Transcript National Cervical Cancer Prevention and Control Program, Dr

National Cervical Cancer
Prevention and Control Program
Safina Yuma MD,MPH
RH-cancer Unit
Thursday, April 09, 2015
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Presentation Outline
• Background & burden of disease
• Overview of the National CECAP and Control
Program
• Program progress
o Primary Prevention
o Secondary Prevention (screening, treatment, referrals)
• Challenges
• Lessons learned
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Background
• Cervical cancer is the most common cancer in Tanzania
– Leading cause of cancer related morbidity and mortality in
women in the country
• Tanzania has one of highest cervical cancer burdens in
the world and the highest in Eastern Africa
– Age-standardized incidence rate (ASR) of 50.9 cases per
100,000 women
• Despite the high burden, majority of women in Tanzania
do not have access to CECAP services
Cervical Cancer Burden
Country/Re
gion
Thursday, April 09, 2015
Incidenc
e Rate
(per
100,000)
Mortality
Rate
(per 100,000)
Tanzania
50.9
37.5
Eastern
Africa
34.5
25.3
Africa
25.2
17.6
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NEW CANCER CASES AT OCEAN ROAD CANCER INSTITUTE 2006 - 2011
Type of Cancer
2006
2007
2008
2009
2010
2011
Cervical cancer
955
1006
1288
1374
1510
1881
Kaposi sarcoma
295
404
418
447
681
814
Breast cancer
244
245
275
322
386
526
Esophageal cancer
181
256
282
307
380
511
Head and neck
155
206
244
272
289
361
Lymphomas
201
199
226
245
186
269
Leukemias
46
78
87
103
142
261
Urinary bladder
46
88
87
98
109
153
Skin cancer
40
108
111
123
129
141
Eye cancers
46
76
80
95
84
119
Others
598
472
382
390
299
208
TOTAL
4/9/2015
2807
3138
3480
3776
4195
5224
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Cervical Cancer Prevention and Control Program
in Tanzania

The government of Tanzania is committed to
address cervical cancer burden
 2008 : MoHSW established a RH-Cancer unit
through its Reproductive and Child Health
Section (RCHS).
 The Tanzania Cervical Cancer Technical Working
Group provides guidance to the national
program.
To increase demand for CECAP services MoHSW
collaboration with partners developed;
 The National Cervical Cancer Prevention and
Control Strategic Plan (2011-2015)
 Developed Tanzania CECAP and Control service
delivery guidelines
 IEC materials-Posters and Brochures
 Monitoring Tools
 Training package-final stage
 National TOT –for VIA/Cryo
 National TOT- for LEEP
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Strategic Framework
• Vision: women free from the burden of cervical cancer in
Tanzania
• Mission: The MOHSW is committed to translate cancer
prevention and control knowledge into public health action in
collaboration with stakeholders including community.
• The Goal of Strategic Plan : To reduce Cervical Cancer
Incidence, morbidity and Mortality in Tanzania
Program progress
• HPV vaccine launched in Tanzania as
demonstration project may 2014
• Launch of the community awareness
Campaigns for cervical and breast cancer
strong support by the First Lady, mama
Kikwete (WAMA Foundation)
• Cervical cancer indicators included into the
DHIS Monitoring
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Secondary Prevention
• MoHSW endorsed low cost tech VIA screening test as a national
strategy to promote access
• feasible to implement at low levels of the health care system.
• Main focus: SVA –screening and treatment using
• Cryotherapy (all facilities-with skilled personnel)
• LEEP (Regional & District level facilities)
• Target group: 30-50 years & HIV positive at any age
• Screening frequency: 3 years (HIV-/Unk) and yearly for HIV+
women
• Integration: RCH services
• /HIV care services/gyn clinic
• Coverage: more than 200 screening sites
SECONDARY PREVENTION
CURRENT STATUS OF PARNER REGIONAL
SUPPORT
EGPAF/MST
EGPAF/
WHO
ENGEND
IMA
World
ICAP
MST
• ICAP/
12D
EGPAF
THPS
EGPAF
CER12
UMATI
THPS
DOD
DOD
Upcoming:
1.PSI-Private
Hospitals
2.Mtwara:
EGPAF/THPS
3.UMATI sites
JHPI
EGO/
PSI
WHO
DSM:
MDH/
JHPIEGO
JHPIEGO
EGPAF
Focus:
1. Regional level
Hospitals
2. District level
Hospitals
3. Few Health Centers
Referral Pathway
Large lesions: Regional Hospitals, District Hospitals with
skilled providers
Suspicious for Cancer: CCS site-Regional Hospital, or
referral to MNH or to ORCI
Confirmed Cervical Cancer: referred to ORCI for
radiotherapy treatment and palliative care (upcoming
Bugando MC)
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Challenges
• Shortage of staffs & work overload -providers doing CECAP as one
amongst other services Linkages of CCS
• Lack of pathology services at regional level facility
• Referral system for suspect cancer cases and large lesions
• Maintenance of cryotherapy units
• Re-screening of one year follow up clients is still very low
• Essential equipment still not included within MSD catalogue eg. Cryo and
LEEP machines
• Long term sustainability of the program
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Lessons Learned
•
•
•
•
•
•
•
Acceptability of the program is very high
Referral system for SC/LL needs improvements
Mechanism for maintenance of Cryo & LEEP machines need to be strengthened
Not easy to include CCS budget line item in CCHP (competing priorities)
National level advocacy of CECAP program is highly needed
Updating CECAP training curriculum in pre service education for nursing & medical
schools must be the future direction to ensure sustainability of CECAPC program
With strong partnership and collaboration we can easily scale up CCS services in
the country
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Breast cancer
• Mass Screening Campaigns for breast cancer
• No standardized guidelines
• Solicit funds for the program
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