| 4. In which ways is the initiative creative and innovative?
|
|
Cervical cancer is a silent killer for women. Considering the effectiveness of vaccine is up to 99%, the development of qualified human resources as a main asset of country can be achieved through vaccination. Cervical cancer vaccination becomes more effective and efficient compared to a high-cost cancer treatment which also constitutes a social and economic burden.
This becomes a creative primary prevention program, seeing that our target priorities are all students from elementary school, junior high school, and senior high school. Besides of students, Local government staffs were also vaccinated. Students in school age as target is a strategic approach to provide protection for women against cervical cancer. In addition, those who were vaccinated, hopefully would be able to give health promotions and informations to community about the danger of cervical cancer and its prevention efforts.
Government's commitment to fully bear the prevention costs, include primary (vaccination), secondary and tertiary prevention, make this program being unique. So that Balinese women can be protected from cervical cancer, then they can live healthy, prosperously and productively at all ages and be able to preserve Balinese culture.
|
|
| 5. Who implemented the initiative and what is the size of the population affected by this initiative?
|
|
This innovation is implemented by the Department of Health and his officials. The goal of this innovation is the entire girls from elementary schools, junior high schools, high schools and government employee in the Badung regency.the district government employee in the
|
| 6. How was the strategy implemented and what resources were mobilized?
|
|
In Indonesia, cancer slowly began to overtake heart attack as the main cause of death. The increment of cancer as cause of death are due to high number of new cases which are coming at an advanced stage. Implementation strategy for cervical cancer prevention through vaccination is carried out with an action plan includes:
6.1 Study
This activity begins with a data collection activities to determine the incidence rate of cervical cancer in the Badung regency which will be used as a frame of reference in the implementation of these activities.
6.2 Socialization
Socialization includes giving information about the disease course, early detection, and prevention through vaccination as well as clean and healthy behavior. Socialization conducted to all targets includes female students, Badung government employees, and community. Socialization is carried out in collaboration with Indonesian Association of Obstetrics and Gynaecology. both directly through face to face counseling and indirectly by using electronic and print media.
Total targets cumulatively from 2012 that have received socialization about cervical cancer are being Increased, as many as 18.140 people in Badung Regency had been informed about cervical cancer.
6.3 Vaccination
Coverage of cervical cancer vaccination in Badung Regency was 1,502 people in 2012; 2,455 people in 2013; 2,150 people in 2014; 1977 people in 2015 and 7,217 people in 2016. In total, as many as 15,004 women in Badung have been vaccinated for cervical cancer. The number of women who get cervical cancer vaccination in Badung is increasing. It means there is an increasing in quantity related the readiness among women in Badung Regency to protect themselves from cervical cancer.
Technically, cervical cancer vaccination is given three times with interval 0, 1 and 6 months. Things to consider before vaccination is those who are sexually active are required to undergo VIA examination or pap smear as secondary prevention.
6.4 Resource
Research results showed that program input of cervical cancer vaccination in Badung Regency has been going well. Input could include funding, existing oranizations, potential cooperation partners, interpersonal or organizational networks, staff and volunteer, time, facility, equipment and supplies. It is including availability of personnel according to the requirement in order to ensure a highly efficient, effective and productive implementation. Infrastructure in this program are all potential used things such as brochures, vaccines, place and transportation which is very important to be prepared so the activity implementation could be well established.
Regarding financial resources as a program input, entirely sourced from Badung district budget from 2012 to 2015 is 11,45 billion Rupiah ($ 880,770), where the total target as many as 6,647 people, as following: 1.,65 billion Rupiah ($ 126,924) in 2012, for the purchase of up to 3,000 vials of vaccines to target 1,517 people; in 2013 amounting to 5,665 billion Rupiah ($ 435,770), for the purchase of as many as 10,300 vials of vaccine targeting 2,892 people; in 2014 amounting to 4.125 billion Rupiah ($ 317,308), for the purchase of 7,500 vials of vaccine targeting 2,238; while in 2015 amounting to 4,708,169,500 Rupiah ($ 362,167), for the purchase of 7,500 vaccine vial with 2,070 targets; and in 2016 amounting to 15,529,248,800 Rupiah ($ 1,194,558) for the purchase of 24,807 vials of vaccine with 8,269 targets. The total budget is already budgeted by Badung Regency government and until 2016, it is amounting to 31,667,418,300 Rupiah ($ 2,435,956). This demonstrates the high commitment of the Badung regency government to prevent cervical cancer.
|
|
| 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
|
|
Many stakeholders are involved in implementation of this cervical cancer vaccination, with cross-sectoral involvement in accordance to their respective duties. The involvement and role of these stakeholders include:
1. Badung Regent
Badung regent as head of region as well as local policy makers have a high commitment to cervical cancer vaccination program.
