Working Meeting on Comprehensive Cervical Cancer Prevention and Control in UNFPA EECARO and ASRO Countries

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Kingdom of Morocco-Working Meeting on Comprehensive Cervical Cancer Prevention and Control in UNFPA EECARO and ASRO Countries

Kingdom of Morocco-Working Meeting on Comprehensive Cervical Cancer Prevention and Control in UNFPA EECARO and ASRO Countries

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  • 2. MAGNITUDE AND BURDEN OF CERVIVAL CANCER IN MOROCCO• 30 000 new cancer cases/year, 1 200 childhood cancer (4%)• Cancer causes of 7,2% deaths• Women : breast cancer (36%), cervical cancer (13%)• Men : lung cancer (24%), prostate cancer (8%)• Reproductive health is a priority program of the Ministry ofhealth• Early detection for cervical cancer is main component
  • 4. LEADERSHIP / GOUVERNANCE• National Framework : National Cancer Prevention and Control Plan 2010 - 2019Early detection of breast and cervical cancer: main priority• Under the leadership of HRH Princess Lalla Salma• Government comitement
  • 5. NATIONAL FRAMEWORKNational Cancer Prevention and Control Plan 2010 - 2019 Communication Prevention Legislation National and Palliative international Screening cares mobilization Early diagnosis Diagnosis Social support Research / Training and treatmentEquity Solidarity Quality
  • 6. GOUVERNANCE• Standards development at different levels of intervention of the health system  HPV immunization : will be fully integrated in the national immunization program : measure 14 of the NCPCP  Early detection for cervical cancer : measures 31 to 43 of the NCPCP  Treatment and palliative care : measures 44 to 74
  • 7. GOVERNANCE• Implementation of a reproductive health strategy• Creation of a department of fight against cancer• Integration of early detection for breast cancer of and cervical cancer in reproductive health• Financial resources mobilized for comprehensive cervical prevention and control, annually: $ 5 million (HR non included)
  • 8. PARTNERSHIP• Under the leadership of MOH – Civil Society – Universities – WHO, UNFPA – Private sector
  • 9. PILOT PROJECT• 5 regions among 16• Target population 40% of national population• Target population 910 000 women (30 – 49 years)
  • 10. PROGRAM COMPONENTS• Organise the screening• Organise the early diagnosis• Organise the therapeutic support• Implement a communication plan• Establish a computerized information system.
  • 11. STRATEGIC AXIS • Integrate into the PHC • Develop the circuit of the1. Services participantAvailability • Strengthen the technical plateau at all levels • Capacity building • Research program on cervical 2. Quality cancer control program matter • Implement quality matter standards in terms of diagnosis and treatment • Implement an information system to enhance the surveillance
  • 12. STRATEGIC AXIS • Promote the early detection of cervical and breast cancer in3. Utilization of the general public RH services • Develop partnerships with local NGOs • Ensure political advocacy in local, regional and national levels • Follow up and monitor the evolution of the screening 4. Follow up • Follow patients in terms of timing, Evaluation diagnosis, treatment and follow up • Ensure better planning of screening
  • 13. FINANCEMENT• Morocco is middle income country• Health insurance – AMO + private insurance : 30% – RAMED : 70%• Comprehensive cervical prevention and control – Screening program : free of charge – Diagnosis : colposcopy, pathology : free of charge – Loop electrosurgical excision procedure (LEEP) : free of charge – Treatment and palliative care: AMO + RAMED
  • 14. FINANCEMENT MOH ALSC United Nations (UNFPA, WHO)Immunizati +++ +onScreening +++ +++ ++Diagnosis +++ +++ ++Treatment +++ +++Research / +++ +++ +++Training
  • 15. SERVICE DELIVERY Intervention levels• Immunization : Health centers (should be integrated in national immunization program in 2013)• The screening level: health centers  Reception and Information on the program  Gynecological examination : VIA  Counselling Physician (general practitioner) or nurse• The diagnosis level : Reproductive health centers  Reception, IEC, Colposcopy, biopsy, …), Pathologic analysis, LEEP, Counselling Specialist practitioners : gynecologist, biologist, cytologist …• Treatment level: oncology centers  Reception, treatment, Counselling, Multidisciplinary staff• Palliative care
  • 16. SERVICE DELIVERY• Cervical cancer  Women between 30 and 49 years old  VIA in the health centers  Every three years• Exclusion criteria  Women with cervical cancer
