Understanding the development process of national cancer control plans in low- and middle-income countries

BACKGROUND: As cancer incidence in low- and middle-income countries (LMICs) continues to rise, the development of National Cancer Control Plans (NCCP) has become an essential policy tool for guiding a comprehensive and coordinated response. The NCCP Development Research Initiative (NCCP DRIVE) is a qualitative study led by the International Cancer Control Partnership (ICCP) to understand the NCCP development process and contextual factors that may enable or impede effective NCCP development. METHODS: In-depth interviews were conducted with country-level cancer planners in nine countries (seven African, two South Asian) within the ICCP network. Transcripts were recorded, transcribed, and double-coded in Dedoose, then analyzed thematically using the Health Policy Triangle (HPT) framework. RESULTS: Findings highlight that NCCP development is dynamic and iterative, following six commonly reported phases: Initiation, Formulation, Negotiation, Communication, Implementation, and Monitoring/Evaluation. Common challenges reported by respondents included limited financial and human resources, competing priorities, fragmented health systems, and inadequate data. These constraints led to compressed timelines, overlapping planning activities, and gaps in costing and implementation plans. To address these challenges, respondents employed various strategies, including integrating cancer control efforts with existing health programs, engaging multisector actors, building political will, and securing technical assistance (TA) from partners. Building partnerships was pivotal, helping to set priorities, align plans with national and global agendas, and leverage resources. However, some respondents reported misaligned timelines and priorities, and coordination challenges. CONCLUSION: This study contributes a policy framework-informed, implementation-focused analysis of NCCP development, offering practical insights into how countries navigate complex challenges to initiate and sustain cancer control planning. Findings underscore the need for flexible TA models and stronger data systems, and the value of integrating cancer control priorities within existing health systems. Understanding these dynamics from initiation to implementation offers practical insights for countries at various stages of development, and for partners providing technical assistance.