INCREASING DEMAND GENERATION FOR VISUAL INSPECTION USING ACETIC ACID AMONG WOMEN 20 YEARS OLD AND ABOVE IN DAVAO REGION

INCREASING DEMAND GENERATION FOR VISUAL INSPECTION USING ACETIC ACID AMONG WOMEN 20 YEARS OLD AND ABOVE IN DAVAO REGION.

DAVAO CENTER FOR HEALTH DEVELOPMENT. o. 9*S8.

Davao Center for Health Development. Vision: Healthier and happier families in a responsive health system by 2022 . Mission: A strategic leader in implementing people- centered , equitable health systems, sustaining responsible expertise and harnessing partnerships for the implementation of Universal Health Care..

Davao Center for Health Development. Goals: Recognized as a trusted agency. Competent Human Resources for Health Collaborative partnerships Financial risk protection Functional service delivery network Empowered community.

Davao Center for Health Development. Values : D – Determination, Dedication A – Accountability & Affection V – Virtue (Vibrant) A – Action Oriented O – Order & Oneness.

INTRODUCTION. Cancer is one of the four epidemic non-communicable diseases (NCDs) or lifestyle-related diseases (LRDs) which include cardiovascular diseases, diabetes mellitus, and chronic respiratory diseases. A t present there is a low cancer prevention consciousness and most cancer patients seek consultation only at advanced stage. Cancer survival rates are relatively low. Cancer remains a national health priority in the country with significant implications for individuals, families, communities, and the health system..

BURDEN OF DISEASE World Cancer Cases in 2040. 18M.

BURDEN OF DISEASE Adult Cancer Incidence and Mortality.

Reference: WHO Global Cancer Observatory 2020. BURDEN OF DISEASE Adult Cancer Incidence by Gender.

INTRODUCTION. Cervical Cancer: Cancer of the cervix, cancer starts in the cervix, which connects the vagina to the lower part of the uterus It is a potentially preventable disease if appropriate screening and prophylactic strategies are employed . Cervical cancer screening is one of the effective interventions to early detect cervical cancer cases, gynaecological disorders and identify risk factor causing the development of the disease . Non-compliance with screening guidelines continues to be a major risk factor for invasive cervical cancer..

INTRODUCTION. In Davao Region, the accomplishment generated using the Regional Health Information System for Visual Inspection using Acetic acid in 2016-2021 is very low at 9.25% (77,517 ). Incidence 182 cases and Mortality 92 cases in 2020 There is also low proportion of trained health workers for cervical cancer screening and low to no program budget in the past years..

RATIONALE. This study was conducted with the following objective : To identify the gaps on the demand generation of cervical cancer screening in the barangay/city/municipal health facilities and find ways to address these problems T o increase coverage of women given cervical cancer screening to at least 80 % To improve early diagnosis and proper treatment of those identified with abnormal screening results To establish systems in support to delivery of quality cervical prevention and control services..

ANALYSIS:. VIA ACCOMMPLISHMENT OF DAVAO REGION (2016-2021).

ANALYSIS. Health service Delivery Cervical cancer screening is not among the priority health services offered by the facilities Low proportion of trained health workers for VIA, No dedicated staff for cervical cancer screening Target population is not aware of the cervical cancer screening service at the health centers , Women 20 years old and above are too busy to have themselves screened for VIA Lack of cancer awareness campaign activities in the community to build partnership and support from other local counter parts. Some trained health workers are not able to perform the skills in their respective areas of assignment due to other priorities Not a priority program by the LCE, No budget for VIA commodities For monitoring and evaluation, there is no team created to oversee the implementation of the activity to monitor issues and concerns and its success..

ANALYSIS. B. Health Financing Cancer prevention and Control program at the regional level has a low to no budget in the past years. With the recent pandemic, other health program budget was pooled to support COVID response activities. Some LGUs are dependent on the commodities augmented by DOH No cryotherapy machine at DOH referral Hospitals Cancer can be a significant economic burden for Filipinos leading to financial catastrophe Cancer Assistance Fund is also established by the NICCA law “to support the cancer medicine and treatment assistance program.

ANALYSIS. C. Health Regulation Administrative Order (AO) No.89-A s1990: Phil. Cancer Prevention Program AO No. 19, s1998: National Policy on Cyto -screening in the Cervical Cancer Control Program Proclamation No. 368: Declaring the month of May of every year as Cervical Consciousness Month AO No. 2005-0006: Establishment of a Cervical Cancer Screening Program Department Memoranda: 2009,2010, 2011, 2012: Guidelines in the Conduct of Cervical Cancer Screening in DOH Retained Hospitals PhilHealth Circular No. 010, s2012: Implementing Guidelines for Universal Health Care Primary Care Benefit Package (VIA Screening) for CY 2012-2013 PhilHealth Circular No. 002, s2013: Z Benefit Package Rate of Php120,000 which includes laboratories, medicines, surgery, chemotherapy/ radiotherapy/ brachytherapy, etc..

