Long Term Plan for National Cancer Control Program in Indonesia
Content
LONG TERM PLAN FOR
NATIONAL CANCER CONTROL PROGRAM IN INDONESIA
dr.Ratna Rosita Suryo Subandoro,MPH.M
STAFF AHLI MENTERI KESEHATAN BIDANG TEKNOLOGI KESEHATAN DAN GLOBALISASI MINISTRY OF HEALTH, REPUBLIC OF INDONESIA
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Cancer control program was known since 1989 stated in Integrated & Comprehensive Cancer Control Program (SK Menkes No 604/Menkes/ SK/1989) Every hospital should develop their own cancer control program based on their resources & capacity (SK Menkes No 10/Menkes/SK/I/1994) Indonesia participated in developing Jakarta Statement on Cancer Control Program è the statement of strategic effort toward optimal cancer control and care (initiated by UICC & WHO) Establishment of Dharmais Cancer Hospital (1993) in the future hopefully will become National Cancer Center Establishment of Directorate of NCD Control, including Sub Directorate of Cancer Control
GLOBAL MORTALITY BY CAUSE, ALL AGES 2005
35 30 25 20 15 10 5 COPD 0
DIABETES CARDIO-VASCULAR DISEASES
TREND OF MORTALITY IN INDONESIA BY CAUSE, ALL AGES IN 1992 – 2001
HOUSE HOLD HEALTH SURVEY 1992, 1995, 2001
Percentage
CANCER
HIV AIDS TB
MALARIA
Infectionparasite
Circulation
Digestive Injury Perinatal Neoplasma Respiratory
* NCD is the most common cause of death in the world
**Source: WHO and World Bank 2005
1992
1995
2001
Disease Burden in Indonesia
n n
n
n
House hold health survey, 2001 : cancer is the 5 th cause of death Pathology based data from 13 main hospitals in Indonesia, 1998: cervical ca is the highest among ca cases (17,2%) followed by breast ca (12,8%) Indonesia hospital admission in 2005: Breast cancer is the highest and followed by cervical cancer. Riskesdas 2007 : tumor/cancer is the 7th (5,7%) cause of death in Indonesia, with prevalence 4.3 per 1000 people
10 Commonest Malignancy Jakarta (30 Hospitals) * 2005-2007
Breast Cervix Uteri Bronchus and Lung Leukemia Pharynx Ovary Lymph Nodes Colon Thyroid Gland Hepar
0%
18.4% 10.6% 6.8% 5.8% 5.7% 4.5% 3.6% 3.6% 3.3% 2.7%
5% 10% Percent 15% 20%
Topography
*) tanpa data tahun 2005 dari regional utara
10 Commonest Malignancy in Male Jakarta (30 Hospitals) * 2005-2007
10 Commonest Malignancy in Male Female Jakarta (30 Hospitals) * 2005-2007
Bronchus and Lung Pharynx Leukemia Lymph Nodes
Topography
13.7% 10.0% 8.4% 5.8% 5.8% 5.7% 4.6% 4.4% 3.1% 3.0%
0% 5% 10% 15% Topography
Breast Cervix Uteri Ovary Leukemia Thyroid Gland Pharynx Bronchus and Lung Corpus Uteri Colon Lymph Nodes 7.2% 4.3% 4.0% 3.2% 2.8% 2.5% 2.3% 2.3% 16.9%
28.9%
Prostate Gland Colon Hepar Rectum Renal Pelvis - Bladder Soft Tissue
0% 5% 10% 15% 20% 25% 30% 35% Percent
Percent
*) tanpa data tahun 2005 dari regional utara
*) tanpa data tahun 2005 dari regional utara
VISION of MoH-RI MoHSELF MOTIVATED COMMUNITY TO LIVE HEALTHY LIFE
MAKE PEOPLE HEALTHY
MoH of RI Organization Structure
Expert staffs of MoH Ministry of Health
MISSION
Secretary General
DG of Medical Services
DG of Pharm & Med Supp Secretary of DG of Med Serv
DG of Disease Control & EH
DG of Public Health
Inspectorate General
Secretary of DG DC & EH
Directorate of Specialistic Med Services
Other Directorates
Directorate of NCD Control
Other Directorates
Subdit of Specialistic Hospitals
Other Subdits
Subdit of Cancer Control
Subdit of Chronic Disease
Other Subdits
UU No : 36/2009 à Kesehatan PP No : 19/2003à Pengamanan rokok bagi kes
Kepmenkes: •No : 1575/2005 à Organization & Tasks of MoH •No : 1468/2006 à RPJPK 2005-2009 •No : 1116/2003 à Gudeline of Health Surveillance System •No : 1479/2003 à Guideline of Epid-Surveil of CD & NCD •No : 430/2007 à Guideline of Cancer Control •No : 1163/2007 à Working group on Cervical and Breast Cancer Control
To decrease cancer morbidity, disability,mortality and improve quality of life of cancer patients
NCD programmer ( center, UPT, district) Inter program & inter sector related Professional Org. & NGO Community & groups at risk
