1. Informational-Educational Program on cervical cancer issues in Kyrgyzstan I n collaboration with PATH and Department of Public Health Service in Kyrgyzstan Bishkek 2003-2004

2. Project executives NGO Project executives NGO «Family and Healthy Generation» Project Assistant Rada Abakirova Technical Assistant Venera Djunusova Project Manager Nadejda Kazakova

3. Project objectives Early detection and prevention of cervical cancer through propaganda of regular prophylactic examinations amongst women; Early detection and prevention of cervical cancer through propaganda of regular prophylactic examinations amongst women; Advancing of professional knowledge and skills of health workers; Advancing of professional knowledge and skills of health workers; Involvement of public communities into the issue of cervical cancer. Involvement of public communities into the issue of cervical cancer.

4. Pilot region introduction There are 4 rayons in Bishkek, from where the Leninskiy one is the biggest by it’s territory; There are 4 rayons in Bishkek, from where the Leninskiy one is the biggest by it’s territory; On the territory of this pilot rayon 62 520 women in the age of 30 till 60 has been dwelling (in accordance with the Statistic Department Data, 2003); On the territory of this pilot rayon 62 520 women in the age of 30 till 60 has been dwelling (in accordance with the Statistic Department Data, 2003); There are 6 city multi-profile policlinics and 6 Centres of Family Medicine (CFM) on the pilot rayon territory; There are 6 city multi-profile policlinics and 6 Centres of Family Medicine (CFM) on the pilot rayon territory; In the CFM 163 family doctors have been operating, where 37 are gynaecologists. In the CFM 163 family doctors have been operating, where 37 are gynaecologists.

5. Into the project performance have been involved: Family doctors for studying professional skills for proper consulting and rendering professional help in combination with respect to client’s needs and delicate attention to the problems they are suffered from; Family doctors for studying professional skills for proper consulting and rendering professional help in combination with respect to client’s needs and delicate attention to the problems they are suffered from; Pharmacists as they often the first main advisers for people with health problems; Pharmacists as they often the first main advisers for people with health problems; Domkoms (socially active women). Domkoms (socially active women).

6. Poll April It was held preliminary poll amongst women and health workers of CFM with the aim of detection of their awareness on cervical cancer issues with the aim of detection of their awareness on cervical cancer issues

7. In the questioning list for women were included following questions: Who in your life decides to visit gynaecologist? Who in your life decides to visit gynaecologist? How often do you visit gynaecologist for practical examinations? How often do you visit gynaecologist for practical examinations? Do you know what cervical cancer is? Do you know what cervical cancer is? What symptoms in your opinion characterize cervical cancer? What symptoms in your opinion characterize cervical cancer? What do you think can cause cervical cancer? What do you think can cause cervical cancer? Is there way to heal cervical cancer in medicine? Is there way to heal cervical cancer in medicine? What do you think, in which cases cervical cancer is curable? What do you think, in which cases cervical cancer is curable? When did you pass cytological screening last time? When did you pass cytological screening last time?

8. Objectives: Select problems which are necessary to take into account for successful organisation of activities raising awareness of population on cervical cancer issues; Select problems which are necessary to take into account for successful organisation of activities raising awareness of population on cervical cancer issues; Generalize experience acquired during the work of local policlinics and CFM; Generalize experience acquired during the work of local policlinics and CFM; Attract social attention to the problem of cervical caner in the republic through mass media. Attract social attention to the problem of cervical caner in the republic through mass media. Round Table May The Round Table with participation of leading specialists on women’s reproductive health in Kyrgyzstan was conducted in May. The Round Table with participation of leading specialists on women’s reproductive health in Kyrgyzstan was conducted in May.

9. Media Campaign June-July TV-program devoted to the problem of early detection of cervical cancer; TV-program devoted to the problem of early detection of cervical cancer; TV-reports in frames of TV- information broadcasts; TV-reports in frames of TV- information broadcasts; Russian and Kyrgyz language radio-rolics on cervical cancer issues; Russian and Kyrgyz language radio-rolics on cervical cancer issues; “The best article covering problem of cervical cancer” competition among local newspapers. “The best article covering problem of cervical cancer” competition among local newspapers.