2. Education, Youth and Sports Office of Badung Regency
Education, Youth and Sports Office as an agency in charge are responsible to mobilize vaccination target.
3. Health Department of Badung Regency
Health Department along with Technical Executing Unit of Public Health Center are technically responsible, include in the provision of logistics and event implementers.
4. Badung General Hospital
As a referral hospital, Badung General Hospital have a responsibility as a supervisor and implementer, also responsible for follow-up in case of adverse events following immunization.
5. POGI, IDI dan IBI
As a professional organization, POGI, Indonesian Medical Association and Indonesian Midives Association has acted as a resource and supervisor in these vaccination activities.
6. Peers
Peers have an important role in motivating and encouraging target so that the target proactively come to seek vaccination.
7. Family
Family is the main motivator in supporting these young women to involve in vaccination program.
8. Female Adolescents
As the main target, female adolescent are expected to be a major stakeholder in promoting and forwarding this activity to others.
9. Other Relevant Parties
Many parties are involved as a supporting element for this vaccination implementation, is Badung Regional Secretariat, Women's Empowerment Office, Family Planning and Family Welfare Department, and other relevant parties.
|
|
| 8. What were the most successful outputs and why was the initiative effective?
|
|
The output is a product of certain services are expected to be generated by an activity of the input provided to achieve program objectives. Output program is the result to be achieved from this program. In detail, the results of vaccination coverage of cervical cancer in the Badung regency year period 2012-2015 as follows: in 2012 by 99%, in 2013 84.9%, amounting to 96.1% in 2014 and 2015 amounted to 96%. This indicates that the active participation of young women in Badung very high to protect themselves from the threat of cervical cancer.
Cervical cancer vaccinations that have been held by Badung Regency Administration have reached outputs as follow:
1. Increasing the knowledge of students and society how to prevent cervical cancer through vaccination.
The high average number of vaccination participants who attend this program in every year indicate an enhancement of cervical cancer prevention. Several studies of cervical cancer vaccination program in Badung Regency imply similar results.
2. Providing spesific protection in women against HPV infection.
Cervical cancer vaccination demonstrated a good effectiveness, hence this vaccination is expected to provide maximal protection against cervical cancer. Based on studies, protection of this cervical cancer vaccination is up to 10 years, means that women are protected in the course of 10 years.
3. Stimulating the society to be more concerned about cervical cancer.
Vaccinations are given by the government to female students in public senior high school or public senior vocational high school as well as all public and private junior high school in Badung Regency. The goal of this program is to stimulate other society to do vaccination indepedently, therefore the scope of cervical cancer vaccination may be greater. People outside the target are expected to prevent herselves from cervical cancer.
4. Reducing the financial burden against the threat of cervical cancer.
Government fully covers the financial burden of this vaccination. This is expected to reduce the burden of public health costs.
5. Enhancing the coverage of noncommunicable disease prevention program, especially prevention againts cervical cancer through vaccination.
The increasing number of targets that have been vaccinated cumulatively indicate cervical cancer prevention program performance is also getting better.
|
|
| 9. What were the main obstacles encountered and how were they overcome?
|
|
There are many challenges in the implementation of this cervical cancer vaccination programs. In developed countries, cervical cancer vaccine are received by young women, parents and the medical communities, while in Indonesia the cervical cancer vaccine is still under challenge in the form of contrary to the administration of the vaccine because this is considered to bring sexual freedom to children. Another question is who should be vaccinated. If the vaccine main function is to reduce the incidence of HPV infection, the reduction in the number of infected will appear if the vaccine is given to girls before they have sex. Administration of the vaccine to women who had sexual intercourse before, also can reduce the number of HPV infection although not as effective as those who have never been sexually.
Until now vaccination program for cervical cancer in the Badung Regency is prioritized to public senior high school as well as public and private junior high schools. The extension of this to private senior high school schools will bring some difficultiues in financial side due to the high price of the vaccine.
Other issues in the vaccination for cervical cancer include the reluctance of women to be examined because of shame, doubting the importance of the examination due to lack of knowledge, fear of the reality to be faced, fear of feeling pain at the time of vaccination, reluctance of being vaccinated by men paramedics and lack of family encouragement.
The solution to solve the constraints are by convening socialization to all stakeholders of society, the medics, the religion and the ethics, by using all existing media. Such efforts are needed to explain the importance of cervical cancer prevention through vaccination as well as straighten out misunderstandings regarding the cervical cancer vaccine.
|