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The primary aim of service delivery is to enable eligible women to have maximum access to quality cervical cancer screening and treatment services. This would include providing counseling to women targeted by the program, performing screening through Visual Inspection of the Cervix with Acetic Acid (VIA) and giving appropriate treatment if necessary. The CECAP sites have developed their own practices in order to deliver quality services in their areas.

Luzon

Cancer Institute, University of the Philippines-Philippine General Hospital, Manila

The Detection Clinic in the Cancer Institute, University of the Philippines is home to two nurses, Annie Gay Ricamara and Nordeliza Roa, and two midwives, Connie Mangahas and Henny Honrado, under the leadership of the CECAP Project Manager, Dr. Jaycee Almaria.

Services are offered to women aged 25 to 45 every Wednesday morning, from 8 to 12 pm. To date, the clinic has rendered VIA to 387 women, of which 10 clients were found to be VIA positive. They were subsequently managed accordingly.

Also, the clinic is open to provide counseling services even to those who do not fall on the target population of the CECAP program. Phone calls and e-mails containing queries about cervical cancer are entertained by the providers themselves.

Several lectures have been given to uplift awareness of lay and health professionals regarding cervical cancer prevention. These were conducted in different provinces and also internationally.

Furthermore, the health professionals manning the detection clinic play an important role in the referral system of the CECAP program. Close ties are kept with the UP-PGH Department of Obstetrics and Gynecology in order to assist in the referral of patients from the other pilot sites, be it for other gynecologic problems or for treatment of lesions which are not eligible for cryotherapy.

Recently, the service providers have interactive “Enrichment Sessions” once a month wherein they discuss different aspects of the Single Visit Approach. They would likewise attend the CECAP Journal Club every month to further increase their knowledge on cervical cancer prevention.

Muntinlupa City

Muntinlupa is the southernmost City in Metro Manila with a land area of 46.7sq km and composed of 9 barangays namely: Tunasan, Poblacion, Putatan, Bayanan, Alabang, Ayala Alabang, Cupang, Buli, and Sucat. It has one congressional district. Muntinlupa City has a population of 464,195 on 2008 with a population density of 7,505 / sq. km and annual growth rate of 3.14%.

This city was chosen as one of the initial three pilot areas in the Philippines together with Taytay, Rizal and Minglanilla, Cebu to implement the Cervical Cancer Prevention Program.

Series of dialogue, orientations, meeting were conducted by local health staff and local chief executives highlighting the incidence of cervical cancer and the need to adopt the program as a means for early detection, prevention and prompt treatment particularly for cervical cancer screening. Total trained service provides were 16, out of these 4 Doctors, 4 Nurses, 8 Midwives 3 of which are trainers in SVA.

CECAP was launched in February 2006 during the flag raising ceremony and was highlighted with motorcade and commitment from local health officials of Muntinlupa.

With all the logistics in place and with our trained service providers, the Cervical Cancer Screening program services were made available at Putatan Health Center, Poblacion Health Center and Reproductive Health Center. Target clients were 25-45 yrs. old and women who are sexually active for at least three years. A total of 4,056 clients were served from this program from January 2007 to June 30, 2008. 66 were VIA positive and 18 were treated with cyrotherapy during the first visit (SVA); 22 were treated with cyrotherapy during the follow-up visit, 16 were scheduled for treatment and 21 were referred for large lesion.

The CECAP Program in Muntinlupa is supported by the local government through the signing of the Memorandum of Agreement on December 7, 2006 as a show of commitment.

Executive Order No. 15 was signed by Mayor Aldrin L. San Pedro on August 3, 2007- Creating the Cervical Cancer Prevention Program committee its composition and functions.

Expansion of the program was ensured and services were already offered at the health centers of Alabang, Cupang and Sucat.

Outreach programs were also done through the mobile clinic of Congressman Ruffy Biazon.

Non-government organization like OK-Muntinlupa chaired by Mrs. Leah San Pedro and co-chaired by Mrs. Trina Biazon have strong support and commitment in the local implementation of the program

Taytay, Rizal

The Municipality of Taytay was one of the original sites chosen for the establishment of the CECAP Program. Taytay Emergency Hospital became the home of the Cervical Cancer Prevention (CECAP) Unit in the municipality.

The initial set of 7 trained service providers led by Dr. Gerardo Camba, planned to offer cervical cancer screening in Sitio Bayabas for the first year, covering 436 women. However, due to the dedication of the health professionals manning the program, they have not only covered 90% of their target, but they were able to expand to a total of 8 delivery points in health centers of Sitio Bayabas, San Isidro, Santa Ana, Muzon, Arenda, Dolores, San Juan and Floodway.

