LONG TERM PLAN FOR

NATIONAL CANCER CONTROL PROGRAM

IN INDONESIA

dr.Ratna Rosita Suryo Subandoro,MPH.M

STAFF AHLI MENTERI KESEHATAN

BIDANG TEKNOLOGI KESEHATAN DAN GLOBALISASI
MINISTRY OF HEALTH, REPUBLIC OF INDONESIA
n Cancer control program was known since 1989
stated in Integrated & Comprehensive Cancer
Control Program (SK Menkes No 604/Menkes/
SK/1989)
n Every hospital should develop their own cancer
control program based on their resources & capacity
(SK Menkes No 10/Menkes/SK/I/1994)
n Indonesia participated in developing Jakarta
Statement on Cancer Control Program è the
statement of strategic effort toward optimal cancer
control and care (initiated by UICC & WHO)
n Establishment of Dharmais Cancer Hospital (1993)
in the future hopefully will become National Cancer
Center
n Establishment of Directorate of NCD Control,
including Sub Directorate of Cancer Control
 GLOBAL MORTALITY BY CAUSE, TREND OF MORTALITY IN INDONESIA BY
ALL AGES 2005
CAUSE, ALL AGES IN 1992 – 2001
HOUSE HOLD HEALTH SURVEY 1992, 1995, 2001
Percentage
35
30
25
CARDIO-VASCULAR
20
DISEASES

15
10
CANCER

5
COPD

0
HIV Infection- Circulation Digestive Injury
AIDS TB MALARIA DIABETES parasite Respiratory Neoplasma Perinatal
1992 1995 2001
* NCD is the most common cause of death in the world
**Source: WHO and World Bank 2005

Disease Burden in Indonesia

n House hold health survey, 2001 : cancer is the 5 th cause of death
n 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%)
n Indonesia hospital admission in 2005: Breast cancer is the highest and
followed by cervical cancer.
n Riskesdas 2007 : tumor/cancer is the 7th (5,7%) cause of death in
Indonesia, with prevalence 4.3 per 1000 people
 10 Commonest Malignancy
Jakarta (30 Hospitals) *
2005-2007

Breast 18.4%

Cervix Uteri 10.6%

Bronchus and Lung 6.8%

Topography

Leukemia 5.8%

Pharynx 5.7%

Ovary 4.5%

Lymph Nodes 3.6%

Colon 3.6%

Thyroid Gland 3.3%

Hepar 2.7%

0% 5% 10% 15% 20%

Percent

*) tanpa data tahun 2005 dari regional utara

 10 Commonest Malignancy in Male 10 Commonest Malignancy in Male
Female
Jakarta (30 Hospitals) * Jakarta (30 Hospitals) *
2005-2007 2005-2007

Bronchus and Lung 13.7% Breast 28.9%

Pharynx 10.0% Cervix Uteri 16.9%

Leukemia 8.4% Ovary 7.2%

Lymph Nodes 5.8% Leukemia 4.3%

Topography

Topography
Prostate Gland 5.8% Thyroid Gland 4.0%

Colon 5.7% Pharynx 3.2%

Hepar 4.6% Bronchus and Lung 2.8%

Rectum 4.4% Corpus Uteri 2.5%

Renal Pelvis - Bladder 3.1% Colon 2.3%

Soft Tissue 3.0% Lymph Nodes 2.3%

0% 5% 10% 15% 0% 5% 10% 15% 20% 25% 30% 35%

Percent Percent

*) tanpa data tahun 2005 dari regional utara *) tanpa data tahun 2005 dari regional utara
 VISION of MoH-
MoH-RI
SELF MOTIVATED COMMUNITY
TO LIVE HEALTHY LIFE

MISSION
MAKE PEOPLE HEALTHY

MoH of RI
Ministry of Health
Organization
Structure
Expert staffs of MoH Secretary General

DG of Medical DG of Pharm & Med DG of Disease DG of Public Health Inspectorate

Services Supp Control & EH General

Secretary of DG of Med Serv Secretary of DG DC & EH

Directorate of
Specialistic Med Other Directorates Directorate of NCD Other Directorates
Services Control

