LONG TERM PLAN FOR LONG TERM PLAN FOR NATIONAL CANCER CONTROL PROGRAM NATIONAL CANCER CONTROL PROGRAM

IN INDONESIAIN INDONESIA

STAFF AHLI MENTERI KESEHATANSTAFF AHLI MENTERI KESEHATANBIDANG TEKNOLOGI KESEHATAN DAN GLOBALISASIBIDANG TEKNOLOGI KESEHATAN DAN GLOBALISASI

MINISTRY OF HEALTH, REPUBLIC OF INDONESIAMINISTRY OF HEALTH, REPUBLIC OF INDONESIA

dr.Ratna Rosita Suryo Subandoro,MPH.M

n Cancer control program was known since 1989 stated in Integrated & Comprehensive Cancer Control Program (SK Menkes No 604/Menkes/ SK/1989)

n Every hospital should develop their own cancer control program based on their resources & capacity (SK Menkes No 10/Menkes/SK/I/1994)

n Indonesia participated in developing Jakarta Statement on Cancer Control Program è the statement of strategic effort toward optimal cancer control and care (initiated by UICC & WHO)

n Establishment of Dharmais Cancer Hospital (1993) in the future hopefully will become National Cancer Center

n Establishment of Directorate of NCD Control, including Sub Directorate of Cancer Control

GLOBAL MORTALITY BY CAUSE, GLOBAL MORTALITY BY CAUSE, ALL AGES 2005ALL AGES 2005

* NCD is the most common cause of death in the world**Source: WHO and World Bank 2005

CA

RD

IO-VA

SCU

LAR

DISEA

SES

CA

NC

ER

CO

PD

DIABETESMALARIATBHIV

AIDS

05

101520253035

Infection-parasite

CirculationRespiratory

DigestiveNeoplasma

InjuryPerinatal

1992 1995 2001

TREND OF MORTALITY IN INDONESIA BY TREND OF MORTALITY IN INDONESIA BY CAUSE, ALL AGES IN 1992 CAUSE, ALL AGES IN 1992 –– 2001 2001

HOUSE HOLD HEALTH SURVEY 1992, 1995, 2001HOUSE HOLD HEALTH SURVEY 1992, 1995, 2001

Disease Burden in IndonesiaDisease Burden in Indonesiann House hold health survey, 2001 : cancer is the 5House hold health survey, 2001 : cancer is the 5thth cause of death cause of death nn Pathology based data from 13 main hospitals in Indonesia, 1998: cervical Pathology based data from 13 main hospitals in Indonesia, 1998: cervical

ca is the highest among ca cases (17,2%) followed by breast ca (12,8%)ca is the highest among ca cases (17,2%) followed by breast ca (12,8%)nn Indonesia hospital admission in 2005: Breast cancer is the highest and Indonesia hospital admission in 2005: Breast cancer is the highest and

followed by cervical cancer.followed by cervical cancer.nn RiskesdasRiskesdas 2007 : tumor/cancer is the 72007 : tumor/cancer is the 7thth (5,7%) cause of death in (5,7%) cause of death in

Indonesia, with prevalence 4.3 per 1000 peopleIndonesia, with prevalence 4.3 per 1000 people

