Comprehensive Cervical Cancer Prevention and Control: Program Guidance for Countries

1. February 2011 Comprehensive Cervical Cancer Prevention and Control: Program Guidance for Countries

2. Purpose Guide program managers in Ministries of Health, UNFPA COs and partner agencies in when developing or updating their cervical cancer prevention and control programs

3. Who participated Experts from 14 countries GAVI Alliance IPPF Jhpiego PAHO PATH UICC WHO UNFPA

4. Structure Cervical Cancer Prevention and Control Programming Integration of HPV Vaccine Delivery in Health Systems Advocacy and Community Mobilization

5. Guidance for National Strategies and Programming for Cervical Cancer Prevention “In order to have an impact on cervical cancer mortality these programs must have universal coverage of targeted population and financing for long-tem sustainability”

6. Leadership and Governance National normative framework Cervical prevention and control should be part of national RH programs Multi-disciplinary committee/task force on cervical cancer: coordination role Leveraging resources through partnership with non-health programs Focus on all women of the target age especially those in marginalized groups

7. Leadership and Governance Allocation of sufficient resources to scale up Apply health system approach Access to treatment of precancerous lesions Screening and pre-cancer treatment – part of essential health services Delivery through PHC services Universal coverage of services

8. Financing Mix of public and private and out-of-pocket fees should cover the costs of prevention services Subsidy of services to ensure access for disadvantaged groups Principles of WHO-UNICEF Joint Statement of Vaccine Donation should be applied when accepting donations for CCP

9. Service Delivery Screening delivered at PHC; integrated in vertical SRH programs (STIs, oncology, ASRH, etc) Services should be accessible for disadvantaged women Innovative approaches to screening may be tested and utilized When starting CCCP cytology-based screening is not advisable (low sensitivity and high health system requirements)

10. Service Delivery Where cytology-based programs established, assessment should be done to determine whether to continue strengthening these programs or improve their quality and coverage through introduction of other screening methods Combination of different screening modalities can be used Strengthening referral systems Algorithm for programs to treat women with precancerous lesions should be chosen based on resources and health system infrastructure

11. Human Resource Management Geographical distribution and availability of screening tests Motivation of staff Attrition of staff over time Supervision, management and governance Training for counseling and screening, treatment, lab services and maintenance of equipment Task sharing and task shifting

12. Technology and Equipment Proper management of procurement processes, storage and distribution Financing for procurement should consider costs associated with maintenance

13. Health Information System HIS should be able to monitor coverage of screening and adequate treatment using WHO indicators Quality and completeness of registered data Operation research Avoid a vertical system of data collection only for cervical cancer

14. Integration of HPV Vaccine Delivery into Health Systems “The principles highlighted in the WHO position paper on HPV vaccines recommend introduction of these vaccines when certain conditions are met”

15. Leadership and Governance Introduction plan for HPV vaccination – part of comprehensive cervical cancer prevention and control strategy; reflected in cMYP Vaccination should be coordinated with other health services and information for youth

16. Financing The bottom line: MOH has to have resources and capacity to sustain the vaccination programs after donor funding is exhausted

17. Service Delivery Modalities No evidence on which vaccine delivery modality is the most effective Coverage is important Countries should consider whether vaccination should be voluntary or mandatory, and whether it requires written or implied consent

18. Advocacy and Community Mobilization Advocacy plan: policies required for comprehensive programming, and behavioral changes ; Evidence-based communication messages for target audiences; Opportunities to give information to adolescents on HIV/STIs prevention; Strategic dissemination of information through mass media channels Engagement of public figures in advocacy campaigns Reach out to marginalized populations through civil society organizations