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National Cervical Cancer Prevention and Control Program

Safina Yuma MD,MPHRH-cancer Unit

Tuesday, April 18, 2023 1

Presentation Outline

• Background & burden of disease • Overview of the National CECAP and Control

Program• Program progress

o Primary Preventiono Secondary Prevention (screening, treatment, referrals)

• Challenges • Lessons learned

2

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

Tuesday, April 18, 2023 4

Country/Region

Incidence 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

04/18/23 5

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 2807 3138 3480 3776 4195 5224

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

6

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

Tuesday, April 18, 2023 8

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

CER12• 12D

ICAP EGPAF/MST

EGPAF/WHO

IMA World

EGPAF

ICAP/THPS

DOD

THPS

JHPIEGO

WHO

EGPAF

MST

SECONDARY PREVENTIONCURRENT STATUS OF PARNER REGIONAL

SUPPORT

JHPIEGO/PSI

DSM:MDH/

JHPIEGODOD

ENGEND

UMATI

Focus:1.Regional level Hospitals2.District level Hospitals3.Few Health Centers

EGPAF

Upcoming:1.PSI-Private Hospitals2.Mtwara: EGPAF/THPS3.UMATI sites

Referral Pathway

11

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

Tuesday, April 18, 2023 12

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

Tuesday, April 18, 2023 13

Breast cancer

• Mass Screening Campaigns for breast cancer • No standardized guidelines• Solicit funds for the program

Tuesday, April 18, 2023 14