1. 1 April 2010 Jhpiego/Baltimore Veronica Reis, MD, MPH MCHIP Technical Director MAPUTO, MOZAMBIQUE BREAST AND CERVICAL CANCER PREVENTION ACTIVITIES INTEGRATED ON FP/RH SERVICES

2. Total population: 20.53 million (2007) Life expectancy at birth: 42 years Major cause of death (all ages): Malaria HIV prevalence rate: 16.2% Background: General Health Situation in Mozambique Source: 2007 Census, DHS 2003

3. The cervical cancer situation in Mozambique  Data from the cancer registry at the pathology services of Central Hospitals, indicate that “the cervical cancer is currently the most frequent malignant tumor in adult women”.  According to the registry, most cases are diagnosed in advanced stages when surgery is no longer possible – Carrilho, 2004. Parkin DM, Ferlay J, Hamdi-Cherif M, Sitas F, Thomas J, Wabinga H, Whelna SL (eds) Cancer in Africa: epidemiology and Prevention (IARC Scientific Publications 153), pp. 268-276, Lyon, IARCPress, 2003. Photo: Ismael Miquidade

4. Mais actualmente, nao ha um There is no population-based, national cancer registry in Mozambique and until 2007 there was no national policy or strategy to fight cervical cancer.

5. Action Plan Developed on 2007 with Jhpiego support under Non Communicable Disease Strategy OBJECTIVES:  To adopt and implement interventions to fight cervical and breast cancer in Mozambique.  To reduce the incidence and mortality due to reproductive cancer.

6. MAIN INTERVENTIONS 1.Adopt and promote the use of VIA and Cryotherapy as the prime method for cervical cancer prevention 2.Adopt and promote the early detection of breast cancer through self and clinical breast examination 3.Develop standardized norms and training materials for the early detection and management of cervical cancer and breast cancer 4.Acquire equipment and train health professionals 5.Organize primary health services and referral services for cervical cancer prevention and control integrated in the FP/RH services 6.Strengthen the information, monitoring and evaluation systems for cancer control in Mozambique

7. MCHIP Mozambique Objectives May 2009 – Nov 2010 7  Strengthen EMNC and BEmONC services, including PPFP, in selected healthcare facilities in all provinces, as well as key integrated RH/MCH services in selected healthcare facilities in selected provinces.  Strengthen BEONC and CEONC in an integrated manner in pre-service institutions for MCH mid-level nurses.  Assist the MOH on the development of modular, integrated in-service training package for RH/MCH.

8. MCHIP – Main Interventions for key integrated RH services  Develop and disseminate National Policy and Guidelines for key integrated RH/MCH services, including cervical cancer (CxCa) screening and treatment based on the “single visit approach” (SVA)  Translate/adapt/develop and print reference, training, and IEC CxCa prevention materials  Train 20 healthcare workers from 5 HC in key integrated RH services, including CxCa prevention using the SVA  Train 10 professionals from referral sites in Colposcopy and LEEP procedures

9. MCHIP – Main Interventions for key integrated RH services  Train as trainers 10 healthcare workers and preceptors from training institutions in CxCa prevention using SVA  Provide technical support for 5 healthcare facilities to implement CxCa prevention services using the SVA  Strengthening Information system and referral mechanisms for CxCa prevention services,  Develop an Integrated national RH, including CxCa prevention services, roll out plan

10. Main Results Achieved from May 2009-February 2010  Supported the MoH in the development of the National Family Planning Strategy and of the National Guidelines for cervical cancer prevention based on the SVA.  Translated CECAP reference Manual and Training package (from English to Portuguese)  Developed and printed IEC materials for CxCa prevention  Supported the procurement and distribution of cryotherapy, colposcopy and LEEP equipment acquired by UNFPA  Supported the development of information and monitoring forms for cervical cancer prevention

11. Main Results Achieved  45 professionals, from 10 health care facilities, trained on VIA and cryotherapy.  14 professionals (including health workers and preceptors from training institutions) trained as supervisors.  15 professionals, from 4 referral sites trained on colposcopy biopsy and LEEP to treat advanced precancerous cervical lesions.  Norms and IEC materials for referral sites services in development process

12. VIA & Cryotherapy Training Maputo, Sept 2009

13. Workshop for Supervisors – Maputo, Sept 2009 BoaneObserve Discuss Recommend

14. VIA & Cryotherapy Training – Zambézia, Feb 2009

15. A Colposcopy & LEEP Training Maputo Feb 2009

16. VIA&Crio Services Results from September-February  1080 women screened for cervical cancer at FP/RH service  31 VIA positive  20 treated immediately with Cryotherapy

17. Challenges  Limited availability of MOH technical health workers at all level, given the current severe shortage of personnel, implied in difficulties on the activities implementation;  High rotation of health workers;  Problems with equipment acquired (especially cryoterapy units);  Limited human and financial resources at MCHIP Mozambique to face the amount of support needed by the MOH at Central and Provincial level.

18. THANK YOU!