InformationalInformational--Educational Educational Program on cervical cancer Program on cervical cancer

issuesissues in Kyrgyzstanin Kyrgyzstan

IIn collaboration with PATH andn collaboration with PATH andDepartment of Public Health Service in Department of Public Health Service in

KyrgyzstanKyrgyzstan

BishkekBishkek 2003-2004 2003-2004

Project executivesProject executives NGO NGO

«Family and Healthy Generation»

Project Assistant Rada Abakirova

Technical AssistantVenera Djunusova

Project ManagerNadejda Kazakova

Project objectivesProject objectives

Early detection and prevention of Early detection and prevention of cervical cancer through propaganda cervical cancer through propaganda of regular prophylactic examinations of regular prophylactic examinations amongst women; amongst women;

Advancing of professional knowledge Advancing of professional knowledge and skills of health workers;and skills of health workers;

Involvement of public communities Involvement of public communities into the issue of cervical cancer.into the issue of cervical cancer.

Pilot region introductionPilot region introduction There are 4 rayons in There are 4 rayons in

Bishkek, from where the Bishkek, from where the Leninskiy one is the biggest Leninskiy one is the biggest by it’s territory; by it’s territory;

On the territory of this pilot On the territory of this pilot rayon 62 520 women in the rayon 62 520 women in the age of 30 till 60 has been age of 30 till 60 has been dwelling (in accordance with dwelling (in accordance with the Statistic Department the Statistic Department Data, 2003);Data, 2003);

There are 6 city multi-profile There are 6 city multi-profile policlinics and 6 Centres of policlinics and 6 Centres of Family Medicine (CFM) on the Family Medicine (CFM) on the pilot rayon territory;pilot rayon territory;

In the CFM In the CFM 163 163 family family doctors have been operating, doctors have been operating, where 37 are gynaecologists. where 37 are gynaecologists.

Into the project Into the project performance have been performance have been

involved:involved: Family doctors for studying professional Family doctors for studying professional

skills for proper consulting and rendering skills for proper consulting and rendering professional help in combination with professional help in combination with respect to client’s needs and delicate respect to client’s needs and delicate attention to the problems they are attention to the problems they are suffered from; suffered from;

Pharmacists as they often the first main Pharmacists as they often the first main advisers for people with health problems; advisers for people with health problems;

Domkoms Domkoms ((socially active women).socially active women).

PollPollAprilApril

It was held preliminary It was held preliminary

poll amongst women poll amongst women

and health workers of and health workers of

CFMCFM

with the aim of detection of with the aim of detection of their awareness on cervical their awareness on cervical

cancer issuescancer issues

In the questioning list for women were In the questioning list for women were included following questions:included following questions:

Who in your life decides to visit gynaecologistWho in your life decides to visit gynaecologist?? How often do you visit gynaecologist for practical How often do you visit gynaecologist for practical

examinationsexaminations?? Do you know what cervical cancer isDo you know what cervical cancer is?? What symptoms in your opinion characterize cervical What symptoms in your opinion characterize cervical

cancercancer?? What do you think can cause cervical cancerWhat do you think can cause cervical cancer?? Is there way to heal cervical cancer in medicineIs there way to heal cervical cancer in medicine?? What do you think, in which cases cervical cancer is What do you think, in which cases cervical cancer is

curablecurable?? When did you pass cytological screening last timeWhen did you pass cytological screening last time??

ObjectivesObjectives:: Select problems which are Select problems which are

necessary to take into necessary to take into account for successful account for successful organisation of activities organisation of activities raising awareness of raising awareness of population on cervical cancer population on cervical cancer issues; issues;

Generalize experience Generalize experience acquired during the work of acquired during the work of local policlinics and CFM; local policlinics and CFM;

Attract social attention to the Attract social attention to the problem of cervical caner in problem of cervical caner in the republic through mass the republic through mass media.media.

Round TableRound TableMayMay

The Round Table with The Round Table with participation of participation of

leading specialists on leading specialists on women’s women’s

reproductive health reproductive health in Kyrgyzstan was in Kyrgyzstan was conducted in May.conducted in May.

Media CampaignMedia CampaignJuneJune--JulyJuly

TV-program devoted to the TV-program devoted to the problem of early detection problem of early detection of cervical cancer; of cervical cancer;

TV-reports in frames of TV- TV-reports in frames of TV- information broadcasts;information broadcasts;

Russian and Kyrgyz Russian and Kyrgyz language radio-rolics on language radio-rolics on cervical cancer issues; cervical cancer issues;

““The best article covering The best article covering problem of cervical cancer” problem of cervical cancer” competition among local competition among local newspapers. newspapers.

Training of Training of TrainersTrainers

JuneJune

During 3-day training During 3-day training seminar were trained 10 seminar were trained 10 trainers for following trainers for following training of family doctors, training of family doctors, pharmacists and pharmacists and domkomsdomkoms

Priority objectives: Analysis of adults study Analysis of adults study

principles; principles; Mastering of trainer’s Mastering of trainer’s

many-sides; many-sides; Studying of trainer’s and Studying of trainer’s and

facilitator’s skills;facilitator’s skills; Analysis of training Analysis of training

realisation methods; realisation methods; Mastering of training Mastering of training

leading skills; leading skills; Applying of own Applying of own

experience during experience during training. training.

