Single Visit Approach: An Approach to prevent Cervical Cancer in Karawang District, West Jawa, Indonesia

Cervical cancer in Indonesia is a serious problem whose impact is neither widely appreciated nor well documented. Existing services are expensive and out of reach of the average woman. There are only 277 pathologists and fewer than 100 cytotechnicians in the whole country (to serve an at risk female population of 55,500,000 million), which means that a Pap smear-only based program will never achieve sufficient coverage to make an impact on cervical cancer-related morbidity and mortality. The coverage rate in 2003 was a mere 3% (Indonesian Cancer Foundation).

With funding from Ford Foundation, JHPIEGO is providing technical assistance to the Indonesian Ministry of Health (MOH) to establish cervical cancer prevention services using Single Visit Approach (SVA) to screening with visual inspection with household vinegar (VIA) and cryotherapy. This approach is an evidence based effective method for detecting and treating precancer cervical lesions. It can be provided by trained midwifes, nurse or doctors. Since August 2007, the program has established services at 4 health centers (Puskesmas) in Karawang, and with the district hospital as the referral point

To date, a total of 947 clients have been screened by puskesmas staff through the SVA, of which 31 were found to have precancerous lesions and 9 underwent cryotherapy treatment. Five women were found to have cancer and have been refer to Karawang District Hospital.

SVA is an effective and low cost approach compared to other method. The Karawang District Health Office has requested funding from local government to scale up SVA for other Puskesmas within Karawang.