  • 17. ORGANIZATION CHART Organisation chart DPCC Oncology centers Third Level Treatment Multidisciplinary staff Invasive Cytology Confirmation of CIN or micro invasive cancer Cancerhealth Centers Follow up/Reproductive RAD/CONISATION 1Colposcopy 2th level Biopsie /year Suspicion of CIN or Suspect lesion of non-invasive cancer. invasive cancer Colposcopy Normal Next examination Négative + First level PHC Health centers 3 years JSP Positive Négative invisible Participant Screening / VIA Non Recruiting women participant aged 30-50
  • 18. SERVICE DELIVERYGuide pratique de détection précoce des cancers du sein et du col utérin
  • 19. HUMAN RESOURCES• Use of available human resources• Development of a global training plan – Practical aspects of early detection of cervical cancer and LEEP – Programmatic and managerial aspects of the early detection for cervical cancer and his integration in the reproductive health – Communication aspect – Information system
  • 20. HUMAN RESOURCESTraining achievement Nurses Physicians Gynecologists ManagersPractical 337 213 36aspects ofearly detectionof cervicalcancer andLEEPProgrammatic 337 213 36 100andmanagerialaspectsCommunicatio 337 213 36 100n aspectInformation 271 165 20 06system
  • 21. TECHNOLOGY AND EQUIPMENT • PHC : – Salle de vaccination• Immunization – Matériel de vaccination• Screening – Salle d’examen• Communication – Table d’examen• Information – Source de lumière – Spéculum – Acide acétique… – Matériel audio visuel – Matériel informatique
  • 22. TECHNOLOGY AND EQUIPMENT • Reproductive Health centers – Mammography and ultrasound (breast cancer)• Diagnosis – Salle d’examen• LEEP – Table d’examen – Colposcopy – Biopsy equipment – LEEP equipment
  • 23. TECHNOLOGY AND EQUIPMENT• Treatment • In the oncology centers
  • 24. INFORMATION SYSTEM Each HC has its own databaseHealth Centers (HC) Orientation The HRC contains all Health reproductive CS + HRC database centers (HRC) Normal circuit Oncology Centers
  • 25. INFORMATION SYSTEM First quarter 2011 (2 regions) Screening (Primary Health centers)Pop.Target Goal # Participation # Reference Achievement 2011 participants Rate referred rate (%) (%) IVA + (%) 160,000 44,000 2,900 1.8 500 17.0 6.6 Diagnosis (Reproductive health centers)# examined # CIN LEEP Pathology Biopsy Invasive / IVA + Colposcopy cervical cancer 420 212 05 03 03 02 04
  • 26. OPERATIONAL RESEARCH• 2 studies :  Acceptability of HPV vaccine : ongoing  Research on Standardization acts and the evaluation of the system of reference and feedback : ongoing • Objectives – Studying adequacy of the context and the organization process at different level of the health system – Assess prospectively the efficiency of the national early detection program for cervical cancer
  • 27. ADVOCACY AND COMMUNICATION• Objectives  Increase awareness of the interest of prevention, screening and early diagnosis  Promote the availability of the immunization, screening and treatment for the target population  Strengthen skills in interpersonal communication technics/ counseling for the health workers  Increase target women participation in the cervical cancer screening program
  • 28. ADVOCACY AND COMMUNICATIONStrategic axis • Advocacy of the decision makers and partners • Strengthening the skills of health professionals • Communication on cancer perceptions
  • 29. HEALTH SYSTEM STRENGTHENING APPROACH for CERVICAL CANCER PREVENTION AND CONTROLCHALLENGES ACTIONS TAKENWidespread cervical cancer screening to Mobilization of decision makers and partnersthe whole country to mobilize resources for pilot areaAchieve a target of 60% among women Implementation of a clear communicationparticipating in screening program strategy to raise awareness Mobilization of civil society and privateExtend the strategy of early detection of sector pharmacist and health professionalcervical cancer in the private sector Validate national guidelines of HPVImplementation of HPV vaccination strategy vaccination and acquire HPV vaccine ( on going)Sustainability of the program
  • 30. HEALTH SYSTEM STRENGTHENING APPROACH for CERVICAL CANCER PREVENTION AND CONTROL Lessons learned• Unanimity on the relevance of the program Political level: commitment of the Government Strategic level: commitment of national and regional leaders Operational level: mobilization of care providers• Commitment of partners: UNFPA, ALSC,• Feasible training strategy• Integration of early detection for cervical cancer in Reproductive Health program at different level of the national health system
  • 31. HEALTH SYSTEM STRENGTHENING APPROACH for CERVICAL CANCER PREVENTION AND CONTROLWays forward/ future plans• Mainstreaming integrative Strategy for the program (operational plan and budget 2019)• Training of trainers at national level on Standardize and finalize pedagogical package• Operational researches on health system strengthening (integrative reproductive health services )• Integrative information system for monitoring evaluation