scholarly journals Cervical Cancer Screening Financing in Indonesia

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 93s-93s ◽  
Author(s):  
M. Wahidin
Keyword(s):  
Primary Care ◽  
Cervical Cancer ◽  
Health Insurance ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
National Health Insurance ◽  
Cervical Screening ◽  
Health Centers ◽  
Primary Health ◽  
Care Facilities

Background: Indonesia has been developing social health insurance as attempt of universal health coverage with target of 100% population by 2019. The coverage was for all diseases from primary care until secondary care. Cervical cancer screening was among these which were covered by the insurance. In line with national program of cervical cancer screening, the insurance will strengthen the development of the program. As a new concept of financing - started in 2014- it need to know many circumstances of cervical cancer screening financing in Indonesia. Aim: The study was aimed to know overview of cervical cancer screening financing in Indonesia. Methods: Design of the study was descriptive study through literature review from related sources. Secondary data were collected from Directorate of Noncommunicable Disease Control and Center of Health Financing, Ministry of Health, and National Health Insurance Body (BPJS). The study was conducted in January- February 2018. Results: Cancer was ranked number 3 of highest claim for national health insurance with total IDR 1.54 trillion in 2014, became IDR 2.3 trillion in 2015. Number of cases of cancer, as claimed in hospitals, was also increasing from 702,207 cases in 2014 became 1,325,776 cases in 2015. Cervical cancer was among the highest claim. Based on Minister of Health Decree No. 52/2016 about tariff of healthcare in social health insurance, cervical cancer screening was covered by the insurance. Tariff of visual inspection with acetic acid (VIA) was maximum IDR 25,000 (USD 2), tariff of Papanicolaou test was maximum IDR 125,000 (USD 10), and tariff of cryotherapy of positive VIA was IDR 150,000 (USD 11.5). These tariffs can be claimed by providers of cervical screening in primary care facilities to BPJS through noncapitation scheme. This scheme was number of claim financing by BPJS to primary health centers according to type and number of health services. Mechanism of claiming was conducted by screening providers to financing officers in primary health centers using specific form to be sent to BPJS. Then, BPJS will process payment for accepted claim. Number of population became of BPJS in 2017 was 187.9 million out of 257 million target (73%). Meanwhile number of primary care facilities collaborated with BPJS was 20,708 (including 9813 primary health centers) out of 24,336 primary care facilities (84%). It means the financing of cervical screening could be used as optimal as possible to achieve national target of screening which was 37.4 million women aged 30-50 years. Conclusion: Cervical cancer screening financing was covered by national health insurance in Indonesia. Majority of primary care facility collaborated with BPJS which become strengthening factor to enhance achievement of national target of cervical screening.

scholarly journals VIA (Visual Inspection With Acetic Acid) Service Goes to Public to Make Jakarta Free From Cervical Cancer

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 143s-143s
Author(s):  
L.M.F. Sirait ◽  
L.A. Anggreni ◽  
W.E. Prasetyo ◽  
W. Kendar Susantyo ◽  
R.K. Priharto
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Early Detection ◽  
Health Services ◽  
Cervical Cancer Screening ◽  
Public Transportation ◽  
Reporting System ◽  
Health Centers ◽  
Mobile Service ◽  
Primary Health

