Exploring elements of governance in the development and implementation of national cancer control plans

Governance is an essential component of effective national cancer control plan (NCCP) development and implementation and this study aims to describe how and the extent to which governance is defined and outlined in NCCPs. It utilizes data from a global review of 98 NCCPs in 2023 conducted by 77 experts in cancer control planning using a 95-question form that examines components of NCCP development and implementation. To assess the governance elements represented in NCCPs, we used the Health Policy Triangle (HPT) framework, categorizing questions and developing a score based on its four components: content, context, actors, and mechanisms. Strengths were identified in the adequate involvement of several actors in NCCP development and implementation, such as Ministries of Health, and in appropriate mechanisms for NCCP governance, such as information about who is responsible for plan implementation. However, the inclusion of global cancer control targets and initiatives was often lacking. Overall governance scores were poor, but some variability was observed across WHO regions and country income levels. NCCPs from countries within the WHO Regional Office for Africa and low-income countries presented the highest scores across all four components. The HPT provides a framework to assess NCCPs and may pave the way for the development of further guidance regarding the governance of NCCPs.