Training of family doctors Training of family doctors JulyJuly--AugustAugust

ObjectivesObjectives:: Uncover problems leading to Uncover problems leading to

late detection of cervical late detection of cervical cancer; cancer;

Detect objectives and Detect objectives and activities for raising activities for raising awareness of population on awareness of population on cervical cancer issues; cervical cancer issues;

Familiarize with client’s rights; Familiarize with client’s rights; Practice knowledge and skills Practice knowledge and skills

for consulting of clients; for consulting of clients; Develop the system of self-Develop the system of self-

evaluation.evaluation.

Trainings visitedTrainings visited:: 150 150 family doctorsfamily doctors 60 60 pharmacistspharmacists 45 45 domkomsdomkoms

EvaluationEvaluationSeptemberSeptember--DecemberDecember

Creations of evaluationCreations of evaluation:: Work conditions contribute to adaptation of Work conditions contribute to adaptation of

knowledge on practice; knowledge on practice; DoctorDoctor//pharmacistpharmacist//domkom rendered in affable domkom rendered in affable

form information about cervical cancer and form information about cervical cancer and necessity of regular prophylactic measures; necessity of regular prophylactic measures;

Woman passed through cytological screening. Woman passed through cytological screening.

ResultsResults Raising of recognition amongst key persons of Raising of recognition amongst key persons of

Public Health Service; Public Health Service; Realisation of importance of such programs Realisation of importance of such programs

implementation for Kyrgyz system of Public implementation for Kyrgyz system of Public Health Service at all; Health Service at all;

Obtained experience is irreplaceable for successful Obtained experience is irreplaceable for successful extension of the program and for new projects in extension of the program and for new projects in sphere of medical education and service as well; sphere of medical education and service as well;

Information coverage of population not only on the Information coverage of population not only on the territory of pilot rayon but far and away it due to territory of pilot rayon but far and away it due to media campaign. media campaign.

Awareness of population on cervical cancer issues before and after the project

36%

23%

47%39%

71%

19%14%

72%

53%

89%

Ряд1

Ряд2

Ряд1 36% 23% 47% 39% 71%

Ряд2 19% 14% 72% 53% 89%

I do not know what CC is

CC is incurableI do know

reasons of CCI do know

symptoms of I do know

prophylactis

DifficultiesDifficulties There are shortage of instruments for cytological There are shortage of instruments for cytological

screening in most of Centres of Family Medicine. screening in most of Centres of Family Medicine. Shortage of instruments took third place in circle Shortage of instruments took third place in circle of problems family doctors meet with in practice.of problems family doctors meet with in practice.

Reasons leading to late detection of cervical cancer

89%

56%

43%

11%

19%Finance difficulties ofpopulation

Ignorance ofprophylactic methods

Shortage of medicalinstruments

Fear ofgynaecologicalexamination

Shortage of time forvisit of ginaecologist

Most women ignore Most women ignore necessity of necessity of prophylactic cytological prophylactic cytological examinationsexaminations

and as a result visit and as a result visit gynaecologist only gynaecologist only in advanced cases.in advanced cases. Women prefer not to Women prefer not to know about disease know about disease because in case of because in case of it’s detection it can it’s detection it can demand additional demand additional expanses that are expanses that are too high for too high for a a middle family. middle family.

Implementation of Implementation of co-payment system co-payment system in July 2003 and in July 2003 and reduction of reduction of prophylactic prophylactic examinations plan in examinations plan in 4 times changed the 4 times changed the situation to the situation to the worse. Desirable worse. Desirable effects of novelties effects of novelties implementation in implementation in Kyrgyz Public Health Kyrgyz Public Health Service system lead Service system lead to rise of women to rise of women refused from medical refused from medical service. service.

In accordance with In accordance with monitoring conducted, monitoring conducted, number of cytological number of cytological screening in Bishkek screening in Bishkek decreased in 26 % decreased in 26 % comparing with the comparing with the same period of last year. same period of last year.

100%

87%

77%

14%19%

Results of cytological screenings in Bishkek 2002 - 2003

number of womenat risk age

number ofgynaecologicalexaminations 2002number ofgynaecologicalexaminations 2003number ofcytologicalscreenings 2002number ofcytologicalscreenings 2003

RecommendationsRecommendations

To implement regular training seminars on To implement regular training seminars on advancing of professional knowledge and skills of advancing of professional knowledge and skills of health workers for effective consulting on cervical health workers for effective consulting on cervical cancer issues; cancer issues;

To develop evaluation system of knowledge and To develop evaluation system of knowledge and skills of health professionals they obtained during skills of health professionals they obtained during training seminars ; training seminars ;

To inculcate monetary incentive system for family To inculcate monetary incentive system for family doctors in cases of early detection of cervical doctors in cases of early detection of cervical cancer;cancer;

To hold annual media-campaigns for raising To hold annual media-campaigns for raising awareness of population on cervical cancer issues. awareness of population on cervical cancer issues.

We express our gratitude for We express our gratitude for support and collaboration support and collaboration

to PATH to PATH