative care must therefore be
regarded as integral and essential elements of a national cancer programme. Provision
of pain and symptom relief, spiritual and psychosocial support from diagnosis to the
end of life and bereavement.

Strategic Activities
1. Improvement of cancer diagnosis
 Develop evidence based guidelines for cancer diagnosis and standard
operating procedures.
 Strengthen histopathology, cytology, radiology services
2. Enhancing accessibility of cancer treatment services

National Cancer Prevention and Control Strategy 2019 19

 
Develop an essential cancer drug list and integrate it into the national
essential drug list.
 Develop clinical protocols and quality assurance (QA) guidelines for cancer
management.
3. Manage advanced cases of cancers
 Update guidelines for palliative care services including pain management.
 Develop quality assurance mechanism to oversee proper delivery of
palliative care for cancer patients
 Conduct awareness campaigns on palliative care targeting policy makers,
public, media, health care personnel and regulators.
 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 elderly.

4.2.4 Strategic Objective 4: To strengthen cancer surveillance, research and

strategic information systems

Cancer surveillance involves the routine and continuous collection of information on the
incidence, prevalence, mortality, diagnostic methods, stage distribution, and survival of
those with cancer and aspects of care received. A fully functioning and dedicated cancer
registry with appropriate expertise is a cornerstone of cancer-control. Research is
needed across the spectrum of cancer control to provide the basis for continual
improvement. A coordinated agenda for cancer research is an essential element in the
effective prevention and control of cancer.

Cancer surveillance is a fundamental element of any cancer control strategy since it

provides the foundation for advocacy and policy development. Cancer control research
seeks to identify and evaluate the means of reducing cancer morbidity and mortality
with an aim of improving the quality of life.

Strategic Activities
1. Improve availability of comprehensive data on cancer and its risk factors
 Build capacity for cancer registration personnel and sensitise health
personnel on cancer registration.
 Review existing cancer surveillance and registration tools.
 Strengthen cancer data collation, analysis, interpretation and dissemination.
2. Enhancing capacity for research in cancer
 Identify research priorities for common cancers in the country.
 Mobilise funds from sustainable sources for funding research.
 Facilitate capacity building in cancer research at various levels of the health
system.
 Promote collaboration between various stakeholders involved in cancer
research.

National Cancer Prevention and Control Strategy 2019 20

4.2.5 Strategic Objective 5: To improve the institutional and technical capacity for
cancer prevention and control

The promotion of National Cancer Prevention and Control Unit (NCPCU) is a key
strategy in fighting against cancer worldwide. The WHO is assisting Member States to
build and reinforce capacity for planning and implementing effective programmes.
Within this context, the development of systematic NCPCU Capacity Assessment is
considered an essential necessity in order to identify gaps and strengths, and to monitor
progress of cancer control plans and programmes at the country, regional and global
levels. The NCPCU Capacity Assessment will be part of a broader capacity surveillance
system for Non-Communicable Diseases which is under development.

Strategic Activities
1. Strengthen the National Cancer Prevention and Control Unit
 Establish and approve an organogram for the cancer control unit.
 Appoint relevant personnel for the unit.
2. Mobilize and allocate adequate resources
 Prepare a map of oncology needs and resource requirements.
 Advocate for a budget line for cancer programming and management
including research.
 Advocate for increased budgetary allocation for establishment of a
comprehensive cancer control programme.
3. Improve the knowledge of cancer among individual and skills of health personnel
 Undertake survey to assess the workforce devoted to cancer prevention and
control.
 Develop health education packages on cancer for the general public.
 Develop and implement training carriculum for community and primary
healthcare workers on cancer prevention, early detection, treatment and
palliative care.
 Expand coverage of cancer subjects with practical work in the
training/learning curriculum for students in health training institutions.
 Initiate and facilitate local and international training for candidates
interested in the field of oncology.
4. Ensure adequate infrastructure for cancer prevention and control
 Procure quality laboratory and treatment equipment and materials including
drugs for cancer treatement.
 Forecast and procure chemotherapy medicines for cancer.

4.2.6 Strategic Objective 6: To establish a high level mechanisms for multi-

sectoral coordination and partnership for prevention, treatment, care and
rehabilitation of cancer

A centralised coordinating body such as a National Cancer Institute is suggested to

coordinate all cancer prevention and control activities thus ensuring efficient use of
resources. This aids in directing efforts of all key stakeholders towards a common goal
and ensures smooth running of programs and avoids overlaps and redundancies.

