Cervical and Breast Cancer: Community Health Service and Community Mobilization Development

Cervical and Breast Cancer:

Community Health Service and

Community Mobilization Development

Objective

After the presentation participants will understand

about:

1. Jhpiego global CECAP program

2. Jhpiego Indonesia CECAP Objective

3. CECAP Model development in Karawang

District

4. Community mobilization approach on CECAP

Magnitude of The Problem

Affecting 1,4 Million women worldwide1

460,000 new cases occur/year and 231,000 women die of the diseases2

80% occur in Developing countries

•The most common cancer in Indonesia (34.4% of women cancer)

instead of breast cancer3

•Almost 70% diagnosis are at advance stage ( > stage IIB) 4

•15.000 new cases, 8.000 death 5; •40 – 45 new cases, 20 – 25 death/day, 1 cervical Cancer women die/hour•Coverage of Cervical Cancer screening < 5% (ideal ~ 80%)

1 Ferlay et al, 20012.Parkin 2000; Sherris and Herdman 20003.Dirjen Pelayanan Medik Departemen Kesehatan RI. Badan Registrasi Kanker IAPI, Yayasan Kanker Indonesia. Kanker di Indonesia Tahun1998. Data Histopatologik.

4.)Mochtarom M. Data registrasi Kanker Ginekologik. Bagian Obstetri dan Ginekologi.RSUPN /FKUI, Jakarta 19925. IARC, Globocan 2002 database; Summary table by Cancer 2002. http://www-dep.iarc.fr/top.htm.AccessedFeb 1, 2007

Resolution on Cancer Prevention & Control

(WHA 2005)

Approved in May 2005

Expresses the strong commitment of WHO

and its Member States:

– to intensify action against cancer

– to give priority to the control of tumours

• which are of public health relevance

• which are amenable to early detection and

successful treatment such as cervical and

breast cancers

Sumber WHO/RHR

Jhpiego Country Experience

GHANA

MALAWI

PHILIPPINES

THAILAND

ZIMBABWE

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PAST PROGRAMS

CURRENT PROGRAMS

COTE D’IVOIRE

GUYANA

INDONESIA

MOZAMBIQUE

PERU

SOUTH AFRICA

TANZANIAINITIATIVES

ETHIOPIA

KENYA

NEPAL

India

MDI STUDY

PHILIPPINES

THAILAND

Project Propose

The Cervical Cancer Prevention Initiative in Indonesia aims to lay the foundation for a national cervical cancer prevention program

Through

(1) working at national level on policy, guidelines, advocacy and management issues to ensure that the proper systems are in place to support delivery of a Single Visit Approach and

(2) implementing and evaluating a cervical cancer screening and treatment service delivery model in selected districts so that best practices from this intervention can be shared and scaled up to other districts throughout Indonesia

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Project Site Karawang District

Jhpiego Project site 2007-2010

Scaling up 2008-2009

Scaling up 2009-2010

Conceptual Framework

Quality

Improvement at

service sites

Advocacy dan

Policy

Community

Mobilization

Improvement availability of

standardized cervical and

breast cancer screning and

treatment sites.

Government and

stakeholders support on

the Cervical cancer and

breast cancer screening

and treatment

Increasing community

awareness and demand on

Cervical and breast cancer

screening

Coverage

Screening

and treatment

Ca Cervix to

at least 80 %

Coverarge

screening of

Breast cancer

increase

Decrease

morbidity

and

mortality

Technical input Out Put Out Come Impact

Technical In Put

1. Development and adaptation Training Modules

2. Training of Trainers

3. Karawang District Training center (P2KP) strengthening for

CECAP and Breast Cancer Prevention clinical training

4. Standardization training for Puskesmas and Hospital Providers

(doctors and midwifes)

5. Clinical sites service model development

6. Providing equipment and supplies

7. Strengthening recording at service sites to provide qualified

service site data's

8. Monitoring and on the job mentoring

9. Standard Base Management and recognition (SBM-R) tools

development

Technical Input Results

National CECAP Technical guideline and training modules developed

SBM-R tools develop

Recording reporting tools develop

9 National and Province Gynecologist Oncologist are trained as National supervisor

14 District ObGyn (2 obgyn*) are trained as District clinical supervisor and trainers

65 GP’s (17 GP’s*)

121 (69 Midwifes*) midwifes are trained

*In Karawang

ImpactGoalResultProcessInput

SocMob strategy

BCC strategy

Improved coverage

Cervical cancer screening

Decrease number of

Advance stage

Increased use of

skilled providers for

screening Cervical Ca

Increased availability

and accessibility of

community-based

action for Cervical

cancer Prevention

Organizing

community through

Participatory

Analysis and

Problem Solving

Agents of Change:

• Facilitators

• Midwives

Raising community

awareness through CaCervix prevention

Campaign

Building political

commitment of

diverse stakeholders

Community Behavioral Changes Intervention towardsCervical Cancer prevention

Communication

Formative study

Review the current communication tools on

Cervical and breast cancer

Improvement communication tools

Develop modules for Kader

Training Kader on Cervical and Breast Cancer

prevention communication tools

Conduct community education on cervical and

breast cancer at any event in the village

Working with APPI to spread out the

communication among women organizations

associate with APPI

Social Mobilization

Develop modules for community

leaders advocacy

Training advocacy for community

leaders

Develop forum advocacy

Integrated community mobilization

into the current community

mobilization program including Desa

Siaga activities etc

Program : Challenge

Effective services

system is important

Good test coverage

Appropriate management of screen positive

Limit lost to follow up

Reasonable Treatment cost

Link Screening

& Treatment

Effectiveness

of treatment

Screening

Coverage

Results Of Cancer Screening

Institution # Of Women

screened

VIA + Getting Cryo

Depkes1 74 941 2 634 (3.15%) ?

FCP2 34 692 1 556 (4.56%) 1 346 (86.5%).

Jhpiego3 32 703 744

(2.33%)

414

(55.74%)

1 Subdit Cancer MOH data 2007-20092 FCP, Lokakarya Kanker leher rahim 20083 Dinas Kesehatan Kab karawang, August 2010

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