Policies on Cancer Control
n n
Based on social participation and community empowerment through local enhancement Developing collaboration and partnership networking Integrating program of primary, secondary and tertiary prevention. Performing services delivery by professionals and qualified healthcare providers Developing surveillance of risk factors and cancer registry Quality Assurance
n
n
n
n
STRATEGIES
n n n
n n n
Social mobilization and community empowerment for healthy living Encouraging health service development Encouraging and facilitating community participation Developing early detection program Improving health services access Developing risk factors surveillance and cancer registry Proposing cancer treatment in the compulsory health insurance for the poor payment scheme
n
•Polices, •Guidelines, •Modules
Establishment of Networking
Developing Program
• Advocacy • Socialization • Promotion
Budget development Monitoring &Technical assistance
Human Investment
Epidemiological Surveillance & Information Technology
Logistics
1. NCCP Policy : • Promotion & prevention on community based (Avoid risk factor, Tobacco control phisical activity, healthy diets&healthy life) • Early detection & prompt treatment (cervical cancer, breast cancer, colorectal ca, retinoblastoma, etc) • Cancer registry (Hospital based & Population based) - choose the area => Yogyakarta, bali, etc • Diagnosis and Treatment : - especially in cancer centre hospital - to increased hospital services on regional cancer hospital 2. Guidelines • Screening program • Treatment for cancers • Risk factors control • Epidemiological Surveillance • Community empowerment • Promotion & campaign, etc 3. Modules • TOT for providers • TOT for managers • Training for providers • Training for managers • Training for cadres
Policies, Guidelines, Modules
1. Public Awareness - Promotion - Public education 2. Screening è Pilot Project for Cervical & Breast Cancer - Started in 6 Districts (6 provinces) since 2007, now expanded to another 2 districts - Goal : finding pre-cervical cancer lession & breast tumor pre- Target : woman age 30 -50 yrs - Coverage target: 80% from target at the population - Location : 6 Districts (Deli Serdang, Gowa, Karawang, G. Kidul, Kebumen, Gresik) @ 8 Primary Health Care each - Metode : single visit approach with Visual Inspection with Acetic acid/VIA & Cryotherapy (for VIA+), and Clinical Breast Examination/CBE - Provider : well trained MD & midwives in PHC - Supervisor: 1. Clinician (Obsgyn & Surgeon) 2. Management by District & Province official health officer 3. Vaccination - HBV Vaccination : child immunization since 1997 è compulsory - HPV Vaccination : private 4. Cancer Registry è Pilot Proyect in DKI Jakarta since 2007
Advocacy & Socialization
• Advocacy
n
Decision makers : MoH, Min of Finance, National Planning Bureau, etc Traditional & religious leaders Professional organizations NGOs Etc Public education Mass campaign
• Socialization
n n n n
• Promotion
n n
Establishment of Networking
• National
n
Working group on Cervical and breast cancer control UICC and IACR
• International
n
Human Investment
o TOT & training on Cervical & Breast Ca screening
o o TOT on management of NCCP Training for cadres èPKK
Logistics è For Screening
• IVA set
• • • • • Cryo set cervicograph, Colposcopy LEEP Mammografi
n
n
n
n
n
To develop national cancer registry, it needs a model, DKI Jakarta is chosen as the model. model. The budget of the model is still supported by WHO representative to Indonesia Divided 5 regions : East, West, North, Central, & South Jakarta In beginning, there are 40 hospitals chosen to run cancer registry Hope following population base in DKI Jakarta area in 2010 year
Plan of Regional Cancer Centre Indonesia
Regional Cancer Centre National Cancer Centre
n
n
Cancer control in Indonesia are already established, which is in developing stage. It’s need fundamental system NCC is needed to support the programs on:
• Scientific • Analytic • Operational research
NATIONAL CANCER CONTROL PROGRAM IN INDONESIA
dr.Ratna Rosita Suryo Subandoro,MPH.M
STAFF AHLI MENTERI KESEHATAN BIDANG TEKNOLOGI KESEHATAN DAN GLOBALISASI MINISTRY OF HEALTH, REPUBLIC OF INDONESIA
n
n
n
n
n
Cancer control program was known since 1989 stated in Integrated & Comprehensive Cancer Control Program (SK Menkes No 604/Menkes/ SK/1989) Every hospital should develop their own cancer control program based on their resources & capacity (SK Menkes No 10/Menkes/SK/I/1994) Indonesia participated in developing Jakarta Statement on Cancer Control Program è the statement of strategic effort toward optimal cancer control and care (initiated by UICC & WHO) Establishment of Dharmais Cancer Hospital (1993) in the future hopefully will become National Cancer Center Establishment of Directorate of NCD Control, including Sub Directorate of Cancer Control
GLOBAL MORTALITY BY CAUSE, ALL AGES 2005
35 30 25 20 15 10 5 COPD 0
DIABETES CARDIO-VASCULAR DISEASES
TREND OF MORTALITY IN INDONESIA BY CAUSE, ALL AGES IN 1992 – 2001
HOUSE HOLD HEALTH SURVEY 1992, 1995, 2001
Percentage
CANCER
HIV AIDS TB
MALARIA
Infectionparasite
Circulation
Digestive Injury Perinatal Neoplasma Respiratory
* NCD is the most common cause of death in the world
**Source: WHO and World Bank 2005
1992
1995
2001
Disease Burden in Indonesia
n n
n
n
House hold health survey, 2001 : cancer is the 5 th cause of death Pathology based data from 13 main hospitals in Indonesia, 1998: cervical ca is the highest among ca cases (17,2%) followed by breast ca (12,8%) Indonesia hospital admission in 2005: Breast cancer is the highest and followed by cervical cancer. Riskesdas 2007 : tumor/cancer is the 7th (5,7%) cause of death in Indonesia, with prevalence 4.3 per 1000 people
10 Commonest Malignancy Jakarta (30 Hospitals) * 2005-2007
Breast Cervix Uteri Bronchus and Lung Leukemia Pharynx Ovary Lymph Nodes Colon Thyroid Gland Hepar
0%
18.4% 10.6% 6.8% 5.8% 5.7% 4.5% 3.6% 3.6% 3.3% 2.7%
5% 10% Percent 15% 20%
Topography
*) tanpa data tahun 2005 dari regional utara
10 Commonest Malignancy in Male Jakarta (30 Hospitals) * 2005-2007
10 Commonest Malignancy in Male Female Jakarta (30 Hospitals) * 2005-2007
Bronchus and Lung Pharynx Leukemia Lymph Nodes
Topography
13.7% 10.0% 8.4% 5.8% 5.8% 5.7% 4.6% 4.4% 3.1% 3.0%
0% 5% 10% 15% Topography
Breast Cervix Uteri Ovary Leukemia Thyroid Gland Pharynx Bronchus and Lung Corpus Uteri Colon Lymph Nodes 7.2% 4.3% 4.0% 3.2% 2.8% 2.5% 2.3% 2.3% 16.9%
28.9%
Prostate Gland Colon Hepar Rectum Renal Pelvis - Bladder Soft Tissue
0% 5% 10% 15% 20% 25% 30% 35% Percent
Percent
*) tanpa data tahun 2005 dari regional utara
*) tanpa data tahun 2005 dari regional utara
VISION of MoH-RI MoHSELF MOTIVATED COMMUNITY TO LIVE HEALTHY LIFE
MAKE PEOPLE HEALTHY
MoH of RI Organization Structure
Expert staffs of MoH Ministry of Health
MISSION
Secretary General
DG of Medical Services
DG of Pharm & Med Supp Secretary of DG of Med Serv
DG of Disease Control & EH
DG of Public Health
Inspectorate General
Secretary of DG DC & EH
Directorate of Specialistic Med Services
Other Directorates
Directorate of NCD Control
Other Directorates
Subdit of Specialistic Hospitals
Other Subdits
Subdit of Cancer Control
Subdit of Chronic Disease
Other Subdits
UU No : 36/2009 à Kesehatan PP No : 19/2003à Pengamanan rokok bagi kes
Kepmenkes: •No : 1575/2005 à Organization & Tasks of MoH •No : 1468/2006 à RPJPK 2005-2009 •No : 1116/2003 à Gudeline of Health Surveillance System •No : 1479/2003 à Guideline of Epid-Surveil of CD & NCD •No : 430/2007 à Guideline of Cancer Control •No : 1163/2007 à Working group on Cervical and Breast Cancer Control
To decrease cancer morbidity, disability,mortality and improve quality of life of cancer patients
NCD programmer ( center, UPT, district) Inter program & inter sector related Professional Org. & NGO Community & groups at risk
Policies on Cancer Control
n n