National Cancer Prevention and Control Strategy 2019 21

Strategic Activities
1. Strengthen interdisciplinary collaboration and intersectoral and multisectoral
partnerships for synergy of action
 Re-establish multi-sectoral coordination committee.
 Establish a Technical Working Group for Cancer Control.
2. Develop collaboration with the following international organizations to support and
strengthening the coordination of all cancer prevention and control activities and
trainings
a. International Atomic Energy Agency (IAEA)
- Provides Member States with a wide range of tools, services and
support to assist them in their efforts to address the cancer
burden.
- Provides assistance in the area of cancer through imPACT
(Programme of Action for Cancer Therapy)
- Reviews and resource mobilization, and by supporting the
development of strategic documents such as Comprehensive
National Cancer Control Plans and bankable documents for
fundraising.
b. International Agency for Research on Cancer (IARC)
- IARC is part of the World Health Organization.
- IARC coordinates and conducts both epidemiological and
laboratory research into the causes of human cancer. Work
under four main objectives:
o Monitoring global cancer occurrence
o Identifying the causes of cancer
o Elucidation of mechanisms of carcinogenesis
o Developing scientific strategies for cancer control
c. African Cancer Coalition (ACC)
- Assist African region in development of new cancer care
guidelines that take into account the context in which care is
being provided.
- Strengthen clinical guidelines, training, and technical
collaboration to ensure that all people with cancer get access to
effective, affordable treatment.
d. African Cancer Registry Network (AFCRN)
- Improve the effectiveness of cancer surveillance in sub Saharan
Africa by providing expert evaluation of current problems and
technical support to remedy identified barriers, with long-term
goals of strengthening health systems and creating research
platforms for the identification of problems, priorities, and
targets for intervention.
- Provides technical and scientific support to countries;
- Delivers tailored training in population-based cancer registration
and use of data and advocate the cause of cancer registration in
the region and facilitating setting up associations and networks
of cancer registries; and coordinate international research
projects and disseminating findings.

National Cancer Prevention and Control Strategy 2019 22

 e. African Organisation for Research and Training in Cancer (AORTIC)
- An African based non-governmental organisation that is
dedicated to the promotion of cancer control and palliation in
Africa
- Its key objectives are:
o To further research relating to cancers prevalent in Africa,
o To facilitate and support training initiatives in oncology for
health care workers
o To create cancer prevention and control programmes, and
to raise public awareness of cancer on the continent.
o To organize biennial international cancer conferences and
multi-disciplinary workshops in conjunction with
ministries and policy makers.

National Cancer Prevention and Control Strategy 2019 23

Chapter 5

5.1 Monitoring and Evaluation

To measure progress in the implementation of the National Cancer Prevention and

Control Strategic Plan, Monitoring and Evaluation will be considered as a priority. In
this regard, a Monitoring and Evaluation Framework with defined impact, outcomes,
and output indicators will be developed.

Monitoring the implementation of the NCPC Strategic Plan as well as assessing progress
made through achievements is essential. Monitoring will address the implementation of
planned activities through a set of indicators related to inputs, process and outputs,
while assessment will focus on effectiveness of interventions through outcomes and
impact on incidence as well as on mortality with particular attention paid to case
fatality rate.

The evaluation of the implementation of NCPC Strategic Plan will be carried out at mid-
term as well as at the end of the 4 year period. Mid-term evaluation will offer
opportunity to learn from experience of the first two years on the implementation,
taking corrective measures where actions have not been effective, and reorienting parts
of the plan in response to unforeseen challenges.

5.2 Programme Management

In order to effectively manage the NCPC Programme and implementation of the NCPC
Strategy, there is need for strengthening of the current NCPC Programme and continued
commitment from Government.

There is a need of strengthening staff at the NCPC Programme. This has been reflected
in the proposed organogram (Appendix A). In addition, it should be highlighted that
strengthening of NCPC staff is required at all levels; national and community.

However, the efficient and effective implementation of the NCPC Strategic Plan will
require a multi-sectoral approach with effective partnership through involvement of
Governmental Institutions, Private Sectors, Faith Based Organizations (FBOs), NGOs as
well as communities through local associations. It is important to note that this multi-
sectoral approach will necessitate a strong harmonization and coordination among all
partners and this role remains the responsibility of the Ministry of Health.