Although services are already in place in different health centers, the providers recognized the great demand for cervical cancer screening services in their area. Thus the concept of providing basic screening in the form of VIA or visual inspection of the cervix with acetic acid in the community through mobile services materialized. Despite the limited resources in the area, this did not pose as a road block to the providers of this CECAP site. Instead, this resulted to an increase in their screening coverage and the commitment remains as strong as they started. Armed with 8 more trained providers, they continue to touch the lives of more women of Taytay by not only providing static services but by visiting far flung communities to counsel and screen.

Currently, they have provided cervical cancer screening to 1,783 women aged 25 to 45 and 33 of which were noted to have VIA positive lesions. Treatment in the form of cryotherapy is perfomed in the CECAP unit and those with possible premalignant lesions have already been duly scheduled to undergo the procedure. Women suspected to have cancer and other gynecologic problems were referred to the partner referral institution, Cancer Institute of the UP-PGH.

In order to ensure sustainability of CECAP in the Municipality, a Memorandum of Agreement forging ties between involved parties for the remaining 4 years of the program is being arranged.

Taytay boasts of two reputable CECAP trainers, Miss Charrilyn Reyes and Miss Mila Tapawan who were part of the training team in the Clinical Skills Training Course on the Single Visit Approach in Ospital ng Muntinlupa last January 20 to 26, 2008. They also participated as supervisors in the VIA mission of the Philippine Obstetrical and Gynecological Society-Southern Tagalog Region in Puerto Princesa, Palawan along with the CECAP Training Coordinator last February 21, 2008. They also play an active role during transfer of learning visits and have helped keep the service providers adept about cervical cancer screening and treatment strategies.

The barangay health workers (BHWs) of Taytay have been strong partners in motivating women to seek cervical cancer screening. They have also started working on community mapping which will help CECAP-Taytay determine their actual target population.

The providers and the barangay health workers have been reaching out to more women by conducting lectures and lay fora regarding cervical cancer and the CECAP program.

For the coming years, CECAP-Taytay hopes to get more support from important stakeholders in the community in order to continue what they have started.

Tanza, Cavite

Tanza is the youngest CECAP site to date. Currently, there are 4 health professionals who have been trained by the program and are providing daily services in the Rural Health Unit (RHU) in Tanza, Cavite. The primary CECAP coordinators are Dr. Divina Pichay-Rojas, Founding Chair of the General Emilio Aguinaldo Memorial Hospital (GEAMH) Obstetrical and Gynecological Department and Dr. Andrew Rouldan Buizon, a gynecologic oncologist and at present, the Chair of the OB-GYN department of GEAMH.

Dr. Ruth Punzalan, the Municipal Health Officer of Tanza and Jingle Alcantara, a nurse in the RHU are the service providers for cervical cancer screening. They have provided VIA services to 187 patients from the month of April to June of 2008. 17 patients were noted to have VIA positive lesions and were subsequently referred for treatment to referral institutions.

It is also noteworthy that the Philippine Obstetrical and Gynecological Society – Southern Tagalog Region, through the coordination of Dr. Rojas, involved certified CECAP Trainers in a VIA medical mission in Ospital ng Palawan, Puerto Princesa catering services to 51 clients. A client with VIA positive lesion was referred for electrocautery to a POGS member residing in the same province.

Procurement of cryotherapy unit is already on its way, with the Local Government Unit (LGU) providing Ph P 150,000.00 for its purchase. As of this time, patients with lesions amenable for treatment with cryotherapy are brought to CI, UP-PGH and the local providers, under the supervision of the CECAP Training Coordinator, Dr. Jaycee Almaria, would provide management themselves. This way, monitoring is also facilitated and this has helped the local providers be more adept with the knowledge and skills they have learned during training.

A Memorandum of Agreement (MOA) between CECAP and the LGU of Tanza was signed last April 2008 which assures PhP 150,000.00 annual fund for the next five years. Memoranda of Understanding (MOU) between CECAP, GEAMH, De La Salle University Medical Center (DLSUMC), and the POGS – Southern Tagalog Chapter have also been signed to strengthen the referral system in their area.

Furthermore, a Continuing Medical Education (CME) was organized by Dr. Rojas and Dr. Buizon last February 2008 to orient Municipal Health Officers in Cavite regarding VIA and other methods on cervical cancer prevention which was supported by the Governor Ayong Maliksi, the Provincial Health Officer Dr. Vilma Diez and POGS-Southern Tagalog Chapter.

The future plans of CECAP-Tanza include holding an orientation workshop for 20 Barangay Health Workers (BHWs) to assist in completing the list of women in the different barangays of Tanza aged 9 – 55 which would benefit from cervical cancer screening, and later on HPV vaccination, and likewise to serve as motivators of the community to seek medical care. Likewise, CECAP-Tanza is preparing to host a Clinical Skills Training on the Single Visit Approach for capacity building which they plan early next year.