PROPOSED BUDGET FOR NICCA FY 2021. PROGRAM BUDGET ( Php ) 1) Expanded Breast Cancer Medicines Access Program 320,964,005.40 2) Expanded Childhood Cancer Medicines Access Program 80,000,000.00 3) Early Cervical Cancer Detection Access Program Using HPV DNA Test 28,000,000.00 4) Gynecologic Cancer Medicines Access Program 20,000,000.00 5) Early Colorectal Cancer Detection Access Program 16,500,000.00 6) Medicines Access Program for Blood Cancers 49,989,000.00 7) Thyroid Cancer Treatment and Surveillance Access Program 1,104,000.00 8) Palliative and Hospice Care Medicines Access Program 25,000,000.00 TOTAL 542,202,005.40.

Irnplernenting Rules and Regulations Of the S IGNED ! — 711-1001 71 1-1002 officialDOHgov.

ANALYSIS. HEALTH REGULATION. Name of the Regulatory Mechanism Key Content Outcomes Limitations R.A. 11215 or National Integrated Cancer Control Act 1. National Cancer Control Program 2. Quality Health Care Systems 3. Cancer Awareness 4. Affordable Cancer Care and Treatment 5. Essential Medicines There is hereby established National Integrated Cancer Control Program, under Cancer Control Division of the Disease Prevention and Control Bureau, which shall serve as the framework for all cancer related activities of the government. The DOH, local government units (LGUs), and other government agencies concerned shall strengthen the capability of public health systems and facilities, provision of services and continuum of cancer Slow roll out of NICCA due to COVID 19 Pandemic.

Name of the Regulatory Mechanism Key Content Outcomes Limitations R.A. 11215 or National Integrated Cancer Control Act 6. Supportive Environment for Cancer Patients, Persons with Cancer and Cancer survivors 7. Cancer registry and monitoring system 3. The DOH together with the relevant government agencies, the LGUs and all stakeholders, including community health workers, shall intensify the cancer awareness campaign and provide the latest and evidence-based information for the prevention and treatment of cancer including practical advice, support and referral pathway for cancer patients, person living with cancer, cancer survivors, their families and carers. Slow roll out of NICCA due to COVID 19 Pandemic.

Name of the Regulatory Mechanism Key Content Outcomes Limitations R.A. 11215 or National Integrated Cancer Control Act 4. There is hereby established a Cancer Assistance Fund to support cancer medicine and treatment assistance fund 5. The DOH and other concerned government agencies shall implement reforms supporting early access to essential medicines, innovative medicines and health technologies, to ensure highest possible chance of survival among cancer patients and persons living with cancer. 6. The DOH in collaboration with the Council and other stakeholder, shall establish a national cancer registry and monitoring system. The registry must cover all forms of cancer among adults, children, and elderly and serve as guide in the policy development of the council. Slow roll out of NICCA due to COVID 19 Pandemic.

D. HEALTH GOVERNANCE. Stakeholder Stake in the project Resources Potencial impact/ rewards Perceived Risks Stakeholder Position Stakeholder Management Strategy NCD Coordinators in the DDO, CHD and PHO/CHO Techinical Assistance providers 1.National policy/guideline/ framework 2.Commodities 3.TOT/ Training designs 4.Program Funds 1.Enhanced Screening and Diagnosis Services 2.Strengthened Health Information System on Cervical Cancer 3.Enhanced delivery of cervical cancer prevention and screening services 4.Strengthened referral diagnosis 5.Equipped health facilities for cervical cancer screening 6.Increased number of women screened in VIA 7.Empowered and more health responsive Davaoenas 8. More cases of cervical cancer screened at an early stage 1.will need to provide additional budget for VIA 2. will need to provide additional manpower dedicated to VIA 3. will need to provide additional equipment and manpower dedicated for VIA health information systems and data analysis 4. will need to invest for capacity building Power/ Leadership 3 S manage and coordinate CCPC efforts advocate support for CCPC annual assessment and planning monitoring of CCPC efforts and results provide training to local levels provide logistics augmentation.