Background and context: According to GLOBOCAN data 2012, cervical cancer in Indonesia was in 2nd rank of cancer incidence for women in Indonesia. Aim: To raise public awareness toward cervical cancer and to increase the number of citizens who go through the early detection procedure of cervical cancer in Jakarta. Strategy/Tactics: In January 2017, Department of Health of Special Capital Region of Jakarta issued a new policy to increase the rate of cervical cancer screening in the city. The new policy includes: 1. A new reporting system in which all the patients who are subjected to cervical cancer screening to be recorded in a special form, so it can be well reported and traced. 2. The changes in the conventional way of cervical cancer screening in primary health centers into mobile service to make the medical staffs able to easily reach patients who live in peripheral areas in Jakarta. Program/Policy process: The enhancement of health education on cervical cancer and health promotion regarding the importance of cervical cancer screening using public transportation (Transjakarta bus), Papanicolaou test, and VIA test socialization in primary health centers. The results were obtained and assessed between January 2017-December 2017. Early detection rates were expected to increase by 50% compared with 2016. Outcomes: The results obtained include: 1. The new reporting system works as expected, tracing the patient with a positive VIA value becomes easier to monitor. 2. Medical teams are more active on introducing the early detection cervical cancer screening to society. 3. Various innovations were carried out, among others, by using public transportation, motorcycles to carry the medical tools and devices, a modified car that is equipped with mobile health services, and a house of citizens and the community hall that were turned into a place for examination. The number of people who have started to realize to do early detection after being educated with the knowledge of VIA test and cervical cancer is increased. The number of citizens who joined the cervical cancer early detection in 2016 was 48,960. After the policy and innovation was applied, the number increased into 105,060 citizens (increased by 114% from the previous year). What was learned: The increase of early detection rate of cervical cancer is quite significant from the previous year. For patients with positive result in their VIA test, cryotherapy was included as the part of treatment and follow-up. Costs incurred due to the treatment of cervical cancer can be reduced. With the result of this study, we can learn that there is an improvement in the quality of health services so that the number of deaths and morbidity from cervical cancer in Jakarta can be reduced.

scholarly journals Scaling Up of Cervical Cancer Screening at Primary Health Care Level in Rwanda

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 54s-54s
Author(s):  
U. Francois ◽  
J.P. Balinda ◽  
M. Hagenimana ◽  
R. Samuel ◽  
E. Arielle ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Screening Program ◽  
Health Centers ◽  
Care Level ◽  
Primary Health ◽  
Cancer Screening Program ◽  
District Hospitals ◽  
Cervical Cancer Screening Program

Background: Rwanda is a high cervical cancer-burden country, with an age standardized rate (ASR) of cervical cancer incidence of 41.8 cases per 100,000 people in 2012. In the same year, cervical cancer mortality lay at 26.2 deaths per 100,000 people. Aim: To address this burden, Rwanda initiated the vision inspection with acetic acid (VIA) screening-based strategy in 2013 in line with WHO recommendations for low- and middle-income countries. The target audience of the program was set for women between the ages of 30 and 49 and remains today. Here, we describe the implementation status of the program at the primary health care level; health centers and district hospitals in Rwanda. Methods: Integrating into Rwanda's existing health system, the program was purposefully rooted in health centers, with a pathway designed for women who screen positive to be referred to the district hospital for cryotherapy or LEEP, according to the lesions' size. Nurses, midwives and medical officers from health centers and district hospitals are trained through a 10-day curriculum (5 days for theory and 5 days for practice) before initiating the provision of services to clients in routine care. Monitoring of the program is conducted through both quarterly, on-site mentorship and screening indicators that are integrated into Rwanda's Health Management Information System (HMIS), through which facilities report on monthly basis. Results: Since its initiation in August 2013, Rwanda's cervical cancer screening program has been established in 21 of 38 (55%) district hospitals and 256 health centers in their catchment area. Training has been an integral component as well, with at least two nurses/midwives trained at implementing health centers and a medical officer with two nurses/midwives trained on cervical cancer screening and the treatment of precancerous lesions at district hospital. In addition, district hospitals have been equipped with cryotherapy, LEEP, and colposcopy machines. Over this program's implementation three-and-a-half-year course, 38,000 women have been screened for cervical cancer. Conclusion: Using a simple VIA-based strategy, Rwanda has been able to swiftly and effectively increase the number of health facilities implementing cervical cancer screening program. Though additional innovative implementation strategies are still needed to proportionally increase women's screening coverage, these initial steps hold great promise in Rwanda's ability to effectively implement a sustainable cervical cancer screening program.

