Every year, cancer is estimated to cause more than 17,000 deaths in Mozambique. Many of these deaths are happening too early: cancer accounts for almost half of the country’s ‘premature deaths’ (dying before the age of 70) for noncommunicable diseases.
As a result, cancer is a critical barrier to Mozambique achieving SDG target 3.4, to achieve a reduction in premature mortality by 2030. And the need for achieving SDG 3.4 will only become more urgent, with the number of Mozambicans with breast or cervical cancer expected to double from current levels by 2040.
Despite the high burden, many countries don’t include cancer in the set of health services and products they agree to provide for their population for free – commonly known as a universal health coverage ‘benefit package’.
To date, this has been the case in Mozambique.
Surgery, radiotherapy and chemotherapy for cervical and some other cancers are only available in certain areas of the country – though efforts are underway to increase capacity. A lack of reliable cancer registry data remains an area for improvement, and as of 2021, only one quarter of eligible women had been screened for cervical cancer in the last five years.
Tobacco smoking – a leading cause of cancer – is declining among men and women, and dietary behaviors are improving among younger people, but other risk factors for cancer, such as consuming alcoholic beverages, obesity and pollution rates remain stubbornly high or are worsening. And despite at least five billion people globally now being covered by at least one of WHO’s live-saving ‘MPOWER’ measures to address the worldwide tobacco epidemic, Mozambique is among a minority of countries that has not fully adopted any measure.
Building a national plan for cancer
Recognizing the importance of a comprehensive national plan to reduce the cancer burden, the Ministry of Health in Mozambique has been working with WHO to develop and cost its National Cancer Control Plan.
The National Cancer Control Plan is, however, just the latest step in recent action to help support people at risk of, or living with, cancer in Mozambique. Recently, national screening, early diagnosis and pre-cancer treatment programs have been established nationwide for breast and cervical cancer. National guidelines for early detection and cancer management are being designed, as they have been for pathology services, and HPV vaccination is now included in Mozambique’s vaccination schedule.
As such, the Plan is part of the Ministry of Health’s commitment to “redouble efforts” to reduce new cancers, by “preventing risk factors and reducing the gap in access to care by strengthening the health system”. Specifically, the Ministry identifies raising awareness, access to vaccination, screening, the early detection of cancer, strengthening diagnostic and treatment capacity, and palliative care as key opportunities.
The National Cancer Control Plan has been developed by expert consultations from different clinical and non-clinical areas of cancer prevention and control, to ensure that cancer needs are being addressed according to the local context. The Plan has been championed by the First Lady, Her Excellency Isaura Nyusi, with this political priority being key to planning, partnership mobilization and implementation.
Developing the investment case
A core part of developing the Plan has been exploring and prioritizing the costs, and resulting benefits, of adopting different ‘best buy’ policies for cancer. To do so, the Ministry of Health, with WHO’s support, is conducting a health impact analysis, and designing an investment case for cancer care that reflects the specific needs of the country.
Together, this analysis will map out how new policies and programs will save lives and improve livelihoods, while the investment case sets out why investing in cancer is effective, cost-effective and equitable. In doing so, it mirrors a recent global analysis by WHO, that finds investing US$ 1 per person in preventing and managing NCDs could save seven million lives annually, and that the quicker investments are made, the quicker they pay themselves back again and again .
“Mozambique’s development of a cancer impact analysis and the investment case will constitute an entry point to better leverage cancer prevention and management at primary health care level and advanced care level”says Dr Raquel Dulce Mahoque of WHO’s Mozambique Country Office. “This can help ensure that everyone can have access to cancer care, wherever and whenever they need it, without financial hardship”.
The National Cancer Control Plan is designed to complement the country’s wider integrated NCD plan, that also sets out how people should have access to high-quality and compassionate palliative care. Increasing cancer within national plans for universal health coverage would also increase the reach of this care for free to more people who need it.