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COMPREHENSIVE CERVICAL CANCER CONTROL C4. Country: FIJI Presenter: L Volavola. 1. Status of National Programme. Year of starting: Responsible unit: GoF [Ministry of Health] Financing: GoF, AusAID, Merck US Components: Current status: Implementation into routine EPI -2012. 2008-2010.
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COMPREHENSIVE CERVICAL CANCER CONTROLC4 Country: FIJI Presenter: L Volavola
1. Status of National Programme • Year of starting: • Responsible unit: GoF [Ministry of Health] • Financing: GoF, AusAID, Merck US • Components: • Current status: Implementation into routine EPI -2012 2008-2010
2. Screening for cervical cancer • Test used: PAP, VIA[ project under UNSW,FNU and FPA] • Coverage:9.6% • Number screened per year: approximately 20,000 • Limitations: number of technicians at 3 divisional labs but now centralised to CWMH, now centralised at National level,non motivated staff-need cytology training
3. Cancer treatment • Number of centres offering treatment for cervical cancer: 3 divisional plus one private [limited] • Radiotherapy availability: nil • Brachytherapy: nil • Most common stage at presentation:high grade CIN abnormalities(CIN 2 and CIN 3)
4. Monitoring and evaluation • Cancer registry –yes(Ministry of Health) • Since-2000 • Population covered by cancer registry: National • Incidence rate of cervical cancer-51.3 per 100,000
5. Challenges and opportunities for cervical cancer control • Challenges: current –TAT for reports from lab; slow uptake of free screening at established health facilities; poor understanding of benefits of early screening [resorting to religious/traditional methods] • Opportunities: strong HPV immunisation program for 9y.o. girls; good partnerships between govt and NGOs with campaigns e.g. Biggest Morning Tea for awareness on prevention and early diagnosis; VIA
7. HPV vaccination: Decision-making and planning Factors that led to decision to introduce HPV vaccine High burden of disease [Irwin Law 2004] Donation from Merck US to Fiji of 110,000 doses of Gardasil in 2008 Funding sources for vaccine and operational costs: GoF, AusAID [through FHSIP] Vaccine selected: through donation –Gardasil [Merck US]; main serotypes were covered Communications with community, schools, health staff and others to prepare for vaccine introduction: MRIP Campaign
8. HPV vaccination: Immunization systems Location: school-based program but also from health centres [MCH Clinic]*2008 –parental consent and concern for new vaccine. Staff who administer vaccine: registered nurses System to obtain parental consent: written, signed by parent/guardian Monitoring forms used: yes System for follow-up of absent or missed girls-yes, through register kept at MCH Clinic/school health program but monitored/coordinated by P.O.
9. HPV vaccination: Challenges in implementation and solutions found Sustainability of funding, support by policymakers –cabinet endorsement of the introduction of HPV as routine in August 2011. Budget of $F1M approved but also includes 2 other new VPDs. Acceptance of (or demand for) HPV vaccination by parents, girls, school and health officials: good acceptance but only over time
9. HPV vaccination: Challenges in implementation and solutions found Logistics of delivery in schools or other locations: used routine school health program vehicles but also assisted with donor support Attaining high coverage for first dose and complete series: good social marketing campaign; additional doses donated after proposal from GoF to Merck US came in 2009 of 8,000 doses Others: resistance from GP fraternity but MoH responded with offers to speak at mini-conferences; initial resistance from Fiji Cancer Society spokeswoman based on allegations
