Problem: High rates of cancer mortality; projected rise in both cancer incidence and prevalence; concerns regarding the financial sustainability of cancer-related services provision; lack of coordination for cancer-related services.
Solution highlights: A national cancer plan was developed by the Ministry of Health to unite current services and coordinate the fight against cancer; ten priority areas for action were identified by the initiative: governance, health promotion, prevention, screening, diagnostics, treatment, rehabilitation, resources, patients’ rights and research; strong government commitment was essential for realizing a coordinated national approach; involving a diverse range of stakeholders from the beginning helped to guide the initiative; implementation of the national cancer plan is still in the early phases and any improvements will take time to observe.
Description of practice
In 2012, cancer was the leading cause of mortality in men (32.1%) and the second leading cause in women (26.7%). Despite national availability of high-quality cancer care, services were believed to lack coordination. Furthermore, projected increases of cancer incidence in Luxembourg’s ageing population, coupled with rising numbers of people living with cancer or post-cancer morbidities due to better survival rates, triggered concerns over the financial sustainability of cancer service provision which was largely concentrated in specialist settings.
Recognizing the need for an overarching strategic vision to direct and coordinate the fight against cancer, the Ministry of Health began the development of a national cancer plan in 2013. In developing the plan, international recommendations from both the European Partnership for Action Against Cancer and the World Health Organization were adapted to the national context. Additionally, extensive input was sought from stakeholders and incorporated into the plan’s design. In 2014, the final National Cancer Plan 2014-2018 was approved by the Ministry of Health. Ten priority areas for action were outlined by the Plan: governance, health promotion, prevention, screening, diagnostics, treatment, rehabilitation, resources, patients’ rights and research. Specific actions to be taken within each priority area include, for example, increasing the availability of smoking cessation programmes, establishing systematized screening programmes for priority cancers, validating care guidelines, strengthening community-based care, fostering multidisciplinary team working and implementing performance assessments for health providers. Proposed changes in services delivery will be supported with complementary legislation and policies at the Ministry level. Cross-ministry partnerships, such as the proposed collaboration between the Ministry of Health and Ministry of Education to improve nursing education, will be established. Several other national-level organizations will also play key roles in enacting the Plan and the Ministry of Health intends to establish a new National Cancer Institute to lead cancer-related initiatives. Investments in existing organizations will also be made, including a new genetic research department within the National Health Laboratory.
Implementation of practice
What stage is the practice currently in?
Who was/is responsible for the implementation of the practice?
Development of the National Cancer Plan 2014–2018 was initiated by the Ministry of Health. A project coordinator was hired to oversee both the design and implementation of the Plan to facilitate its advancement. Stakeholder engagement was an important area of activity and all key stakeholders were engaged throughout the development process. Interviews with each key stakeholder group - including insurance companies, cancer societies, health providers and patients - were first held individually. A series of workshops then brought different stakeholder groups together to collectively define priorities under mediation from the project coordinator. Expert working groups have been established by the Ministry to oversee activities for each of the Plan’s stipulated priorities throughout the implementation phase.
Implementation of the National Cancer Plan 2014–2018 is underway, but is still in the early stages at present. A rigorous evaluation strategy for the Plan has been laid out, with a midway evaluation planned for 2016 and a final evaluation anticipated in 2018. The Ministry of Health has already begun looking ahead to the National Cancer Plan 2019–2023.
This case was prepared as part of a larger effort by the WHO Regional Office for Europe and published (2016) in the document, "Lessons from transforming health services delivery: Compendium of initiatives in the WHO European Region".
© Copyright World Health Organization (WHO), 2016
The methodology used for the development of this case is slightly different from the templates used on the IntegratedCare4People web platform, in particular in the analysis of enabling factors and barriers to change.
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- Martine Debacker
- Ministry of Health