1. National Cervical Cancer Prevention and Control Program
Safina Yuma MD,MPH
RH-cancer Unit
Sunday, April 16, 2017

2. Presentation Outline Background & burden of disease
Overview of the National CECAP and Control Program
Program progress
Primary Prevention
Secondary Prevention (screening, treatment, referrals)
Challenges
Lessons learned

3. Background Cervical cancer is the most common cancer in Tanzania
Leading cause of cancer related morbidity and mortality in women in the country
Tanzania has one of highest cervical cancer burdens in the world and the highest in Eastern Africa
Age-standardized incidence rate (ASR) of 50.9 cases per 100,000 women
Despite the high burden, majority of women in Tanzania do not have access to CECAP services

4. Cervical Cancer Burden
Country/Region
Incidence Rate
(per 100,000)
Mortality Rate
Tanzania
50.9
37.5
Eastern Africa
34.5
25.3
Africa
25.2
17.6
Sunday, April 16, 2017

5. NEW CANCER CASES AT OCEAN ROAD CANCER INSTITUTE 2006 - 2011
Type of Cancer
2006
2007
2008
2009
2010
2011
Cervical cancer
955
1006
1288
1374
1510
1881
Kaposi sarcoma
295
404
418
447
681
814
Breast cancer
244
245
275
322
386
526
Esophageal cancer
181
256
282
307
380
511
Head and neck
155
206
272
289
361
Lymphomas
201
199
226
186
269
Leukemias 46 78 87
103
142
261
Urinary bladder 88 98
109
153
Skin cancer 40
108
111
123
129
141
Eye cancers 76 80 95 84
119
Others
598
472
382
390
299
208
TOTAL
2807
3138
3480
3776
4195
5224
4/16/2017

6. Cervical Cancer Prevention and Control Program in Tanzania
The government of Tanzania is committed to address cervical cancer burden
2008 : MoHSW established a RH-Cancer unit through its Reproductive and Child Health Section (RCHS).
The Tanzania Cervical Cancer Technical Working Group provides guidance to the national program.
To increase demand for CECAP services MoHSW collaboration with partners developed;
The National Cervical Cancer Prevention and Control Strategic Plan ( )
Developed Tanzania CECAP and Control service delivery guidelines
IEC materials-Posters and Brochures
Monitoring Tools
Training package-final stage
National TOT –for VIA/Cryo
National TOT- for LEEP

7. Strategic Framework
Vision: women free from the burden of cervical cancer in Tanzania
Mission: The MOHSW is committed to translate cancer prevention and control knowledge into public health action in collaboration with stakeholders including community.
The Goal of Strategic Plan : To reduce Cervical Cancer Incidence, morbidity and Mortality in Tanzania

8. Program progress
HPV vaccine launched in Tanzania as demonstration project may 2014
Launch of the community awareness Campaigns for cervical and breast cancer strong support by the First Lady, mama Kikwete (WAMA Foundation)
Cervical cancer indicators included into the DHIS Monitoring
Sunday, April 16, 2017

9. Secondary Prevention
MoHSW endorsed low cost tech VIA screening test as a national strategy to promote access
feasible to implement at low levels of the health care system.
Main focus: SVA –screening and treatment using
Cryotherapy (all facilities-with skilled personnel)
LEEP (Regional & District level facilities)
Target group: years & HIV positive at any age
Screening frequency: 3 years (HIV-/Unk) and yearly for HIV+ women
Integration: RCH services
/HIV care services/gyn clinic
Coverage: more than 200 screening sites

10. CURRENT STATUS OF PARNER REGIONAL SUPPORT
CER12
SECONDARY PREVENTION
CURRENT STATUS OF PARNER REGIONAL SUPPORT
IMA World
ICAP
MST
EGPAF/MST
12D
EGPAF
EGPAF/
WHO
ICAP/
THPS
ENGEND
EGPAF
UMATI
DSM:
MDH/
JHPIEGO
THPS
DOD
JHPIEGO/PSI
JHPIEGO
DOD
Focus:
Regional level Hospitals
District level Hospitals
Few Health Centers
EGPAF
Upcoming:
1.PSI-Private Hospitals
2.Mtwara: EGPAF/THPS
3.UMATI sites
WHO

11. Referral Pathway
Large lesions: Regional Hospitals, District Hospitals with skilled providers
Suspicious for Cancer: CCS site-Regional Hospital, or referral to MNH or to ORCI
Confirmed Cervical Cancer: referred to ORCI for radiotherapy treatment and palliative care (upcoming Bugando MC)

12. Challenges
Shortage of staffs & work overload -providers doing CECAP as one amongst other services Linkages of CCS
Lack of pathology services at regional level facility
Referral system for suspect cancer cases and large lesions
Maintenance of cryotherapy units
Re-screening of one year follow up clients is still very low
Essential equipment still not included within MSD catalogue eg. Cryo and LEEP machines
Long term sustainability of the program
Sunday, April 16, 2017

13. Lessons Learned Acceptability of the program is very high
Referral system for SC/LL needs improvements
Mechanism for maintenance of Cryo & LEEP machines need to be strengthened
Not easy to include CCS budget line item in CCHP (competing priorities)
National level advocacy of CECAP program is highly needed
Updating CECAP training curriculum in pre service education for nursing & medical schools must be the future direction to ensure sustainability of CECAPC program
With strong partnership and collaboration we can easily scale up CCS services in the country
Sunday, April 16, 2017

14. Breast cancer Mass Screening Campaigns for breast cancer
No standardized guidelines
Solicit funds for the program
Sunday, April 16, 2017