There should be a national and governmental context for planning of CRC screening. The programme
needs political support with sustainable funding to succeed. If appropriate structures in the healthcare
system are lacking, screening should not be implemented until they are developed, for example using
the implementation phase to build up the needed structures.
It is essential that the programme is integrated into the healthcare system and is accepted by both
the population and health professionals involved in the diagnostic process for CRC. Organisation of the
screening programme should integrate the structures of the entire health care system appropriately
and it should comply with national guidelines and protocols. Within the organisational framework of
the programme, the target population should be defined as well as the frequency of screening. Provisions
should be made for the financing of the programme, including evaluation costs.
The professional and organisational managers of a screening programme must have sufficient authority
and autonomy, including an identified budget and sufficient control over the use of resources to
effectively control the quality, effectiveness and cost-effectiveness of the programme and the screening
service. The institutional structure must facilitate effective management of quality and performance.
Process and outcome indicators should be constantly evaluated to serve the needs of the individual
and the health service.
Adequate protection of all data should be ensured, following requirements set by European directives
concerning data protection and national privacy legislation.
Local conditions at the start of a programme
Before implementation of a screening programme, an inventory of baseline conditions including information
on opportunistic screening rates, background CRC incidence rates and availability of endoscopic
resources should be made.