Based on social participation and community empowerment through local enhancement Developing collaboration and partnership networking Integrating program of primary, secondary and tertiary prevention. Performing services delivery by professionals and qualified healthcare providers Developing surveillance of risk factors and cancer registry Quality Assurance
n
n
n
n
STRATEGIES
n n n
n n n
Social mobilization and community empowerment for healthy living Encouraging health service development Encouraging and facilitating community participation Developing early detection program Improving health services access Developing risk factors surveillance and cancer registry Proposing cancer treatment in the compulsory health insurance for the poor payment scheme
n
•Polices, •Guidelines, •Modules
Establishment of Networking
Developing Program
• Advocacy • Socialization • Promotion
Budget development Monitoring &Technical assistance
Human Investment
Epidemiological Surveillance & Information Technology
Logistics
1. NCCP Policy : • Promotion & prevention on community based (Avoid risk factor, Tobacco control phisical activity, healthy diets&healthy life) • Early detection & prompt treatment (cervical cancer, breast cancer, colorectal ca, retinoblastoma, etc) • Cancer registry (Hospital based & Population based) - choose the area => Yogyakarta, bali, etc • Diagnosis and Treatment : - especially in cancer centre hospital - to increased hospital services on regional cancer hospital 2. Guidelines • Screening program • Treatment for cancers • Risk factors control • Epidemiological Surveillance • Community empowerment • Promotion & campaign, etc 3. Modules • TOT for providers • TOT for managers • Training for providers • Training for managers • Training for cadres
Policies, Guidelines, Modules
1. Public Awareness - Promotion - Public education 2. Screening è Pilot Project for Cervical & Breast Cancer - Started in 6 Districts (6 provinces) since 2007, now expanded to another 2 districts - Goal : finding pre-cervical cancer lession & breast tumor pre- Target : woman age 30 -50 yrs - Coverage target: 80% from target at the population - Location : 6 Districts (Deli Serdang, Gowa, Karawang, G. Kidul, Kebumen, Gresik) @ 8 Primary Health Care each - Metode : single visit approach with Visual Inspection with Acetic acid/VIA & Cryotherapy (for VIA+), and Clinical Breast Examination/CBE - Provider : well trained MD & midwives in PHC - Supervisor: 1. Clinician (Obsgyn & Surgeon) 2. Management by District & Province official health officer 3. Vaccination - HBV Vaccination : child immunization since 1997 è compulsory - HPV Vaccination : private 4. Cancer Registry è Pilot Proyect in DKI Jakarta since 2007
Advocacy & Socialization
• Advocacy
n
Decision makers : MoH, Min of Finance, National Planning Bureau, etc Traditional & religious leaders Professional organizations NGOs Etc Public education Mass campaign
• Socialization
n n n n
• Promotion
n n
Establishment of Networking
• National
n
Working group on Cervical and breast cancer control UICC and IACR
• International
n
Human Investment
o TOT & training on Cervical & Breast Ca screening
o o TOT on management of NCCP Training for cadres èPKK
Logistics è For Screening
• IVA set
• • • • • Cryo set cervicograph, Colposcopy LEEP Mammografi
n
n
n
n
n
To develop national cancer registry, it needs a model, DKI Jakarta is chosen as the model. model. The budget of the model is still supported by WHO representative to Indonesia Divided 5 regions : East, West, North, Central, & South Jakarta In beginning, there are 40 hospitals chosen to run cancer registry Hope following population base in DKI Jakarta area in 2010 year
Plan of Regional Cancer Centre Indonesia
Regional Cancer Centre National Cancer Centre
n
n
Cancer control in Indonesia are already established, which is in developing stage. It’s need fundamental system NCC is needed to support the programs on:
• Scientific • Analytic • Operational research
