1 April 2010 Jhpiego/Baltimore

Veronica Reis, MD, MPHMCHIP Technical DirectorMAPUTO, MOZAMBIQUE

BREAST AND CERVICAL CANCER PREVENTION ACTIVITIES INTEGRATED ON FP/RH SERVICES

Total population: 20.53 million (2007)

Life expectancy at birth: 42 years

Major cause of death (all ages): Malaria

HIV prevalence rate: 16.2%

Background: General Health Situation in Mozambique

Source: 2007 Census, DHS 2003

The cervical cancer situation in Mozambique

Data from the cancer registry at the pathology services of Central Hospitals, indicate that “the cervical cancer is currently the most frequent malignant tumor in adult women”.

According to the registry, most cases are diagnosed in advanced stages when surgery is no longer possible – Carrilho, 2004.

Parkin DM, Ferlay J, Hamdi-Cherif M, Sitas F, Thomas J, Wabinga H, Whelna SL (eds) Cancer in Africa: epidemiology and Prevention (IARC Scientific Publications 153), pp. 268-276, Lyon, IARCPress, 2003.

Photo: Ismael Miquidade

Mais actualmente, nao ha um

There is no population-based, national cancer registry in Mozambique and until 2007 there was no national policy or

strategy to fight cervical cancer.

Action Plan Developed on 2007 with Jhpiego support

under Non Communicable Disease Strategy

OBJECTIVES:

To adopt and implement interventions to fight cervical and breast cancer in Mozambique.

To reduce the incidence and mortality due to reproductive cancer.

MAIN INTERVENTIONS

1. Adopt and promote the use of VIA and Cryotherapy as the prime method for cervical cancer prevention

2. Adopt and promote the early detection of breast cancer through self and clinical breast examination

3. Develop standardized norms and training materials for the early detection and management of cervical cancer and breast cancer

4. Acquire equipment and train health professionals5. Organize primary health services and referral services for

cervical cancer prevention and control integrated in the FP/RH services

6. Strengthen the information, monitoring and evaluation systems for cancer control in Mozambique

MCHIP Mozambique Objectives May 2009 – Nov 2010

7

Strengthen EMNC and BEmONC services, including PPFP, in selected healthcare facilities in all provinces, as well as key integrated RH/MCH services in selected healthcare facilities in selected provinces.

Strengthen BEONC and CEONC in an integrated manner in pre-service institutions for MCH mid-level nurses.

Assist the MOH on the development of modular, integrated in-service training package for RH/MCH.

MCHIP – Main Interventions for key integrated RH services

Develop and disseminate National Policy and Guidelines for key integrated RH/MCH services, including cervical cancer (CxCa) screening and treatment based on the “single visit approach” (SVA)

Translate/adapt/develop and print reference, training, and IEC CxCa prevention materials

Train 20 healthcare workers from 5 HC in key integrated RH services, including CxCa prevention using the SVA

Train 10 professionals from referral sites in Colposcopy and LEEP procedures

MCHIP – Main Interventions for key integrated RH services

Train as trainers 10 healthcare workers and preceptors from training institutions in CxCa prevention using SVA

Provide technical support for 5 healthcare facilities to implement CxCa prevention services using the SVA

Strengthening Information system and referral mechanisms for CxCa prevention services,

Develop an Integrated national RH, including CxCa prevention services, roll out plan

Main Results Achieved from May 2009-February 2010

Supported the MoH in the development of the National Family Planning Strategy and of the National Guidelines for cervical cancer prevention based on the SVA.

Translated CECAP reference Manual and Training package (from English to Portuguese)

Developed and printed IEC materials for CxCa prevention Supported the procurement and distribution of cryotherapy,

colposcopy and LEEP equipment acquired by UNFPA Supported the development of information and monitoring

forms for cervical cancer prevention

Main Results Achieved

45 professionals, from 10 health care facilities, trained on VIA and cryotherapy.

14 professionals (including health workers and preceptors from training institutions) trained as supervisors.

15 professionals, from 4 referral sites trained on colposcopy biopsy and LEEP to treat advanced precancerous cervical lesions.

Norms and IEC materials for referral sites services in development process

VIA & Cryotherapy Training Maputo, Sept 2009

Workshop for Supervisors – Maputo, Sept 2009

Boane Observe

Discuss Recommend

VIA & Cryotherapy Training – Zambézia, Feb 2009

A Colposcopy & LEEP Training Maputo Feb 2009

VIA&Crio Services Results from September-February

1080 women screened for cervical cancer at FP/RH service

31 VIA positive

20 treated immediately with Cryotherapy

Challenges

Limited availability of MOH technical health workers at all level, given the current severe shortage of personnel, implied in difficulties on the activities implementation;

High rotation of health workers; Problems with equipment acquired (especially cryoterapy

units); Limited human and financial resources at MCHIP

Mozambique to face the amount of support needed by the MOH at Central and Provincial level.

THANK YOU!