5.3 Funding Arrangement

The National Cancer Prevention and Control Department will develop annual costed
action plans which will serve as a financing mechanism for implementation of this plan.
Funding will be sought from government as a primary source of financing and from
development partners. In order to operationalize this intention, the department will
prepare budget requests annually through consultations with stakeholders and submit
them for financing by government as part of planning and budgeting processes of the
ministry. Support from development partners will be sought through systematic
National Cancer Prevention and Control Strategy 2019 24
engagement with them including proposal writing. Through adequate advocacy,
Development Partners and the Private Sector will be expected to supplement
Government efforts by providing both technical and financial support. The costing of the
operational plan will be activity-based and done on a yearly basis.

5.4 Strategy Implementation and Review

The implementation of the NCPC Strategic Plan will be facilitated by the National Cancer
Prevention and Control Unit. It will require technical assistance from International
Partners (WHO), hospitals, community clinics, NGOs and the private sector.

The implementation of the Strategy will cover a period of 4 years from 2019 – 2022. At
4 years, there will be an end of term review to evaluate the changes, reassess the cancer
situation in Eswatini, and produce recommendations in light of this and new
developments in the cancer prevention and control field.

National Cancer Prevention and Control Strategy 2019 25

APPENDIX A. THE IMPLEMENTATION PLAN

Objective 1: To reduce by 10% the number of new cancer cases attributable to modifiable risk and environmental factors
by 2022.
Key Performance Indicator: Percentage of new cancers diagnosed at stage I and II one year following awareness campaign
Intervention Activity Output Responsible Entities Timelines
Y1 Y2 Y3 Y4
Create awareness in Develop and disseminate health education Communities NCPCP X X X X
the general population messages aimed at preventing risky adopt HPU
on modifiable risk behaviours and adopting healthier healthy Civil Society
factors that pre- lifestyles (Tobacco use, harmful use of behaviours
dispose to cancer alcohol, unhealthy diet, physical inactivity
and sexual behaviour)
Create dialogue with at risk populations to Communities NCPCP X X X X
enhance community participation in promote HPU
cancer prevention cancer Civil Society
prevention
Advocate for the incorporation of risk -Teachers NCPCP X X
factors reduction strategies into teach MOET
educational curriculum students on
cancer
risk factors
-Learners
adopt
healthy
lifestyles
Control tobacco use Promote tobacco cessation programmes Tobacco NCPCP X X X X
and address alcohol users quit HPU
Civil Society
National Cancer Prevention and Control Strategy 2019 26
 abuse, unhealthy diet, Advocate for physical environments that Youths avoid NCPCP X X X X
physical inactivity and support safe active commuting, and create initiating HPU
sexual and space for recreational activity. smoking Civil Society
reproductive factors Adapt and implement national guidelines Communities NCPCP X
on diet and physical activity. adopt NCDs
healthy
lifestyles
Advocate for the implementation of Police NCPCP X X X X
legislation on production and enforce NCDs
consumption of alcohol legislation Royal Eswatini police
Control of biological Conduct awareness campaigns on -At risk NCPCP X X X X
agents that cause screening for infectious diseases related to populations EPI
cancer cancer (HIV, helicobacter pylori, HPV, screen for HIV
hepatitis B and C and Epstein Barr virus) infections HPU
-Health
workers
conduct tests
Educate parents on safety and need for Parents and NCPCP X X X X
universal infant immunization with the Caregivers EPI
aim of increasing uptake and coverage vaccine their HPU
child
Support and promote the introduction of MOH NCPCP X
HPV vaccine introduce EPI
HPV HPU
Control of Promote policy to minimise occupational Workplaces NCPCP X X X X
environmental related cancers and known environmental introduce MOL
exposure to carcinogens safety HPU
carcinogens measures EHP
Conduct awareness campaigns on Communities Ministry of Housing & X X X X
National Cancer Prevention and Control Strategy 2019 27
 reducing exposure to air pollution and prevent air Urban Development
other carcinogens via contamination of pollution and NCPCP
food (aflatoxins or dioxins) observe food HPU
safety EHP
procedures
Engage with employers to reduce Workplace Ministry of Labour X X X X
exposure to occupational carcinogens introduce NCPCP
safety EHP
procedures Municipalities

