SOCIAL MARKETING PLAN FOR CERVICAL CANCER PREVENTION AND

CONTROL

BACKGROUND
The natural history of cervical cancer suggests that screening initially should focus on women at the highest risk of precancerous lesions; women in their thirties and forties. Cervical cancer most often develops in women after age 40 and peaks at around age 50. Dysplasia generally is detectable up to 10 years before cancer develops, with a peak dysplasia rate at about age 35. Unscreened women over 50 remain at relatively high risk of cervical cancer, though women in this age group who have had one or more negative screens in their thirties or forties are at low risk. Despite Cervical Cancer being preventable, most women in Uganda especially those living rural areas like Buhweju lack information on the disease, diagnosis and funds for treatment especially when the disease is at an advanced stage. Most women continue to succumb to premature death simply because they do not have access to information on the cervical cancer. Looking at the remoteness and high illiteracy levels especially amongst the majority women in Buhweju, this will be the first time most people especially women will be hearing about cervical cancer. Most women in this area are dying of the disease silently as some sections of this community refer to it as witchcraft that only need intervention by traditional healers. For those that have been able to go to health centers and tested positive of the disease, the main word they heard was that, they have been diagnosed with cancer, and according to them, cancer is not treatable which means they are condemned to go home and wait for the final day that they will die! Intensive counseling and screening of these women followed by massive community sensitization will be tantamount to the successful fight and prevention of cervical cancer among the rural women in Buhweju District. The project will reach at least 2,000 women between the ages 20 to 50 years within Buhweju District in 4 sub-counties.

VISION AND MISSION To prevent Cervical Cancer among rural women in Buhweju and make cervical cancer screening and prevention services available

PROBLEM DESCRIPTION Cervical cancer is the uncontrolled growth of some cells on the cervix (the mouth of the womb). Cells on the cervix begin to grow slowly and abnormally over the years. These early (pre-

cancerous) changes can disappear on their own without causing problems. But in some women, these cells can grow into cancer if they are not identified (screened) and treated early. They spread to other parts of the body and interfere with normal body functions. Uganda has a population of 7.32 million women of ages 15 years and older who are at risk of developing cervical cancer. Current estimates indicate that every year 3,577 women are diagnosed with cervical cancer and 2, 464 die from the disease (WHO/ICO Information Center 2010). Cervical cancer ranks as the first most frequent cancer among women in Uganda, and the second most frequent cancer among women between 15 and 44 years of age. Data is not yet available on the Human Papilloma Virus (HPV) burden in the general population of Uganda. However, in Eastern Africa, the region Uganda belongs, about 33.6% of women in the general population are estimated to harbour cervical HPV infection at a given time.

OBJECTIVES
1. To create awareness about cervical cancer, its effects and the availability of prevention services 2. To provide cervical cancer screening and treatment services to women between 20-50 years of age both at our center and within the community 3. To build local capacities for cervical cancer screening and referral

FORMATIVE RESEARCH
With little information on the disease available to women in Uganda, our major worry is that it will continue to go undiagnosed and untreated if no urgent effort for an adequate outreach Programme for screening and treatment of the disease in early stage is done. Some few awareness campaigns about the disease by some corporate companies, media houses in partnership with Ministry of Health have been organized and conducted but these are only concentrated in the capital Kampala leaving rural women completely unaware of the disease and dying in silence. A study conducted on medical workers at Mulago Hospital in 2006 found that 19% of them had never been screened for the disease, and 78% said they never assessed patients if they had been screened or referred for screening. .

RECOMMENDATIONS
The detailed outcomes (and their indicators) of the project will be presented in the logical framework to be developed in participatory with partners. However the following are some of the key expected outcomes of the project. At least 90% of people screened provided with counseling services 30% of women in the target population screened within the first year of project implementation At least 60% of women aged 20 to 50 years screened for the first time in the past 5 years The capacity of at least 10 health workers within the project area built on cervical cancer screening and are able to perform or refer women for screening At least 60% of women aged 20 to 50 years within the project area knowing basic screening message At least 60% of women aged 20-50 years having a positive attitude towards screening services At least 10% of women with positive screening results diagnosed within the first three months and provided treatment At least 60% of all women treated followed-up annually Reduced incidence of cervical cancer within the project area by project end Reduced mortality rate from cervical cancer within the project area Increased capacity of TUMU foundation to provide support and adequate care to people infected and affected by cervical cancer.

SCOPE OF THE PROJECT

The Project will be implemented in only 4 sub-counties of Buhweju district. Each sub-county will be split into project sites that will be based on parish administrative units. A community outreach visit shall be organized and conducted at each site at least once every year. The distribution of project sites will be as follows: Bihanga Sub-County (Nyakaziba Parish, Rukiri parish and Karembe parish), Karungu Sub-County (Kasharara parish, Katara parish, Rugongo parish and Karungu parish), Rwengwe Sub-County (Kashenyi parish, Kibimba parish, Kyeyare parish, Rwengwe parish, Bwoga parish and Nyakishojwa parish), Bitsya Sub-County (Bitsya parish, Kitega parish, Mushasha parish, Kankara parish). Upon successful implementation of this project in this project area, considerations to enroll to project in other sub-counties shall be reviewed and discussed with the donor.

