Lessons Learned: Building The School-based HPV Program In Malaysia And Opportunities For Piggybacking

Transcription

1 Asia Dengue Summit Shangri La Hotel - Bangkok January 2016 Lessons Learned: Building The School-based HPV Program In Malaysia And Opportunities For Piggybacking Saidatul Norbaya Buang Public Health Physician Family Health Development Division Ministry of Health Malaysia Rohani Jahis Public Health Physician Disease Control Division Ministry of Health Malaysia

2 1 HPV vaccination in Malaysia 2 Promoting HPV vaccine Presentation Outline Malaysia Performance Lesson learned Integration of new Program 6 School Health Service Packages 7 Factors to consider

3 Why HPV vaccination? Cervix, Uteri stage at diagnosis among Malaysian citizen 2008 Stage 3 21% Stage 4 17% Stage 1 24% Stage 2 38% Why HPV vaccination become part of Cervical Cancer strategy? Low Cervical smear uptake among high risk women Delay in seeking treatment WHO endorsed on safe HPV vaccine to prevent Ca Cx Budget/ Target Cost Cost/ person Ca Cervix HPV Vaccination 1,627 cases (2003) 266,000 girls ( 2009) RM millions RM 2.8 millions for pre invasive RM 285 millions for treating new cases ( invasive) RM 94 millions for treating old cases RM 234, RM 1, Incidence 19.7 /100,000 womenunchanged RM millions Vaccine RM319.2 million Additional Cost RM 3 millions (Health Education, Training and logistic 8/1,000,000 (estimate vaccine efficacy at 98%) Aljunid, HUKM

4 Overview of the HPV Vaccine Programme GOAL: To reduce the incidence of Cervical Cancer related to HPV type 16 and 18 infection among immunized 13 years old girls over next 20 years. Single type of vaccine utilization during one procurement cycle 2010/11 : Cervarix : Gardasil Schedule : 0, 1, 6 month Shifted to 2 doses in 2015 ( 0, 6 month) STRATEGY: delivered as part of the Cervical Cancer Prevention and Control Program and the Expended Program of Immunization (EPI) OPERATIONAL POLICY: Free Voluntary School Based HPV Vaccination to Form 1 Malaysian girls High school attendants in Malaysia HPV vaccine as an additional vaccination to existing EPI program Availability of structured comprehensive school health program Strong commitment and support from Ministry of Education

5 Promoting HPV Vaccine Theme: HPV Vaccine as Cervical Cancer Vaccine Media Campaign Based on Health Belief Model 1. Cervical cancer is preventable 2. Parental awareness on voluntary vaccination 3. Persuade girls to complete 2 doses of vaccination as scheduled Public Access to Interactive Information 1. Social Media - HPV Facebook - HPV twitter 2. Phone Hot line Print and electronic advertisement Rumours Surveillance and Program Monitoring 1. Response to media and public queries 2. Provide guideline to implementers 3. Monitor potential program threat and proposed counter measures Addressing the religious and cultural aspect of the HPV vaccination Leading to establishment of Fatwa or religious ruling on HPV vaccination for the Muslim. 5

6 Program target: 3 doses completion at 95%

7 1 Political Will and commitment 2 Public trust in Malaysian Expanded Program in Immunisation Factors Contributing to Success 3 4 School Health Services Infrastructure Existing strong relationship with Ministry of Education 5 Effective Risk Communication Strategy 6 Addressing Religious Issues 7 Competitive Procurement Mechanism 7

8 Integration of New Programs into School Health Activities

9 School Health Program and Services in Malaysia School Health Program Established in 1967 in partnership with MOE School health service is a life course perspective wellness program under Family Health Program Services in schools are being carried out by School Health Teams School Health Team Doctor, Public Health Nurses, Assistant Medical Officer, Community Nurses and Medic Aid Provide mobile health services to 10,159 primary and secondary schools Role and function of each team member is defined by the School Health Service Standard Operating Procedure Performance target are being monitored and discussed at districts, states and national meetings on regular basis.

10 Grade School Health Service Packages in 2006 Service Package Workload (student contact) Pre school Growth and development 250,000 Standard 1 Health Education, Health Appraisal, Vision screening, BMI Monitoring and Immunization 500,000 Standard 6 Health Education, Health Appraisal, 500,000 Form 3 Health Education, Health Appraisal and Immunization 500,000

11 School Health Service Packages in 2016 Grade Service Package Workload ( student contact) Pre school Growth and development 250,000 Standard 1 Standard 3 Standard 6 Health Education, Health Appraisal, Vision screening, BMI Monitoring and Immunization Assessment and diagnosis of Learning Disability (MOE Key performance Indicator) Health Education, Health Appraisal, Scoliosis Screening and Adolescent Health screening 500,000 3, ,000 Form 1 HPV Immunisation (2010) 480,000 Form 3 Health Education, Health Appraisal, Color Defect screening, Adolescent Health Screening and Immunisation 500,000 Form 4 Thalassaemia Carrier Screening ( 2016) ( screening) 900,000 (confirmation) 180,000

12 Adding New Program Into School Health Service 1 Additional new service introduction will not affect existing services performance Guiding Principles 2 3 Implementation approval by Ministry of Education Implementation will not interfere with school schedule 4 Voluntary participation

13 Factors To Consider Before Integrating New Program Into School Health Activities School health infrastructure and resources Initial budget must include implementation requirement resource mobilization New Program objectives and expected impact Long term/ short term Coverage Capacity building Introduction phase Updates Monitoring and evaluation Dealing with public expectation Health promotion campaigns Crisis management Demand for service Parental acceptance Confidence in new program Vaccine safety and efficacy Vaccine combination ( HPV and Tetanus Toxoid) Will the new program effect students performance which cohort to choose from Compliance to schedule/ follow-up Completion within one schooling period

14 By failing to prepare, you are preparing to fail Benjamin Franklin