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Integrated approach for comprehensive cervical cancer control (C4 Thailand)



Comprehensive cervical cancer control for women in rural and remote Thailand
Institution: Roi Et Provincial Health Office, the Kingdom of Thailand
Initiative: Integrated approach of comprehensive cervical cancer control
Category 3 – Promoting gender responsive public services to achieve the SDGs

Brief summary of the Initiative
The burden of cervical cancer remains greatest in low- and middle-income countries. A major obstacle to treatment is inaccessibility to services. The only conventional screening test was Pap smear which required many processes, having to wait for a long period before results come; for abnormal results women have to be referred. Women with cervical cancer had also to be transferred to more technologically advanced facilities far away. These factors can burden women and families with transportation and budgets. Many women cannot adhere to such many appointments. Inefficiency and low quality outcomes with poor control and prevention was inevitable.
Since 1999 Roi Et Provincial Health Office (PHO) has collaborated with strategic partners includes the Royal Thai College of Obstetricians and Gynaecologists (RTCOG), the Jhpiego – an affiliation of the Johns Hopkins University, U.S.A., Chulalongkorn and Khon Kaen Universities and Department of Health, Ministry of Public Health of Thailand, to conduct a demonstration project using visual inspection with acetic acid (VIA) and cryotherapy for cervical cancer control among 4 districts. Women get their results within 1 minute. For abnormal results, cryotherapy can be provided immediately. This innovative method can markedly reduce unnecessarily steps and waiting time, links screening and treatment and reduces loss of follow up rate. This scheme also trains nurses to be providers which can solve staff shortages in rural and remote areas.
After publication in the Lancet, Roi Et PHO has extended VIA & cryotherapy services to all districts as a component of comprehensive cervical cancer control (C4). The Service Development Plan has been written and guided mainly by the WHO Health Systems Framework using six building blocks model. Infrastructures such as cancer registry has been strengthened. Under a collaboration with Chulabhorn Hospital, Roi Et Hospital has been designated by the Ministry of Public Health as a general cancer center.

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