10. Training of Trainers June During 3-day training seminar were trained 10 trainers for following training of family doctors, pharmacists and domkoms During 3-day training seminar were trained 10 trainers for following training of family doctors, pharmacists and domkoms Priority objectives: Analysis of adults study principles; Analysis of adults study principles; Mastering of trainer’s many-sides; Mastering of trainer’s many-sides; Studying of trainer’s and facilitator’s skills; Studying of trainer’s and facilitator’s skills; Analysis of training realisation methods; Analysis of training realisation methods; Mastering of training leading skills; Mastering of training leading skills; Applying of own experience during training. Applying of own experience during training.

11. Training of family doctors July -August Objectives: Objectives: Uncover problems leading to late detection of cervical cancer; Uncover problems leading to late detection of cervical cancer; Detect objectives and activities for raising awareness of population on cervical cancer issues; Detect objectives and activities for raising awareness of population on cervical cancer issues; Familiarize with client’s rights; Familiarize with client’s rights; Practice knowledge and skills for consulting of clients; Practice knowledge and skills for consulting of clients; Develop the system of self- evaluation. Develop the system of self- evaluation. Trainings visited: 150 family doctors 150 family doctors 60 pharmacists 60 pharmacists 45 domkoms 45 domkoms

12. Evaluation September-December Creations of evaluation: Creations of evaluation: Work conditions contribute to adaptation of knowledge on practice; Work conditions contribute to adaptation of knowledge on practice; Doctor/pharmacist/domkom rendered in affable form information about cervical cancer and necessity of regular prophylactic measures; Doctor/pharmacist/domkom rendered in affable form information about cervical cancer and necessity of regular prophylactic measures; Woman passed through cytological screening. Woman passed through cytological screening.

13. Results Raising of recognition amongst key persons of Public Health Service; Raising of recognition amongst key persons of Public Health Service; Realisation of importance of such programs implementation for Kyrgyz system of Public Health Service at all; Realisation of importance of such programs implementation for Kyrgyz system of Public Health Service at all; Obtained experience is irreplaceable for successful extension of the program and for new projects in sphere of medical education and service as well; Obtained experience is irreplaceable for successful extension of the program and for new projects in sphere of medical education and service as well; Information coverage of population not only on the territory of pilot rayon but far and away it due to media campaign. Information coverage of population not only on the territory of pilot rayon but far and away it due to media campaign.

15. Difficulties There are shortage of instruments for cytological screening in most of Centres of Family Medicine. Shortage of instruments took third place in circle of problems family doctors meet with in practice. There are shortage of instruments for cytological screening in most of Centres of Family Medicine. Shortage of instruments took third place in circle of problems family doctors meet with in practice.

16. Most women ignore necessity of prophylactic cytological examinations Most women ignore necessity of prophylactic cytological examinations and as a result visit gynaecologist only in advanced cases. Women prefer not to know about disease because in case of it’s detection it can demand additional expanses that are too high for a middle family. and as a result visit gynaecologist only in advanced cases. Women prefer not to know about disease because in case of it’s detection it can demand additional expanses that are too high for a middle family.

17. Implementation of co- payment system in July 2003 and reduction of prophylactic examinations plan in 4 times changed the situation to the worse. Desirable effects of novelties implementation in Kyrgyz Public Health Service system lead to rise of women refused from medical service. Implementation of co- payment system in July 2003 and reduction of prophylactic examinations plan in 4 times changed the situation to the worse. Desirable effects of novelties implementation in Kyrgyz Public Health Service system lead to rise of women refused from medical service. In accordance with monitoring conducted, number of cytological screening in Bishkek decreased in 26 % comparing with the same period of last year. In accordance with monitoring conducted, number of cytological screening in Bishkek decreased in 26 % comparing with the same period of last year.

18. Recommendations To implement regular training seminars on advancing of professional knowledge and skills of health workers for effective consulting on cervical cancer issues; To implement regular training seminars on advancing of professional knowledge and skills of health workers for effective consulting on cervical cancer issues; To develop evaluation system of knowledge and skills of health professionals they obtained during training seminars ; To develop evaluation system of knowledge and skills of health professionals they obtained during training seminars ; To inculcate monetary incentive system for family doctors in cases of early detection of cervical cancer; To inculcate monetary incentive system for family doctors in cases of early detection of cervical cancer; To hold annual media-campaigns for raising awareness of population on cervical cancer issues. To hold annual media-campaigns for raising awareness of population on cervical cancer issues.

19. We express our gratitude for support and collaboration to PATH