Policies provide foundation and guidelines for all aspects of the program and delivery of services. Last May 12, 2008, Policy Statements on Cervical Cancer Prevention and Control of the Philippines was released.



The Department of Health (DOH) formulated Administrative Order No. 2005-006, titled: Cervical Cancer Screening using Acetic Acid Wash. This has become a policy of the DOH in its recognition of the high incidence of cervical cancer in the Philippines.

The DOH collaborates with the Cervical Cancer Prevention (CECAP) Network Program of the Philippine General Hospital to update the Administrative Order and include a treatment regimen. CECAP is an alliance of organizations from the public and private sectors, including health professionals and other concerned non-government agencies who are all committed in working together to eliminate cervical cancer among Filipino women. DOH and CECAP formulated the following policy statements (guidelines).

1.) Every Filipino woman has the right to be screened and treated for cervical cancer.

2.) DOH will work closely with CECAP for a cervical cancer- free Philippines. CECAP through the University of the Philippines Manila- Philippine General Hospital – Cancer Institute (UPM- PGH- CI) will become the coordinating and training center of DOH. As a task force secretariat for the National Cervical Cancer Prevention and Control, CECAP pledges to support DOH in : - Quality assured “screen and treat” service delivery in the community - Building capacity for comprehensive cervical cancer control - Standard training with monitoring and supervision - Documentation and sustainability of the program - Advocacy and evidenced-based information campaign and; - Researches to support development of policies and guidelines

3.) Comprehensive approach for control of cervical cancer will be implemented by promoting healthy lifestyle and immunization. Prophylactic vaccination should be linked to screening to accelerate the decrease in the incidence of and mortality from cervical cancer. Cervical cancer screening with emphasis on visual inspection with acetic acid (VIA) linked to treatment (cryotherapy) in a single visit approach (SVA) will be established in all public health facilities. Referral center linkages will be enhanced for quality cervical cancer diagnosis and treatment.

4.) Pilot sites which have already started the program will serve as models for best clinical practices. Initial evaluation of the community will be done with the use of an assessment tool to determine the capability of the community to start the program.

5.) Following assessment, a strategic planning will be done for an organized implementation. Training of health providers for the cervical cancer prevention services will be held at DOH- CECAP accredited training centers.

6.) Mapping of the community will include a list of target populations for cervical cancer screening of women 25-45 years old. The aim is to cover 50-85% depending on the capability of the community of the target population in 5 years.

7.) Visual Inspection with Acetic acid (VIA) shall be used as the primary screening tool for cervical cancer and shall be established at Local Health Units (RHUs/HCs), District Hospitals and Provincial Hospitals with no Papanicolau smear (Pap smear) capability. For centers with capabilities for Pap smear, this shall be continued but VIA may also be provided.

8.) This new policy will link VIA screening to treatment using cryotherapy in a single visit approach (SVA). SVA (VIA, cryotherapy, counseling) will be performed by trained doctors who have the competency requirements. Trained nurses and midwives can also do the procedure under the supervision of the trained doctor.

9.) Patients found to be negative for VIA will be advised to follow up after 5 years unless considered as high-risk and need to come back after three years or earlier. Patients with positive VIA results and are eligible for cryotherapy will be subjected to cryotherapy immediately in a SVA.

10.) Reasons for referral to secondary or tertiary centers include: • suspicion of cancer • acetowhite lesions 75% or greater • those extending to the vaginal wall or into the cervical canal • other gynecologic findings • or pregnant patients

11.) Gender sensitive counseling and disclosure shall be a component of any training program for cervical cancer prevention and control. All doctors, nurses, midwives and barangay health workers will be trained to become motivators and counselors.

12.) Sustainability of the program shall be ensured through local financing like subsidy from the local government unit or the health facility concerned, the Philhealth financing, or user fee scheme.

13.) A developed standard system of recording and reporting will be adopted at service delivery point.

14.) Periodic evaluation shall be done at all levels to assess the progress of the CECAP program and its impact on cervical cancer prevention and control.

15.) DOH will support the development and implementation of a national database on target population and women screened and tumor registry on cervical cancer to measure progress on prevention and control efforts in the country.

16.) A regular yearly public information and education campaign aimed at changing behavior shall be done via mass media and interpersonal communication within each health center to inform and entice target women about the cervical cancer prevention services.

The Department of Health (DOH) in partnership with the Cervical Cancer Prevention (CECAP) Network Program to eliminate cervical cancer among Filipino women. Together, they are committed to empower Filipino women against cervical cancer by increasing their awareness about the disease and providing them access to treatments. The Single Visit Approach (SVA) which was adapted by CECAP from JHPIEGO, an affiliate of John Hopkins University in their pilot areas will also be used by DOH as strategy in the early diagnosis and prevention of cervical cancer. The SVA includes the Visual inspection with Acetic Acid, Cryotherapy and counseling. This strategy was not described in the Administrative Order 2005-006 issued by the DOH in 2005, which focused mainly on cervical screening.

The Cervical Cancer Prevention and Control Program will have the following key components: community assessment, capability building, networking and resource mobilization and effective two way referral system, advocacy, monitoring and evaluation and documentation. With these components, the sustainability of the program is ensured.

A new guideline is being finalized designed for a nationwide implementation of the Cervical Cancer Prevention and Control program that will serve as guide for all health care providers.