scholarly journals Cervical Cancer Screening Program by Visual Inspection: Acceptability and Feasibility in Health Insurance Companies

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Apollinaire G. Horo ◽  
Judith Didi-Kouko Coulibaly ◽  
Abdoul Koffi ◽  
Boris Tchounga ◽  
Konan Seni ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Health Insurance ◽  
Cancer Screening ◽  
Diagnostic Accuracy ◽  
Cervical Cancer Screening ◽  
Visual Inspection ◽  
Screening Program ◽  
Cervical Screening ◽  
Screening Method ◽  
Insurance Company

Objective. To assess willingness to participate and diagnostic accuracy of visual inspection for early detection of cervical neoplasia among women in a health insurance company.Patients and Method. Cervical cancer screening was systematically proposed to 800 women after consecutive information and awareness sessions. The screening method was visual inspection with acetic acid (VIA) or Lugol’s iodine (VILI).Results. Among the 800 identified women, 640 (82%) have accepted the screening, their mean age was 39 years, and 12.0% of them were involved in a polygamist couple. 28.2% of women had prior cervical screening. VIA has been detected positive in 5.9% of women versus 8.6% for VILI. The sensitivity was 72.9% and specificity was 95.2% for VIA versus 71.2% and 97.3% for VILI respectively. The histological examination highlighted a nonspecific chronic cervicitis in 4.6%, CIN1 lesions in 5.91%, and CIN2/3 in 1.2% of the cases.Conclusion. Cervical cancer screening by visual inspection showed appropriate diagnostic accuracy when used to detect early cervical lesions. It is a simple and easy to perform method that could be introduced progressively in the health insurance policy while waiting for a national screening program.

scholarly journals Use of Thermocoagulation Within a 'Screen and Treat' Cervical Cancer Screening Programme in Malawi: Outcomes at One Year, Professional Perspectives, and Client Experience

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 84s-84s
Author(s):  
C. Campbell ◽  
B. Kabota ◽  
H. Chirwa ◽  
D. Morton ◽  
R. Ter Haar ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Facial Pain ◽  
Cervical Screening ◽  
Health Centers ◽  
Free Text ◽  
Low Grade ◽  
Pain Scales ◽  
One Year

Background: Thermocoagulation (also known as thermoablation, previously as cold coagulation) is increasingly being adopted as an alternative treatment to cryotherapy within 'screen and treat' cervical screening services using visual inspection with acetic acid (VIA) in resource-constrained settings. This ablative treatment is suitable for low-grade squamous epithelial lesions. Given that much of the current systematic review evidence is drawn from high-income settings, it is critical that the evidence base for use within LMICs is strengthened. Aim: To evaluate the effectiveness of thermo-coagulation in the treatment of VIA-positive lesions within a 'screen and treat' program in Malawi, and its acceptability to clients and providers. Methods: Over the last four years, the Nkhoma Cervical Cancer Screening Program has implemented a 'screen and treat' approach using VIA and treatment using thermocoagulation in a rural district general hospital and associated health centers. Women with VIA-positive lesions are offered treatment with thermocoagulation; treated women are requested to return for review at three- six months, and at one year. Mechanisms to ensure monthly data collection and collation are in place. Semistructured qualitative face-to-face interviews were carried out in English with nineteen providers in nine health centers associated with Nkhoma Hospital: a range of issues were explored, including their experience with use of thermocoagulation. A patient experience questionnaire using validated facial pain scales was developed and translated into Chichewa: women complete this following treatment together with a patient attendant. Results: Between October 2013 and July 2017, over 1650 women have received treatment with thermocoagulation. Of a cohort of 446 treated women who had returned for a 1-year review visit by July 2017, 426 (95.5%) were VIA-negative, i.e., a treatment failure rate of < 5%, comparable with the international literature. Relationship between HIV status, initial VIA positivity, and treatment outcomes, will be presented. Staff reported professional satisfaction in being able to offer treatment consistently to VIA-positive clients, closer to their communities. For some, this was contrasted with previous experience of unavailable cryotherapy resulting in loss to treatment of patients. Over 120 women have completed pain scales questionnaires following treatment with the traditional machine, or with one of the two new hand-held models: their experiences (facial pain scales, and free-text comments) will be reported. Conclusion: In many low-resource settings, VIA-based screening with robust treatment protocols will remain central to cervical cancer control until the promise of HPV vaccination is fully realized. Thermocoagulation is an effective treatment modality, acceptable to clients and patients. Ongoing review of outcomes within and across treatment facilities is critical.