Percentage

10 Commonest MalignancyJakarta (30 Hospitals) *

2005-2007

2.7%

3.3%

3.6%

3.6%

4.5%

5.7%

5.8%

6.8%

10.6%

18.4%

0% 5% 10% 15% 20%

Hepar

Thyroid Gland

Colon

Lymph Nodes

Ovary

Pharynx

Leukemia

Bronchus and Lung

Cervix Uteri

Breast

To

po

gra

ph

y

Percent

*) tanpa data tahun 2005 dari regional utara

10 Commonest Malignancy in MaleJakarta (30 Hospitals) *

2005-2007

3.0%

3.1%

4.4%

4.6%

5.7%

5.8%

5.8%

8.4%

10.0%

13.7%

0% 5% 10% 15%

Soft Tissue

Renal Pelvis - Bladder

Rectum

Hepar

Colon

Prostate Gland

Lymph Nodes

Leukemia

Pharynx

Bronchus and Lung

Topo

grap

hy

Percent

*) tanpa data tahun 2005 dari regional utara

10 Commonest Malignancy in MaleJakarta (30 Hospitals) *

2005-2007

2.3%

2.3%

2.5%

2.8%

3.2%

4.0%

4.3%

7.2%

16.9%

28.9%

0% 5% 10% 15% 20% 25% 30% 35%

Lymph Nodes

Colon

Corpus Uteri

Bronchus and Lung

Pharynx

Thyroid Gland

Leukemia

Ovary

Cervix Uteri

Breast

Topo

grap

hy

Percent

*) tanpa data tahun 2005 dari regional utara

Female

VISION of MoHVISION of MoH--RIRISELF MOTIVATED COMMUNITY SELF MOTIVATED COMMUNITY

TO LIVE HEALTHY LIFETO LIVE HEALTHY LIFE

MISSIONMISSIONMAKE PEOPLE HEALTHYMAKE PEOPLE HEALTHY

MoH of RI MoH of RI Organization Organization

StructureStructure

Ministry of Health

Secretary General

DG of Disease Control & EH

DG of Public Health Inspectorate General

DG of Pharm & Med Supp

DG of Medical Services

Directorate of NCD Control

Other Directorates Directorate of Specialistic Med Services

Subdit of Cancer Control

Subdit of Specialistic Hospitals Other Subdits

Secretary of DG DC & EH

Subdit of Chronic Disease

Other Subdits

Secretary of DG of Med Serv

Other Directorates

Expert staffs of MoH

NCD programmer ( center, UPT, district)NCD programmer ( center, UPT, district)Inter program & inter sector Inter program & inter sector relatedrelatedProfessional Org.Professional Org. & NGO & NGO Community & groups at riskCommunity & groups at risk

To decrease cancer morbidity, To decrease cancer morbidity, disability,mortality and improve disability,mortality and improve quality of life of cancer patientsquality of life of cancer patients

UU No : 36/2009 à Kesehatan

Kepmenkes: •No : 1575/2005 à Organization & Tasks of MoH•No : 1468/2006 à RPJPK 2005-2009•No : 1116/2003à Gudeline of Health Surveillance System•No : 1479/2003 à Guideline of Epid-Surveil of CD & NCD •No : 430/2007 à Guideline of Cancer Control•No : 1163/2007àWorking group on Cervical and Breast

Cancer Control

PP No : 19/2003à Pengamanan rokok bagi kes

Policies on Cancer ControlPolicies on Cancer Controlnn Based on social participation and Based on social participation and

community empowerment through local community empowerment through local enhancementenhancement

nn Developing collaboration and partnership Developing collaboration and partnership networking networking

nn Integrating program of primary, Integrating program of primary, secondary and tertiary prevention.secondary and tertiary prevention.

nn Performing services delivery by Performing services delivery by professionals and qualified healthcare professionals and qualified healthcare providers providers

nn Developing surveillance of risk factors and Developing surveillance of risk factors and cancer registrycancer registry

nn Quality AssuranceQuality Assurance

STRATEGIES STRATEGIES nn Social mobilization and community Social mobilization and community

empowerment for healthy living empowerment for healthy living nn Encouraging health service developmentEncouraging health service developmentnn Encouraging and facilitating community Encouraging and facilitating community

participationparticipationnn Developing early detection programDeveloping early detection programnn Improving health services accessImproving health services access

nn Developing risk factors surveillance and Developing risk factors surveillance and cancer registrycancer registry

nn Proposing cancer treatment in the Proposing cancer treatment in the compulsory health insurance for the poor compulsory health insurance for the poor payment schemepayment scheme

Establishment of Networking

•Polices,•Guidelines,•Modules

• Advocacy• Socialization• Promotion

Epidemiological Surveillance & Information Technology

Logistics

Developing Program

Human Investment

Monitoring &Technical assistance

Budget development

Policies, Guidelines, ModulesPolicies, Guidelines, Modules1. NCCP Policy :

• Promotion & prevention on community based (Avoid risk factor, Tobacco control phisical activity, healthy diets&healthy life)

