1. M O N T E N E G R O Negotiating Team for the Accession of Montenegro to the European Union Working Group for Chapter 28 – Consumer and Health Protection Bilateral screening: Chapter 28 PRESENTATION OF MONTENEGRO Brussels, 15-16 April 2013

2. Chapter 28: Consumer and Health Protection M O N T E N E G R O Negotiating Team for the Accession of Montenegro to the European Union Chapter 28: CONSUMER AND HEALTH PROTECTION. Dr Mensud Grbovic Deputy Minister Ministry of Health mensud.grbovic @mzd.gov.me CANCER

3. Chapter 28: Consumer and Health Protection M O N T E N E G R O Negotiating Team for the Accession of Montenegro to the European Union Contents  Relevant Acquis  Institutional framework  National Legislation  Montenegro National Cancer Control Plan  National program for early colorectal cancer detection  National program for early cervical cancer detection  National program for early breast cancer detection Chapter 28: CONSUMER AND HEALTH PROTECTION

4. Chapter 28: Consumer and Health Protection M O N T E N E G R O Negotiating Team for the Accession of Montenegro to the European Union Relevant Acquis Council Conclusions on action against cancer (13 September 2010) Council Conclusions on reducing the burden of cancer (10 June 2008) 32003H0878 (EUR-Lex: 15.30) Council Recommendation of 2 December 2003 on cancer screening (OJ L 327, 16.12.2003, p. 34) Chapter 28: CONSUMER AND HEALTH PROTECTION

5. Chapter 28: Consumer and Health Protection M O N T E N E G R O Negotiating Team for the Accession of Montenegro to the European Union National Legislation The Constitution of Montenegro Law on Health care (Official Gazette no. 39/2004, no. 14/2010) Law on health insurance (Official Gazette no. 39/2004, no. 14/2012) Law on the health care data collections (Official Gazette no. 80/2008) Strategy for prevention and control of noncommunicable diseases Regulation on detailed content, form and manner of keeping register of diseases of major socio-medical importance, infectious diseases and other conditions related to population health (Official Gazette no. 24/2012) Montenegro national cancer control plan National program for early cervical cancer detection National program for early colorectal cancer detection National program for early breast cancer detection Chapter 28: CONSUMER AND HEALTH PROTECTION

6. Chapter 28: Consumer and Health Protection M O N T E N E G R O Negotiating Team for the Accession of Montenegro to the European Union Institutional Framework Ministry of Health (National Cancer Control Committee) Institute of Public Health Health care institutions Health Insurance Fund Chapter 28: CONSUMER AND HEALTH PROTECTION

7. Chapter 28: Consumer and Health Protection M O N T E N E G R O Negotiating Team for the Accession of Montenegro to the European Union Leading causes of death by diagnostic groups in Montenegro in 2009 Chapter 28: CONSUMER AND HEALTH PROTECTION

8. Chapter 28: Consumer and Health Protection M O N T E N E G R O Negotiating Team for the Accession of Montenegro to the European Union Most frequent cancers as cause of death among men in Montenegro in 2009 Chapter 28: CONSUMER AND HEALTH PROTECTION

9. Chapter 28: Consumer and Health Protection M O N T E N E G R O Negotiating Team for the Accession of Montenegro to the European Union Most frequent cancers as cause of death among women in Montenegro in 2009 Chapter 28: CONSUMER AND HEALTH PROTECTION

10. Chapter 28: Consumer and Health Protection M O N T E N E G R O Negotiating Team for the Accession of Montenegro to the European Union Montenegro – Estimated age standardized incidence for 2008* Chapter 28: CONSUMER AND HEALTH PROTECTION IndictorsMaleFemaleBoth sexes Estimated ASR Incidence per 100000231,1185,2204,3 Risk of getting cancer before age 75 (%)24,018,921,2 Risk of dying from cancer before age 75 (%) 17,610,913,9 *Globocan 2008 (IARC). Section of cancer information

11. Chapter 28: Consumer and Health Protection M O N T E N E G R O Negotiating Team for the Accession of Montenegro to the European Union Montenegro National Cancer Control Plan Key Aims Improving the efficiency and cancer control through data collection and surveillance Reduction in cancer incidence through primary prevention measures Ensuring early detection and screening program aimed at reducing the cancer-related incidence and mortality Improvement of organization and services for diagnostics and treatment of malignant diseases, aimed at reducing the morbidity and mortality Improving the quality of life of cancer patients and their family through the establishment of palliative care and rehabilitation services Quality improvement Strengthening human resources and education Chapter 28: CONSUMER AND HEALTH PROTECTION