D. HEALTH GOVERNANCE. Stakeholder Stake in the project Resources Potential impact/ rewards Perceived Risks Stakeholder Position Stakeholder Management Strategy Service providers Provincial /regional level (Hospital/s) Referral Hospital for VIA positive women Funds 1. Improved delivery of quality treatment services May need additional manpower May need to invest for capacity building May need additional budget for Cervical Cancer treatment Power/ Leadership 3 S provide cryotherpay services administer diagnosis, management and tx services training of service providers on VIA record and maintain client’s records provide report on cervical cancer (back referral) participate in planning, PIR and monitoring.

D. HEALTH GOVERNANCE. Stakeholder Stake in the project Resources Potential impact/ rewards Perceived Risks Stakeholder Position Stakeholder Management Strategy Service Providers Municipal Level BHWs/CHTs BNS Midwives Nurses MDs VIA service provider Manpower Capacity Building activities Funds VIA commodities IEC materials 1.Enhanced Screening and Diagnosis Services 2.Strengthened Health Information System on Cervical Cancer 3.Enhanced delivery of cervical cancer prevention and screening services 4.Strengthened referral diagnosis 5.Equipped health facilities for cervical cancer screening 6.Increased number of women screened in VIA 7.Empowered and more health responsive Davaoenas 8. More cases of cervical cancer screened at an early stage 1.will need to provide additional budget for VIA 2. will need to provide additional manpower dedicated to VIA 3. will need to provide additional equipment and manpower dedicated for VIA health information systems and data analysis 4. will need to invest for capacity building Power/ Leadership 3 S masterlisting of targeted women for cervical cancer screening provide basic info on cervical cancer screening services conduct IEC on CCPC; promotion of healthy lifestyle provide counseling to targeted women mobilize clients to undergo cervical cancer screening perform VIA screening refer clients for cryotherapy or further evaluation record and maintain client’s records mobilize resources for reproduction of forms strengthen networking with hospitals and other facilities develop capability of health managers on data analysis consolidate and submit reports participate in planning, PIR and monitoring.

E. Human Resource for Health. VIA TRAINING INVENTORY IN DAVAO REGION Note: There are 3 District Health Offices in Davao City with no trained health worker on VIA.

E. Human Resource for Health. Sub task Knowledge Skill Attitude Assessment and planning Knowledge on cervical cancer prevention and cervical cancer screening Rational and critical thinking, logical reasoning, g ood decision making, good planning ability commitment, sense of fairness, integrity, confidence, leadership, sense of order, strong personality Health Information dissemination campaign Public speaking/ public relations, well-versed of cervical cancer, problem solving and critical thinking Competency, pleasing personality, persistent, goal oriented VIA service delivery VIA trained Competency and efficiency Information Management Computer literacy, data analysis, records management competency, systematic Logistics management sense of order competency, systematic Monitoring and evaluation Rational and critical thinking, logical reasoning focus, calm,action oriented, Research analytical , systematic action oriented, logical, focus,calm , commitment.

F. Health Information System. Davao region is utilizing RHIS or the Regional Health Information System in Recording data Visual Inspection using Acetic acid In order to effectively use RHIS, there should be a trained personnel to man the system, IT equipment must be available and funds to sustain the HIS . The RHIS shows how low VIA accomplishment is which means that there is a need to revisit and strengthen program strategies and a need to enforce the cervical cancer screening in the barangay/city and municipal health facilities . There is fast turn-over of trained personnel, no dedicated staff and the poor/unstable internet connection in most of the barangays in the region. For VIA, RHIS data is limited to the number of women undergone VIA and breast exam, and number of women who turned out positive with VIA..

Recommendation:. Based on the analysis, these are the recommendations : To include VIA as priority activity for the Work and Financial Plan of Cancer Prevention and Control Program for Fiscal Year 2023 Strengthen Capacity Building for health workers Local Policy Adaptation for Cervical cancer screening Involvement of different groups of service providers at various levels of care Support Systems: Assessment and Planning Information Management Logistics Management Monitoring and Evaluation Cervical Cancer Recording System Investment Planning for Cervical Cancer Prevention and control Cancer Epidemiology and Clinical Research.

Summary:. Cervical cancer is one of the most preventable and successfully treatable forms of cancer. Screening tests offer the best chance to have cervical cancer found early when treatment can be most successful. It can also actually prevent most cervical cancers by finding abnormal cell changes so that they can be treated before they have a chance to turn into a cervical cancer. The objective of cervical cancer screening is to reduce both cervical cancer incidence and mortality. Cervical cancer screening is one of the best ways to protect the women from cervical cancer. Let us support cervical cancer screening and other types of cancer screening services. Let us all act now and be advocates of good physical and mental health..

THANK YOU!. “The groundwork for all happiness is good health.”-Leigh Hunt.