Knowledge and Practice of Cervical Cancer Screening among Women in Orlu Local Government Area, Imo State, Nigeria.

2019 ◽  
Vol 1 (1) ◽  
pp. 55-65
Author(s):  
Jude Egwurugwu ◽  
S.D. Ejikunle ◽  
E.I. Dike ◽  
M.C. Ohamaeme ◽  
Jude Egwurugwu ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Local Government ◽  
Cervical Cancer Screening ◽  
Cervical Screening ◽  
Local Government Area ◽  
Care Providers ◽  
Imo State ◽  
Study Results ◽  
Knowledge And Practice

Background: Cervical cancer is the 2nd commonest cancer among women worldwide and the most common cancer among women in developing countries like Nigeria. Though preventable by screening for premalignant and early cervical lesions, this is predicated on the knowledge and practice of a cervical screening. Objective: To assess the knowledge and practice of cervical cancer screening among women in Orlu, Local Government Area(LGA) Imo State, Nigeria. Materials & Methods: A community based cross-sectional study with the use of 502 interviewer – administered questionnaires was conducted among women in Orlu LGA of Imo State. All the women in the communities attending the annual August Meeting who consented were recruited for this study. Results: The study showed that the mean age of the respondents was 42±2.8years. Furthermore, 82.3% of respondents attained postsecondary school educational level, 61.8% & 21.1% were multiparous and grand multiparous respectively. Also, 80.5% of respondents have heard about cervical cancer screening. Majority (67.5%) of these respondents heard it from health care providers. There was a positive statistically significant relationship between educational status and the likelihood of having knowledge of cervical cancer screening, (p< 0.01). The level of practice of cervical cancer screening was very low among the respondents(13.5%).Though majority of the respondents have high level of educational attainment this did not reflect their practice of cervical cancer screening. Conclusion: There was high knowledge of cervical cancer and cervical screening modalities among women in Orlu but their practice of cervical cancer screening was very low. There is an urgent need to educate and encourage women on the benefits of cervical cancer screening. Key words: cervical cancer, knowledge, Practice, Orlu women, Screening.

scholarly journals Role of Protein Biomarkers in the Detection of High-Grade Disease in Cervical Cancer Screening Programs

2012 ◽  
Vol 2012 ◽  
pp. 1-11 ◽  
Author(s):  
Charlotte A. Brown ◽  
Johnannes Bogers ◽  
Shaira Sahebali ◽  
Christophe E. Depuydt ◽  
Frans De Prins ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Cervical Screening ◽  
False Negative ◽  
Pap Test ◽  
Developed Countries ◽  
Protein Biomarkers ◽  
Ki 67 ◽  
Screening Programs

Since the Pap test was introduced in the 1940s, there has been an approximately 70% reduction in the incidence of squamous cell cervical cancers in many developed countries by the application of organized and opportunistic screening programs. The efficacy of the Pap test, however, is hampered by high interobserver variability and high false-negative and false-positive rates. The use of biomarkers has demonstrated the ability to overcome these issues, leading to improved positive predictive value of cervical screening results. In addition, the introduction of HPV primary screening programs will necessitate the use of a follow-up test with high specificity to triage the high number of HPV-positive tests. This paper will focus on protein biomarkers currently available for use in cervical cancer screening, which appear to improve the detection of women at greatest risk for developing cervical cancer, including Ki-67,p16INK4a, BD ProEx C, and Cytoactiv HPV L1.

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