From Learning to Policy: Adapting National Cancer Control Plans and Implementation to Africa's Cancer Control Realities

Abstract

Background: The Africa Cancer Research and Control ECHO (Africa Cancer ECHO) convenes cancer researchers, advocates, clinicians, policymakers, and implementers to address cancer control challenges with evidence-based approaches, to inform and respond to a country's national cancer control planning efforts.

Aim: To conduct a content analysis of the 2020-2021 Africa Cancer ECHO series, mapping discussions to NCCP core elements and identifying gaps, opportunities, and system-level barriers.

Methods: A SWOT analysis of the 2020-2021 Africa Cancer ECHO series was conducted. 19 sessions were recorded, transcribed, and uploaded to Dedoose^®. Each session was coded using two guiding frameworks: 1) reported strengths, weaknesses, opportunities, and threats (SWOT); and 2) domains of the Core Elements of National Cancer Control Plans (NCCP) Checklist. Also, descriptors were coded to classify session presenter characteristics (i.e., occupation, geographic context). Data was analyzed quantitatively and qualitatively in Excel and Dedoose^® (version 9.0.107).

Results: The case presenters came from six countries, and the didactic presenters came from eight countries (two of which overlap with case presenter countries). Coding resulted in a total of 1547 coded excerpts. Of these, 1446 excerpts were coded to the NCCP core elements, and 931 excerpts were coded to SWOT codes. The top NCCP core element category was Service delivery (402 coded excerpts). The top SWOT element was Opportunity (303 coded excerpts), while the remaining three elements were relatively evenly represented. While research and cancer control are the overall focus of the ECHO, the content most referenced through analysis of the coded excerpts identified diagnosis, staging, and screening, service delivery, and finance as the most discussed topic areas. A key enabler and catalyst for change that was most often discussed during the sessions is task shifting, a strategy that involves redistributing tasks among healthcare providers to maximize efficiency and improve access to care.

Conclusion: The content analysis of the 2020-2021 Africa Cancer ECHO series served as a useful evaluative tool to map the topical issues discussed and identify topical areas that need more emphasis. A more flexible, context-aware NCCP framework may be needed to reflect Africa-specific priorities and realities. Enhanced focus on prevention, palliative care, and surveillance is warranted.

Figure 1

Coding Methodology for Phases 1 and 2

Figure 2

Number of session topics mapped to each NCCP core element (n=19 sessions)

Figure 3

Country representation of the case presenters (6 countries), didactic presenters (8 countries), Steering Committee members (7 countries), and participating countries (25 countries)

Figure 4

Country representation from within the Africa region: D, P = Didactic Presenter and Participant Country (2 countries); C, P = Case Presenter and Participant Country (4 countries); S, P = Steering Committee Member and Participant Country (3 countries); P = Participant Country (non-presenter, non-Steering Committee – 7 countries); D, S, P = Didactic Presenter, Steering Committee Member and Participant Country (1 country); C, D, S, P = Case Presenter, Didactic Presenter, Steering Committee Member and Participant Country (2 countries).

Figure 5

Number of coded excerpts per NCCP core element [n=1,446]

Figure 6

Distribution of coded excerpts to SWOT and NCCP core elements