Nuriye Ortayli-objectives

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Nuriye Ortayli (UNFPA)- STRENGTHENING HEALTHSYSTEMS

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Nuriye Ortayli-objectives

  1. 1. STRENGTHENING HEALTHSYSTEMSDr Nuriye OrtayliUNFPA, Technical Division 1
  2. 2. WHAT IS THE IMPACT Efficacy of your interventionPAP ReferVIA Screen and treatHPV test Single visit Coverage  Scale up to national level (Gradual, or Start Big)  Specifically target high risk, underserved groups 2
  3. 3. SELECT THE BEST Screening method with highest sensitivity and specificity Treatment that is most effective, involves the least risk Cover everybody  Go with the established?  Develop your own solution? 3
  4. 4. CAN YOU DO IT? 4
  5. 5. GETTING STARTED Do the numbers! ◦ How many women in the target age? ◦ How many facilities capable of screening? ◦ How many women/week/facility if all screened in first year? How many if spread over 5 years? 10 years? What is feasible? ◦ If ~15% are screen-positive, how many cryos/week? Phase-in strategies ◦ Gradual build up to steady state with re-screening at desired intervals ◦ Campaign style with big push up front, then drop-off of demand (and drop-off of skills)  Vıvıen Tsu, PATH 5
  6. 6. SERVICE DELIVERY Where should screening take place (as close to the community as possible) Where and when should treatment (of precancerous lesions) take place (to minimise lost to follow-up, balanced with resources) ◦ Screen and treat ◦ Tracking and management of referrals Where and how should invasive cancer referred?Balance between highest coverageand ability to provide quality service 6
  7. 7. HUMAN RESOURCES What are the available human resources to ensure highest coverage? (Numbers, geographic distribution, workload, attrition, possibilities for task shifting) How much (time and resources) it will take to furnish them with needed competencies? What should be the mechanisms of training? What should be the mechanisms for supervision? What measures will be taken for sustainability? 7
  8. 8. INFORMATION SYSTEMSHOW EFFECTIVE IS OUR SYSTEM?HOW EFFECTIVE IS OUR SYSTEEFFECTIVE IS OUREFFECTIVE ISEFFECTIVE ISEFFECTIVE 8
  9. 9. INFORMATION SYSTEM Informing clients (tracking) Informing health system (both decision-makers and providers)  Coverage (%) and who do we screen?  What do we find (how many positives)  How accurate we are (sensitivity, specificity)  What % we treat  How many cancers we prevent?  How many deaths we prevent? Informing the public and politicians 9
  10. 10. INFORMATION SYSTEMSWHO recommends all countries toestablish/enhance cancer registries tobe able to evaluate impact of cervicalcancer prevention activities, includingvaccination and screening.Information on service delivery shouldbe collected and used for decisionmaking.No vertical system should be planned 10
  11. 11. MEDICALPRODUCTS,TECHNOLOGY Tests: Which one to use?  Cost (initiation/continuation)  Infrastructure (both physical and human resources)  Logistics and maintenanceBased on sensitivity and demands on healthsystems, cytology based screening is notrecommendable when starting a programme.A mixture of approaches can be used. 11
  12. 12. FINANCING Who is going to pay for these? Are they willing to pay for it? Can they afford it? What is the balance between increasing access and being realistic? WHO-UNICEF joint statement of Vaccine donation is also applicable for donation of other equipment and supplies, ◦ suitability, ◦ sustainability ◦ informed ◦ supply shelf life, functional ◦ licensed and adoptable 12
  13. 13. LEADERSHIP,GOVERNANCE Simple elements, complex integration Good synchronization Advance planning 13
  14. 14. VACCINATION Plan for introduction of HPV vaccine should be part of country immunization comprehensive multi-year plan and comprehensive cx ca prevention and control strategy Introduction of vaccine can be integrated with delivery of other essential services for adolescents. Price is a big barrier. Negotiated price should be made public. Competitive bidding or conjoint purchase mechanisms (PAHO, GAVI etc) can be used. Financing of delivery should also be taken into account. Donations are only acceptable when in line with WHO-UNICEF statement. Different modalities of delivery are possible with their pros and cons. (community based, school based, mobile clinic) Monitoring for coverage, effectiveness, impact, usage and safety should be planned. 14
  15. 15. COMMUNITYENGAGEMENTServices that are not used are;useless! 15
  16. 16. NO VERTICAL SYSTEMS No vertical systems. ◦ Screening part of PHC ◦ Treatment part of PHC/Secondary HC ◦ Information should be collected as part of HIS ◦ Training and supervision should be integrated. ◦ Vaccination should be part of comprehensive programme of immunization Beware of over-medicalization/over treatment/over specialization 16
  17. 17. AT the servıce of two generatıons
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