FRAMEWORK OF

NATIONAL CANCER CONTROL

PROGRAM IN INDONESIA

ACTING DIRECTOR GENERAL OF

DISEASE CONTROL AND ENVIRONMENTAL HEALTH

MINISTRY OF HEALTH, REPUBLIC OF INDONESIA

Prof. dr. Tjandra Yoga Aditama, Sp.P (K), MARS, DTMH

GLOBAL MORTALITY BY CAUSE,

ALL AGES 2005

* NCD is the most common cause of death in the world**Source: WHO and World Bank 2005

CA

RD

IO-V

AS

CU

LA

R

DIS

EA

SE

S

CA

NC

ER

CO

PD

DIABETESMALARIATBHIV

AIDS

0

5

10

15

20

25

30

35

Infection-

parasite

Circulation

Respiratory

DigestiveNeoplasma

InjuryPerinatal

1992 1995 2001

TREND OF MORTALITY IN INDONESIA BY

CAUSE, ALL AGES IN 1992 – 2001 HOUSE HOLD HEALTH SURVEY 1992, 1995, 2001

Disease Burden in Indonesia

House hold health survey, 2001 : cancer is the 5th 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.

Percentage

The Ten Commonest Malignancy in Female in 31 Hospitals in Jakarta, 2005

0.00 5.00 10.00 15.00 20.00 25.00 30.00 35.00

Liver Ca

Skin Ca

Lung Ca

Nasopharynx Ca

Thyroid Ca

Colorectal Ca

Leukaemia

Ca Ovarium

Cervix Ca

Breast Ca

TO

PO

Percent

The Ten Commonest Malignancy in Male in 31 Hospitals in Jakarta, 2005

2.00

2.60

2.90

4.70

6.00

6.90

10.80

11.10

11.50

12.00

0.00 2.00 4.00 6.00 8.00 10.00 12.00 14.00

Gaster Ca

Brain Ca

Skin Ca

Liver Ca

Prostate Ca

Lymphoma

Colorectal Ca

Leukemia

Lung Ca

Nasopharynx Ca

TO

PO

Percent

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 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 in 2005 (SK Menkes No 1575/Per/Menkes/XI/2005)

VISION of MoH-RI

SELF MOTIVATED COMMUNITY

TO LIVE HEALTHY LIFE

MISSION

MAKE PEOPLE HEALTHY

DG of Disease

Control & EH

Directorate

VBDCDirectorate of

NCDC

Directorate of

EH

Directorate of

SESPIM

Secretary of DG of DC & EH

Subdit

Cardiovas

Subdit. DM & Other

Metabolic disease

Subdit

Cancer

Subdit. Chronis

& degeneratif

Subdit. Violence &

Injury

Directorate

of DCDC

Ministry of Health

DG of Public

Health

Inspectorate

General

DG of Medical

Services

Secretary General

DG of

Farmacies&

med-supp

MoH of RI Organization

Structure

NCD programmer ( center, UPT, district)Inter program & inter sector relatedProfessional Org. & NGO Community & groups at risk

To decrease cancer morbidity, disability,mortality and improve quality of life of cancer patients

UU No : 23/1992 Kesehatan

Kepmenkes: •No : 1575/2005 Organization & Tasks of MoH•No : 1468/2006 RPJPK 2005-2009•No : 1116/2003 Gudeline of Health Surveillance System•No : 1479/2003 Guideline of Epid-Surveil of CD & NCD •No : 430/2007 Guideline of Cancer Control•No : 1163/2007 Working group on Cervical and Breast

Cancer Control

PP No : 19/2003 Pengamanan rokok bagi kes

Policies on Cancer Control Based on social participation and

community empowerment through local enhancement PKK, DW, etc

Developing collaboration and partnership networking POKJA Kanker

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

STRATEGIES

Social mobilization and community empowerment for healthy living kader, PKK

Encouraging health service development

Encouraging and facilitating community participation masyarakat peduli kanker

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

Establishment of Networking

•Polices,•Guidelines,•Modules

• Advocacy• Socialization• Promotion

Epidemiological Surveillance & Information Technology

Logistics

Developing Program

Human Investment

Monitoring &Technical assistance

Budget development

Policies, Guidelines, Modules1. NCCP Policy2. 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

1. Public Awareness- Promotion- Public education

2. Screening 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- 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 PrimaryHealth 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 compulsory

- HPV Vaccination : private

Establishment of Networking• National

Working group on Cervical and breast cancer control

• International UICC and IACR

Advocacy & Socialization• Advocacy

Decision makers : MoH, Min of Finance, National Planning Bureau, etc

• Socialization Traditional & religious leaders

Professional organizations

NGOs

Etc

• Promotion Public education

Mass campaign

Human Investmento TOT & training on Cervical & Breast Ca screening

o TOT on management of NCCPo Training for cadres PKK

Logistics For Screening• VIA set

• Cryo set• cervicograph, • Colposcopy • LEEP• Mammografi

To develop national cancer registry, it needs a model, DKI Jakarta is chosen as the 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

Regional Cancer Centre

National Cancer Centre

Plan of Regional Cancer Centre Indonesia

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