• Early detection & prompt treatment (cervical cancer, breast cancer, colorectal ca, retinoblastoma, etc)

• Cancer registry (Hospital based & Population based)- choose the area => Yogyakarta, bali, etc

• Diagnosis and Treatment :- especially in cancer centre hospital- to increased hospital services on regional cancer hospital

2. Guidelines• Screening program• Treatment for cancers• Risk factors control• Epidemiological Surveillance• Community empowerment• Promotion & campaign, etc

3. Modules• TOT for providers• TOT for managers• Training for providers• Training for managers• Training for cadres

1. Public Awareness- Promotion- Public education

2. Screening è Pilot Project for Cervical & Breast Cancer- Started in 6 Districts (6 provinces) since 2007, now expanded to in 6 Districts (6 provinces) since 2007, now expanded to

another 2 districtsanother 2 districts-- Goal : finding preGoal : finding pre--cervical cancer lession & breast tumorcervical cancer lession & breast tumor-- Target : woman age 30Target : woman age 30--50 yrs50 yrs-- Coverage target: 80% from target at the populationCoverage target: 80% from target at the population-- Location : 6 Districts (Deli Serdang, Gowa, Karawang, G. Kidul, Kebumen, Location : 6 Districts (Deli Serdang, Gowa, Karawang, G. Kidul, Kebumen,

Gresik) @ 8 Primary Health Care each Gresik) @ 8 Primary Health Care each -- Metode : single visit approach with Visual Inspection with Acetic acid/VIA & Metode : single visit approach with Visual Inspection with Acetic acid/VIA &

Cryotherapy (for VIA+), and Clinical Breast Examination/CBECryotherapy (for VIA+), and Clinical Breast Examination/CBE-- Provider : well trained MD & midwives in PHCProvider : well trained MD & midwives in PHC-- Supervisor: 1. Clinician (Obsgyn & Surgeon)Supervisor: 1. Clinician (Obsgyn & Surgeon)

2. Management by District & Province official health 2. Management by District & Province official health officerofficer

3. 3. Vaccination- HBV Vaccination : child immunization since 1997 è compulsory- HPV Vaccination : private

4. Cancer Registry è Pilot Proyect in DKI Jakarta since 2007

Establishment of Networking• National

n Working group on Cervical and breast cancer control

• International n UICC and IACR

Advocacy & Socialization• Advocacy

n Decision makers : MoH, Min of Finance, National Planning Bureau, etc

• Socialization n Traditional & religious leadersn Professional organizationsn NGOsn Etc

• Promotionn Public educationn Mass campaign

Human Investmento TOT & training on Cervical & Breast Ca screening o TOT on management of NCCPo Training for cadres èPKK

Logistics è For Screening• IVA set• Cryo set• cervicograph, • Colposcopy • LEEP• Mammografi

nn To develop national cancer registry, it needs a To develop national cancer registry, it needs a model, DKI Jakarta is chosen as the modelmodel, DKI Jakarta is chosen as the model..

nn The budget of the model is still supported by The budget of the model is still supported by WHO representative to IndonesiaWHO representative to Indonesia

nn Divided 5 regions : East, West, North, Central, & Divided 5 regions : East, West, North, Central, & South JakartaSouth Jakarta

nn In beginning, there are 40 hospitals chosen to In beginning, there are 40 hospitals chosen to run cancer registryrun cancer registry

nn Hope following population base in DKI Jakarta Hope following population base in DKI Jakarta area in 2010 yeararea in 2010 year

Regional Cancer CentreRegional Cancer CentreRegional Cancer CentreRegional Cancer CentreNational Cancer CentreNational Cancer CentreNational Cancer CentreNational Cancer Centre

Plan of Regional Cancer Centre Indonesia

nn Cancer control in Indonesia are Cancer control in Indonesia are already established, which is in already established, which is in developing stage. It’s need developing stage. It’s need fundamental systemfundamental system

nn NCC is needed to support the NCC is needed to support the programs on:programs on:•• Scientific Scientific •• AnalyticAnalytic•• Operational researchOperational research