Subdit of Specialistic Hospitals Other Subdits Subdit of Cancer Subdit of Chronic Other
Control Disease Subdits
 UU No : 36/2009 à Kesehatan
PP No : 19/2003à Pengamanan rokok bagi kes
Kepmenkes:
•No : 1575/2005 à Organization & Tasks of MoH
•No : 1468/2006 à RPJPK 2005-2009
•No : 1116/2003 à Gudeline of Health Surveillance System
•No : 1479/2003 à Guideline of Epid-Surveil of CD & NCD
•No : 430/2007 à Guideline of Cancer Control
•No : 1163/2007 à Working group on Cervical and Breast
Cancer Control

To decrease cancer morbidity,

disability,mortality and improve
quality of life of cancer patients

NCD programmer ( center, UPT, district)

Inter program & inter sector related
Professional Org. & NGO
Community & groups at risk
 Policies on Cancer Control
n Based on social participation and
community empowerment through local
enhancement
n Developing collaboration and partnership
networking
n Integrating program of primary,
secondary and tertiary prevention.
n Performing services delivery by
professionals and qualified healthcare
providers
n Developing surveillance of risk factors and
cancer registry
n Quality Assurance
 STRATEGIES
n Social mobilization and community
empowerment for healthy living
n Encouraging health service development
n Encouraging and facilitating community
participation
n Developing early detection program
n Improving health services access
n Developing risk factors surveillance and
cancer registry
n Proposing cancer treatment in the
compulsory health insurance for the poor
payment scheme
 •Polices, Establishment of
•Guidelines, Networking
•Modules

Developing Program
• Advocacy
• Socialization
• Promotion

Budget
development
Monitoring
&Technical
assistance

Logistics
Epidemiological
Human Investment Surveillance &
Information
Technology
 Policies, Guidelines, Modules
1. NCCP Policy :
• Promotion & prevention on community based (Avoid risk factor,
Tobacco control phisical activity, healthy diets&healthy life)
• Early detection & prompt treatment (cervical cancer, breast cancer,
colorectal ca, retinoblastoma, etc)
• Cancer registry (Hospital based & Population based)
- choose the area => Yogyakarta, bali, etc
• Diagnosis and Treatment :
- especially in cancer centre hospital
- to increased hospital services on regional cancer hospital
2. 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 è Pilot Project for Cervical & Breast Cancer
- Started in 6 Districts (6 provinces) since 2007, now expanded to
another 2 districts
- Goal : finding pre-
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 Primary Health 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 è compulsory
- HPV Vaccination : private
4. Cancer Registry è Pilot Proyect in DKI Jakarta since 2007
Advocacy & Socialization
• Advocacy
n Decision makers : MoH, Min of Finance, National
Planning Bureau, etc
• Socialization
n Traditional & religious leaders
n Professional organizations
n NGOs
n Etc
• Promotion
n Public education
n Mass campaign

Establishment of Networking
• National
n Working group on Cervical and breast cancer control
• International
n UICC and IACR
Human Investment
o TOT & training on Cervical & Breast Ca screening
o TOT on management of NCCP
o Training for cadres èPKK

Logistics è For Screening

• IVA set
• Cryo set
• cervicograph,
• Colposcopy
• LEEP
• Mammografi
n To develop national cancer registry, it needs a
model, DKI Jakarta is chosen as the model.
model.
n The budget of the model is still supported by
WHO representative to Indonesia
n Divided 5 regions : East, West, North, Central, &
South Jakarta
n In beginning, there are 40 hospitals chosen to
run cancer registry
n Hope following population base in DKI Jakarta
area in 2010 year
Plan of Regional Cancer Centre Indonesia

Regional Cancer Centre

National Cancer Centre
n Cancer control in Indonesia are
already established, which is in
developing stage. It’s need
fundamental system
n NCC is needed to support the
programs on:
• Scientific
• Analytic
• Operational research