Conduct awareness campaigns on the Communities HPU X X X X

dangers of exposure to ionizing radiation observe NCPCP
safety Civil Society
measures
Objective 2: To increase to 60% the number of facilities providing screening, early detection and linkages to care.
Key Performance Indicator: Percentage of facilities providing cancer screening, early detection and linkages to care
Expand screening, Develop and rollout basic screening, early Health NCPCP X
early detection and detection and linkage to care package for workers
linkages to care different levels of the health system detect cancer
services. and refer
early
Capacitate facilities to implement the At risk NCPCP X X X X
minimum package. individuals
access
screening
service
Screening of Develop guidelines for screening for Health NCPCP X
asymptomatic and specific cancers. workers
apparently healthy detect cancer
National Cancer Prevention and Control Strategy 2019 28
 individuals and refer
early
Conduct awareness campaigns among Communities NCPCP X X X X
communities on early warning signs and take up HPU
symptoms of cancer, self-screening cancer
methods and participation in screening screening
programmes services
Conduct cancer screening outreach Health NCPCP X X X X
campaigns by trained teams at all levels workers Civil
detect cancer society
and refer
early
Enhance early Create awareness on the early warning Communities NCPCP X X X X
detection of cancer in signs and symptoms of cancer among at take up Civil
symptomatic risk populations and health workers cancer society
individuals screening HPU
services
Integrate early detection of cancer into Health NCPCP X X X X
existing health programs. workers Public
detect cancer Health
and refer Programme
early s
Streamlining the Strengthen and implement the use of Health NCPCP X X X X
referral system for guidelines and standard tools for referral workers
cancer patients system detect cancer
and refer
early
Strengthen/ orientation on the referral Health NCPCP X X X X
pathway. workers
National Cancer Prevention and Control Strategy 2019 29
 detect cancer
and refer
early
Objective 3: To expand to 80% the number of level 3-5 facilities offering basic cancer diagnosis, treatment and palliative
care by 2022
Key Performance Indicator: Percentage of level 3-5 facilities offering basic cancer diagnosis, treatment and palliative care
Improvement of cancer Develop evidence based guidelines for Health NCPCP X X X X
diagnosis cancer diagnosis and standard operating workers
procedures. confirm all
cancer
diagnosis
Apply innovative technology for Health NCPCP X X X X
histopathology, cytology, radiology workers
services confirm all
cancer
diagnosis
Enhancing accessibility Develop clinical protocols and quality Health NCPCP X X X X
of cancer treatment assurance (QA) guidelines for cancer workers
services management manage
cancer
patients
according to
national
guidelines
Develop an essential cancer drug list and Ministry NCPCP X X X X
integrate it into the national essential drug avails all CMS
list. essential
drugs for
cancer
National Cancer Prevention and Control Strategy 2019 30
 Manage advanced Update guidelines for palliative care Health NCPCP X X X X
cases of cancers services including pain management workers
provide
adequate
pain relief
Develop quality assurance mechanism to Health NCPCP X X X X
oversee proper delivery of palliative care workers
for cancer patients provide
palliative
care
Conduct awareness campaigns on Communities NCPCP X X X X
palliative care targeting policy makers, utilise PCP
public, media, health care personnel and palliative Civil
regulators care services
Society
Establish community and home-based Communities NCPCP X X X X
palliative care services including utilise RHM
establishment of nutritional support palliative CBOs
services for cancer patients. care services
Establish social support services for Cancer NCPCP X X X X
cancer patients and provide palliative care patients well
RHM
services for groups with special needs, supported CBOs
children and elderly
Objective 4: To strengthen cancer surveillance, research and strategic information systems
Key Performance Indicator: Number of facilities with systems in place to meet the requirements for cancer surveillance, research,
and strategic information systems
Improve availability of Build capacity for cancer registration -Health NCPCP X X X X
comprehensive data on personnel and sensitise health personnel workers ENCR
cancer and its risk on cancer registration. report all
factors cancer
National Cancer Prevention and Control Strategy 2019 31
 diagnosis
Review existing cancer surveillance and -Cancer NCPCP X X X X
registration tools. Registry Staff ENCR
capture all EDCU
cancers
Orient health workers on cancer data -Health NCPCP X X X X
collation, analysis, interpretation and workers use ENCR
dissemination. cancer EDCU
information
for decision
making
Enhancing capacity for Identify research priorities for common Researchers NCPCP X X X X
research in cancer cancers in the country conduct RU
priority
studies on
cancer
Facilitate capacity building in cancer Health NCPCP X X X X
research at various levels of the health workers RU
system conduct
cancer
research
Promote collaboration between various Stakeholders NCPCP X X X X
stakeholders involved in cancer research share cancer RU
information
Mobilise funds from sustainable sources Funders NCPCP X X X X
for funding research allocate
resources for
cancer
research
National Cancer Prevention and Control Strategy 2019 32
 Objective 5: To improve the institutional and technical capacity for cancer prevention and control
Key Performance Indicator: Number of facilities that are well-equipped with the proper infrastructure, specialists, and technologies
for cancer prevention and control
Strengthen the Establish and approve an organogram for Cancer unit NCPCP X X
National Cancer the cancer control unit implement Directorat
Prevention and Control interventions e
Unit Appoint relevant personnel for the unit Cancer unit NCPCP X X
implement Directorat
interventions e
Mobilise and allocate Prepare a map of oncology needs and Government NCPCP X X X X
adequate resources resource requirements allocates
resources
Advocate for a budget line for cancer Government NCPCP X X X X
programming and management including allocates
research resources
Advocate for increased budgetary Government NCPCP X X X X
allocation for establishment of a allocates
comprehensive cancer control resources
programme.
Ensure adequate Procure quality laboratory and treatment Health NCPCP X X X X
infrastructure for equipment and materials including drugs workers CMS
cancer prevention and for cancer treatment provide
control cancer
services
Forecast and procure chemotherapy Health NCPCP X X X X
medicines for cancer workers CMS
provide
cancer
services
National Cancer Prevention and Control Strategy 2019 33
 Improve the Undertake survey to assess the workforce NCPCP NCPCP X X X X
knowledge of cancer devoted to cancer prevention and control compiles HRH
among individual and register of
skills of health cancer
personnel experts
Develop health education packages on Communities NCPCP X X
cancer for the general public prioritise HPU
cancer
prevention
and control
Develop and implement training Primary care NCPCP X X X X
curriculum for community and primary health RHM
healthcare workers on cancer prevention, workers
early detection, treatment and palliative identify
care cancer and
refer
Expand coverage of cancer subjects with Health NCPCP X X X X
practical work in the training/learning workers Academic
curriculum for students in health training diagnose and Institution
institutions manage s
cancer HRH
Initiate and facilitate local and Health NCPCP X X X X
international training for candidates workers HRH
interested in the field of oncology gains
expertise in
oncology