12. Chapter 28: Consumer and Health Protection M O N T E N E G R O Negotiating Team for the Accession of Montenegro to the European Union Chapter 28: CONSUMER AND HEALTH PROTECTION Raising awareness about the cervical cancer problem and the importance of regular checkups Reduction of mortality caused by cervical cancer by 50% in the period of 10 years after the beginning of implementation of the Program; Reduction of cervical cancer incidence by 50-60% in the period of 8 years after the beginning of implementation of the Program ; Coverage of at least 50% of target population in the period of 3 years after the beginning of implementation of the Program; National program for early cervical cancer detection

13. Chapter 28: Consumer and Health Protection M O N T E N E G R O Negotiating Team for the Accession of Montenegro to the European Union Target Population Women aged 24-64 years, with the interval of examination in every three years Chapter 28: CONSUMER AND HEALTH PROTECTION

14. Chapter 28: Consumer and Health Protection M O N T E N E G R O Negotiating Team for the Accession of Montenegro to the European Union Continuous media campaign about the importance of prevention and early detection of cervical cancer Additional training and education of pathologists, and motivation of staff in primary health care (chosen doctors and nurses) Invitations for PAP test sent from the primary health care centers to the home addresses of eligible women together with educational brochure and questionnaire Cytological examination of cervical smears would be performed at the designated centers Further diagnostic processing and treatment, if needed, at secondary and tertiary health care institution Chapter 28: CONSUMER AND HEALTH PROTECTION Organization of the program for early breast cancer detection

15. Chapter 28: Consumer and Health Protection M O N T E N E G R O Negotiating Team for the Accession of Montenegro to the European Union National program for early colorectal cancer detection Reduction of mortality caused by colorectal cancer by 15% in the period of 5 years after the beginning of implementation of the Program; Detection of colorectal cancer at the early stage of disease and thus enhancing possibility of healing, quality of life and survival; Coverage of at least 60% of target population Chapter 28: CONSUMER AND HEALTH PROTECTION

16. Chapter 28: Consumer and Health Protection M O N T E N E G R O Negotiating Team for the Accession of Montenegro to the European Union Target Population Men and women aged 50-74 years, with the interval of examination in every two years using test for occult bleeding Chapter 28: CONSUMER AND HEALTH PROTECTION

17. Chapter 28: Consumer and Health Protection M O N T E N E G R O Negotiating Team for the Accession of Montenegro to the European Union Organization of the program for early colorectal cancer detection Continuous media campaign about the importance of prevention and early detection of colorectal cancer Additional training and motivation of staff in primary health care (chosen doctors and nurses) Invitations for occult bleeding testing to be sent from the primary health care centers to the home addresses of eligible population together with educational brochure and questionnaire Further diagnostic processing, if needed, in designated endoscopic center Chapter 28: CONSUMER AND HEALTH PROTECTION

18. Chapter 28: Consumer and Health Protection M O N T E N E G R O Negotiating Team for the Accession of Montenegro to the European Union Raising awareness about the breast cancer problem Reduction of female mortality caused by breast cancer by 15% in the period of 5 years after the beginning of implementation of the Program; Early detection of breast cancer above 80% with the possibility to detect in situ lesions above 10% ; Improvement of the quality of life of female patients suffering from breast cancer. Chapter 28: CONSUMER AND HEALTH PROTECTION National program for early breast cancer detection

19. Chapter 28: Consumer and Health Protection M O N T E N E G R O Negotiating Team for the Accession of Montenegro to the European Union Target Population Healthy women aged 40-69 years, with the interval of examination in every two years Chapter 28: CONSUMER AND HEALTH PROTECTION

20. Chapter 28: Consumer and Health Protection M O N T E N E G R O Negotiating Team for the Accession of Montenegro to the European Union Organization of the program for early breast cancer detection Continuous media campaign about the importance of prevention and early detection of breast cancer Additional training and motivation of staff in primary health care (chosen doctors and nurses), as well as radiologists and surgeons Invitations for mammography examination to be sent from the primary health care centers to the home addresses of eligible women together with educational brochure and questionnaire Mammography examination would be performed at the Centers for Radiological Diagnosis at the primary health care centers (double independent reading of mammography) Further diagnostic processing and treatment, if needed, in designated centers Chapter 28: CONSUMER AND HEALTH PROTECTION

21. Chapter 28: Consumer and Health Protection M O N T E N E G R O Negotiating Team for the Accession of Montenegro to the European Union Activities Establishment of the National Cancer Register is in process Organization of screening for colorectal cancer is in process and its beginning is planned on the 22. 04. 2013 National guideline on therapy of chronic cancer pain Chapter 28: CONSUMER AND HEALTH PROTECTION

22. Chapter 28: Consumer and Health Protection M O N T E N E G R O Negotiating Team for the Accession of Montenegro to the European Union Challenges Stable sources of financing Sustainable organization Awareness of population Motivation of health workers (especially chosen doctors) Human resources Physical resources Establishment of palliative care Chapter 28: CONSUMER AND HEALTH PROTECTION

23. Thank you for your attention. QUESTIONS