Caribbean Cervical Cancer Prevention and Control
Project Document
Introduction
For Caribbean women, families, and communities,
cervical cancer is an important preventable problem which impacts
heavily on health and development. The estimated incidence of
cervical cancer in the Caribbean in 2000 was 35.8/100,000, which was
among the top four sub-regions in the world . Cervical cancer was
the second leading cause of cancer deaths among Caribbean women
during the period 1991-95 . Age-specific cervical cancer mortality
rates indicate also that among women in the Americas aged 60 years
and older, Caribbean women are more likely than women in other
sub-regions to die of cervical cancer.
Cervical cancer can be prevented using relatively inexpensive screening and treatment technologies to detect and ablate abnormal cervical tissue before it progresses to invasive cancer. Significant declines in cervical cancer incidence and mortality have occurred in developed countries with the sustained implementation of well-organized cervical cancer screening programmes. For instance in Canada, the age-standardized incidence rate for cervical cancer declined by 50% over the past three decades, while the mortality rate fell by two-thirds over the same period . Similar trends have not been observed in the Caribbean where the estimated incidence is four-times higher than the Canadian rate.
Collectively, Caribbean countries agreed to target cervical cancer specifically and set a goal of reducing mortality from invasive disease by at least 20% over the period 1990-2005 . Despite this, a recently concluded WHO assessment of national capacity for non-communicable disease prevention and control revealed that only one-third of English- and Dutch-speaking Caribbean countries have a cancer control plan that specifically addresses cervical cancer.
A Cervical Cancer Prevention and Control Caribbean Sub-regional Workshop was held in Trinidad and Tobago in June 2001. Convened by the Pan American Health Organization (PAHO/WHO) in collaboration with the International Union Against Cancer (UICC), it was attended by participants from fifteen countries representing a variety of stakeholders. The workshop concluded that screening activities within countries of the sub-region were largely uncoordinated and that a secretariat and work groups were needed in order to develop the technical content of a comprehensive cervical cancer prevention and control plan.
The current project will build on lessons learned during the Caribbean Cervical Cancer Project implemented by PAHO/WHO in ten countries in the sub-region between 1990 and 1996. The aim is to reduce the incidence and suffering associated with cervical cancer in the Caribbean by strengthening capacities and fostering collaboration between CAREC member governments, professional entities, non-governmental organizations, academic institutions and regional agencies. Within the framework of pre-existing National Cancer Control Programmes or other health plans, the project seeks to work with a network of partners to develop, implement, and monitor organized national cervical cancer control programmes. The network will also facilitate sub-regional and regional mechanisms for sharing expertise and other resources to the mutual benefit of all Caribbean women and communities.
Estimated Duration
August 2002 to December 2004
Project Purpose
To enhance the capacity of selected Caribbean countries and the sub-region for implementing well-organized, targeted, and sustained cervical cancer prevention and control programmes.
Project Strategy
The project will operate with direct input from a sub-regional Technical Advisory Group (TAG) on Cervical Cancer Prevention and Control. The group will comprise representatives from various disciplines and Caribbean countries, including representatives from professional associations, universities, Ministries of Health, NGOs, and international agencies and will co-opt content experts as needed.
Strategic planning exercises will be coordinated with 5-8 selected Caribbean countries to identify existing plans, policies, and services and delineate the strengths, weaknesses, gaps and needs in cervical cancer prevention, screening, and management. The countries will be selected based on their commitment to cervical cancer programmes and their readiness to implement changes in health services. Representation will be ensured based on population size and level of development.
With information from the strategic planning exercise and with input from the TAG, participating countries will be assisted in drafting a national cervical cancer prevention and control programme tailored to the country's unique circumstances and integrated effectively into existing national health plans and programmes. Efforts will also be undertaken to ensure that plans developed are widely disseminated nationally and modified accordingly to promote consensus and support.
In order to support implementation of national cervical cancer prevention and control programmes, the project will coordinate necessary technical activities, as determined by the TAG, such as developing sub-regional evidence-based clinical practice guidelines, establishing laboratory quality assurance standards, developing training materials needed for implementing guidelines, and designing information systems appropriate for the Caribbean. In close collaboration with the Media / Communications Officer in the Caribbean Office of Programme Coordination (CPC office, PAHO/WHO), a communications plan will also be developed and implemented.
The project will also identify and communicate with the broad group of cervical cancer prevention and control stakeholders in all 21 CAREC member countries who will be affiliated loosely into a Cervical Cancer Prevention and Control Network. This network will ensure that partners across the sub-region are kept abreast of developments in the project. Even countries not selected specifically for project activities may choose to implement successful elements of the project once they are provided with the information and with tools developed.
Based on the results of the national strategic planning exercises and recommendations from the TAG, the project seeks to develop an integrated Caribbean cervical cancer prevention and control strategy that delineates sub-regional mechanisms for sharing expertise, optimizing national resources, and benefiting from economies of scale. Examples may include shared clinical services, training programmes, communication tools, surveillance systems, or policy development. In conjunction with the TAG, the project will seek endorsement and support for the strategy from regional bodies including the Caribbean Community (CARICOM).
In order to ensure the sustainability and dissemination of the project, a major effort will be undertaken to mobilize resources to implement a sub-regional cervical cancer prevention and control programme across the English- and Dutch-speaking Caribbean beyond the end of the current project period.
The project goal, purpose and expected results are summarized in a Logical Framework (see attached.)
Implementing Agency
The Caribbean Epidemiology Centre (CAREC/PAHO/WHO) will execute the project. The Project Manager will work within the Non-communicable Diseases, Injury and Substance Abuse Programme and will receive further guidance from members of PAHO's regional project on cervical cancer. On issues pertaining to laboratory quality assurance, the Manager will collaborate closely with technical officers in CAREC's EU-funded "Strengthening of Medical Laboratory Services in the Caribbean" project. When relevant, the Project Manager will also liaise with other CAREC divisions and programmes (Laboratory Division, Epidemiology Division, and Special Programme on Sexually Transmitted Infections.)
Partners and Stakeholders
The project manager will coordinate activities with the following partners:
- PAHO's Regional Project on Cervical Cancer
- Office of Caribbean Programme Coordination
(PAHO/WHO):
- Advisor, Chronic Diseases and Health
Promotion
- Media/Communications Advisor
- Technical staff in other PAHO/WHO field offices
- CARICOM
- Ministries of Health and Regional Health
Authorities
- NGO's and patient groups
- Caribbean academic centres
- Professional associations
- Public and private clinical and laboratory
personnel
- Media
- Women and community members
- Caribbean NCD Task Force
References
1. Globocan 2000. International Agency for Research on Cancer
2. Caribbean Epidemiology Centre (CAREC/PAHO/WHO). Mortality Database.
3. National Cancer Institute of Canada. Canadian cancer statistics 2001. Toronto, 2001.
4. CCH Secretariat. Caribbean Cooperation in Health: Phase II. A new vision for Caribbean Health. 1999. The Caribbean Community (CARICOM) Secretariat.
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