Objective 6: To establish a high level mechanisms for multi-sectoral coordination and partnership for prevention,
treatment, care and rehabilitation of cancer
National Cancer Prevention and Control Strategy 2019 34
 Key Performance Indicator: Improved policies or partnerships established for prevention, treatment, care and rehabilitation of
cancer
Strengthen Re-establish multi-sectoral coordination Stakeholders NCPCP X
interdisciplinary committee implement
collaboration and coordinated
inter-sectoral and cancer
multi-sectoral interventions
partnerships for Establish a Technical Working Group for Stakeholders NCPCP X
synergy of action Cancer Control implement
coordinated
cancer
interventions
Partner across the national health system Stakeholders NCPCP X X X X
for improved cancer control. implement
coordinated
cancer
interventions

National Cancer Prevention and Control Strategy 2019 35

REFERENCES

Central Statistical Office, The 2017 Population and Housing Census: Preliminary Results,
Eswatini. September 2017.

E. Chokunonga, M.Z.B., Z.M. Chirenje, A.M. Nyakabau, Zimbabwe National Cancer Registry
Annual report 2010. 2010.

Eswatini Health Management Information System, Annual data. 2012.

GLOBOCAN 2012: Estimated Cancer Incidence, Mortality and Prevalence Worldwide,

2012, http://globocan.iarc.fr/Pages/bar_sex_pop_sel.aspx

Ministry of Health, NATIONAL PREVENTION AND CONTROL OF NON COMMUNICABLE

DISEASES PROGRAMME ANNUAL REPORT 2014.p.1-52.

Lambe M, H.C., Trichopoulos D, Ekbom A, Pavia M, Adami HO, Transient increase in the
risk of breast cancer after giving birth. N Engl J Med, 1994.331:p. 5-9.

Ministry of Health, ESWATINI NON COMMUNICABLE DISEASES RISK FACTORS (STEPS)

SURVEY REPORT. 2014: Mbabane.

Ministry of Health, Service Availability Readiness Assessment Report 2017: Mbabane.

Ministry of Health, Situational Analysis of cancer incidence in Eswatini (2014, 2015)

Mbabane.

WHO’s cancer pain ladder for adults. Geneva 2014.

WHO, Towards a strategy for cancer control in the Eastern Mediterranean Region / World
Health Organization. WHO, 2009.

National Cancer Prevention and Control Strategy 2019 36

National Cancer Prevention and Control Strategy 2019 37