“Improving RH status of Vlora Women through Promotion of Cervical Cancer Prevention” and

1. “Improving RH status of Vlora Women through Promotion of Cervical Cancer Prevention” and “ Improving coverage of cervical cancer screening in Vlora district through information, education, and communication efforts designed for women”

2. Some data on Albania

3. Cases of Syphilis and Gonorrhea Sexually transmitted infectionsSyphilis and Gonorrhea

4. Albania is aligned in the countries with the lowest prevalence ofHIV/AIDS despite the tendency of the growth in recent years. The percentage of infected population less than 0,1%. But increasing rates of infection, however, are disturbing, especiallyconsidering the fact that the number of infected persons in 2001 wasfivetimesmore than the figures reported in 1999.HIV/AIDS cases

5. The estimated population of the Vlora district, including urban rural areas, is approximately 173,259 people. • Twenty eight percent (28%) are women in reproductive age (i.e. 15 - 49 years of age), 15% of population are women age 35-59. • This means that at least 26,162 women in Vlora district are at risk of development of the cervical cancer (INSTAT, 1998). • Public health services in Albania, except the Hospital of Obstetrics and Gynecology in Tirana, do not provide Pap smear testing. Few private clinics offer such services in change of a very high price i.e. 30 USD.

6. 51 % of the Albanian population are women (INSTAT 1998) and according to the LSMS (Living Standards Measurement Survey 2002), unemployment rate is close to 10% ( based on the standard ILO definition for employment), but the figure hide wide underemployment in rural areas • The national unemployment rate virtually doubles if we include among the unemployed the portion of underemployed agricultural workers who reported working few hours a week. • Gender disparities are observed in the labor market. According to the LSMS the share of women holding full time jobs is much lower, with only one woman in five reporting to work full time (one in two among men). Also, women’s labor force participation is only about two thirds that of men’s.

7. While the numbers of the reported cases of HIV positive are relatively low, prevalence of sexually transmitted disease has been estimated at 5% of the adult population, and is increasing each year. • Health care providers demonstrate a low level of knowledge and skills in many areas of reproductive health care including genital cancer prevention and Pap smear testing is viewed mainly as a diagnostic tool.

8. Vlora is chosen as the place for the intervention because: • It is one of the biggest districts of Albania; • It is a coastal districts with a high level of irregular emigration, center of trafficking with considerable number of illegal brothels, and the population is at high risk of the STI’s; • The public health structures of this district are not offering any kind of cervical cancer prevention services; • AFPA has a existent service center in this district, which offers superior sustainability premises. • It was evident that there was a significant lack of information with regard to the cervical cancer prevention among women. Efforts from the public health workers and other health bodies were missing.

9. Description of InterventionIEC ACTIVITIES • IEC materials – leaflet and poster on cervical cancer prevention • TV programs • Educational activities (workshops) with women aged 35-60 • Workshops with the health care professionals working in the public primary health care centers of Vlora district

10. Awareness meetings with abused and trafficked women (women at risk) cooperation with the Shelter Center for trafficked women located in Vlora • Workshops with student of nursing Faculty • Spot publicity • Educational activities (workshops) with rural women aged 35-60

11. ADVOCACY • Two round tables one in Tirana and the other in Vlora city will be organized in the framework of the second project. • In these meetings will participate representatives of : • Central and Local government, • Health Sector from both levels, • local NGOs, • AFPA staff and activists etc. • Media will be used for advocating the need for intervention for cervical cancer prevention programs. The results of the Cervical Cancer prevention projects implemented by APFA, women opinions, live stories and staff experiences will be used for this purpose.

12. SERVICES • Pap smear testing has started to be offered by Vlora Women Center since July 2002 • The information system has been adopted in order to meet the requirement of the Pap smear screening like: • Client records • Cytological examination form • A simple registry • Personal Cards

13. Results • Access for Pap smear testing is increased in the district of Vlora for women pertaining to different social strata. The AFPA policy for offering the service free of charge for women who can not afford has created access for poor women. • As a result of promoting the benefits of cervical cancer prevention information and services the clients demand has increased.

14. More than 2000 copies of the leaflet on Pap smear testing and 1000 copies of poster are disseminated to women in the district of Vlora providing them with a with a simple and very useful information on the cervical cancer prevention. • The TV programs revealed to be very successful in informing the community on the relevance of the pap smear testing. This was showed also by the high number of the phone calls during the programs.

15. 3300 women have been consulted on RH issues and especially on cervical cancer prevention during the project period and out of them 1360 have done a pap smear test. • Workshops organized with women and health care providers raised awareness on the cervical cancer risk and Pap test procedure. The increased percentage of health workers who refer women for screening is an indicator of such a raised awareness. • 528 is the number of direct beneficiaries from the Pap test workshops( only during the first project), but the impact of the workshop is wider to the families they belong and to the community serve.

16. The increased percentage of women with a positive attitude towards screening services is another indicator of the effectiveness of the awareness activities organized in the framework of this project • Local staff capacities are empowered and this will have a long lasting impact. The experience gained by the staff during this period will create a higher potential for managing similar projects in the future • All the activities of the project have empowered the links with the Local Government and community

17. Lessons learned • Building strong relationships with communities which profit from our work is an important factor that influence the successful implementation of the activities, fulfillment of the organization mission and mobilization of local resources • Strengthening of the collaboration with the governmental structures is very important to ensure sustainability for services and activities and having a higer impact • Maintaining and improving the quality of services is one of the main factors influencing in the frequentation of the service centers

18. One of the main lessons learnt by women frequenting the Women Center is the strait connection existing between social conditions and reproductive health and the importance of having access to integrated social and health services • AFPA staff involved in the implementation of the project activities has learnt to organize in an effective way the activities aiming to have a long lasting impact.

19. It is important to find the right approach and the right language that is meaningful to different parts of the community in order to increase the impact • Involving young people in sexual and reproductive health programs aiming at rising awareness on preventive health measures has a crucial importance for improving the SRH of the population • Ensuring a positive environment for preventing genital cancers requires sensitive attitudes, policies and legislation at family, community and national levels.

20. Acknowledgements • Alliance of the Cervical Cancer Prevention and PATH • Open Society Foundation Albania • Directory of Primary Health Care & service provider working nearby primary health care centers in Vlora • Staff working for the Program implementation • Especially to all the women that have been very receptive regarding all the program activities as well as to all the community leaders and Vlora Women Center volunteers that have strongly contributed in the successful realization of the activities