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 worldwide 1
 460,000 new cases occur/year and 231,000 women die of the diseases 2
 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, 2001

2.Parkin 2000; Sherris and Herdman 2000
3.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

1992
5. IARC, Globocan 2002 database; Summary table by Cancer 2002. http://www-dep.iarc.fr/top.htm.Accessed

Feb 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
CURRENT PROGRAMS
PAST PROGRAMS  COTE D’IVOIRE
 GHANA  GUYANA
 MALAWI  INDONESIA
 PHILIPPINES  MOZAMBIQUE
 THAILAND  PERU
 ZIMBABWE  SOUTH AFRICA
INITIATIVES  TANZANIA
 ETHIOPIA MDI STUDY
 KENYA  PHILIPPINES
 NEPAL  THAILAND
5
 India
 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
6
 Project Site Karawang District

Jhpiego Project site 2007-2010

Scaling up 2008-2009
Scaling up 2009-2010

7
 Conceptual Framework
Technical input Out Put Out Come Impact

Quality Improvement availability of

Improvement at standardized cervical and
service sites breast cancer screning and
treatment sites.
Coverage
Screening
Government and and treatment Decrease
stakeholders support on Ca Cervix to morbidity
Advocacy dan the Cervical cancer and at least 80 % and
Policy breast cancer screening Coverarge mortality
and treatment screening of
Breast cancer
increase
Increasing community
Community awareness and demand on
Mobilization Cervical and breast cancer
screening
 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
Community Behavioral Changes Intervention towards
Cervical Cancer prevention

Input Process Result Goal Impact

Building political
commitment of
diverse stakeholders
SocMob strategy

Improved coverage
Agents of Change: Organizing Increased availability Cervical cancer
• Facilitators community through and accessibility of Increased use of screening
• Midwives Participatory community-based skilled providers for Decrease number of
Analysis and action for Cervical screening Cervical Ca Advance stage
Problem Solving cancer Prevention

BCC strategy

Raising community
awareness through
CaCervix prevention
Campaign
 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
Effectiveness
Link Screening
of treatment
 Good test coverage & Treatment
 Appropriate management
of screen positive
 Limit lost to follow up Screening
Coverage
 Reasonable Treatment
cost
 Results Of Cancer Screening

Institution # Of Women VIA + Getting Cryo

screened

Depkes1 74 941 2 634 (3.15%) ?

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

Jhpiego3 32 703 744 414

(2.33%) (55.74%)

1 Subdit Cancer MOH data 2007-2009

2FCP, Lokakarya Kanker leher rahim 2008
3 Dinas Kesehatan Kab karawang, August 2010
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