STRATEGY DEVELOPMENT
To ensure that screening and treatment of precancerous lesions is maintained within the project area, we shall work hand in hand with the district especially the Offices of the Community Development Officer and District Health Officer. We shall advocate and ensure that project activities are included in Districts plans. We shall also engage in lobbying and advocacy activities alongside other development partners including NGOs, civil society organizations and private sector to ensure that Government through Ministry of Health plays a leading role through the national coordinating committee in increasing access to cervical cancer screening and treatment services at all levels across the country. We shall participate in partnership meetings aimed at lobbying government to finalize with the cancer-control policy and to have cervical cancer screening as a national programme. All equipments bought and staff capacity built in the process of this projects implementation shall be maintained at the end of project and will be used to provide screening and treatment services even after the end of the project. We shall ensure there is full participation of beneficiaries, community members, men, local and religious leaders in activities of the project so as to earn their support and acceptance of the project. During the project implementation, emphasis shall also be put on ensuring that VIA and cryotherapy is acceptable treatment method for patients. Tumu Foundation/Hospital owns the structures, office space and the land where its head offices are located. By this, the organization doesnt pay rent or worry of relocation incase of need for property development by the owner. This is more sustainable and provides more assurance for project continuity. The foundation will continue to apply for more funding from other donors so as to support more and more needy and less privileged groups both medically and socially. .

AUDIENCE IDENTIFICATION
Project activities shall be organized and implemented in a chronological manner and at different levels of health care so as to ensure impact creation. At the community level, activities shall include creating awareness, communication and educating targeted women between the ages 2050 years. For patients with advanced disease, palliative care shall be arranged and provided. At the Primary Health Care (PHC) level, VIA shall be performed and women with positive tests will be referred to the next (secondary) level, where VIA and cryotherapy could be provided. For instances where the lesion will not meet the criteria for cryotherapy, women will be referred to the tertiary level for further evaluation and treatment. At the next level, we shall have training of health-care providers, monitoring and evaluation of services that will be required.

AUDIENCE SEGMENTATION
Women who are very ill Women who are more than 20 weeks pregnant Women less than 12 weeks after delivery Women with cauliflower-like growth or ulcer; fungating mass Women with previous history of treatment of cancerous lesions

INTERVENTION DESIGN Product

Cervical cancer is largely preventable but women need to be screened every three to five years to halt the deadly disease. In Uganda, most health Center IV and some of regional referral hospitals are still limited in their ability to treat cervical cancer. For the case of Buhweju, Nsiika Health center IV, the main health center in the district lacks the adequate capacity. Patients who report cervical cancer at its advanced stage are referred to Uganda Cancer Institute at Mulago Hospital for further management. According to Turyasingura Wycliffe, the District Health Officer for Buhweju, very of those referred to Mulago end up there. Others, due to limited resources, decide to stay home and die of the disease. Currently, few women especially those in Buhweju District and other rural areas of Uganda cant afford the cost of treatment at Mulago Hospital; many cant even raise the cost of transport to the capital Kampala where Mulago is located.

Price
All equipments bought and staff capacity built in the process of this projects implementation shall be maintained at the end of project and will be used to provide screening and treatment services even after the end of the project. Promotion We shall begin with a district sensitization meeting where we shall educate and sensitize district officials, district councilors, sub-county chiefs, LCIII chairpersons and religious leaders. The exercise will also be used as a platform for introduce and inform the leaders about the project and its purpose. This will help us to earn their support to the project. We shall lobby their participation and support during the project implementation. The meeting shall target at least 70 participants from all sub-counties within the district.

IMPLLEMENTATION PLAN Community awareness and sensitization activities shall be organized at parish level across the district so as to increase knowledge and create awareness on cervical cancer and its prevention. These awareness activities shall target all women aged 20-50 years and residents in our catchment area. The activities shall be conducted by the project staff who will include physicians, nurses, social workers/community development offers and we shall work hand in hand with local authorities, religious leaders and community health volunteers. We shall invite men and encourage them to participate in our sensitization meetings, provide them with adequate information and ensure they are present during the screening of their women. This will enable them to provide support to their women especially those found with cervical cancer. At least 34 community sensitization meetings shall be organized and conducted in all parishes within the district. These will be organized and conducted through church gatherings, in market places, at health facilities and by inviting people to come for the meetings at selected locations mainly at school compounds, churches, parish or sub-county head quarters within their locality. Mobilization shall be done through church announcements, pinning of posters in strategic locations, funeral meetings, radio announcements and through a team of dedicated community health volunteers.

ENABLEING ENVIRONMENT AND CAPACITY BUILDING Advocacy

We shall engage in media campaigns to raise awareness for continued cervical cancer screening and early detection. With the privatization of communication systems in Uganda, Radio stations have become one of the major forms of public communication in Uganda. Currently, there are 122 FM radio stations, 7 AM stations and 2 shortwave. In the western Uganda, people have mainly relied on local radio stations as the main source of information inform of news bulletins, announcements, entertainment, social affairs and marketing, among others. In Buhweju, at least every family owns a radio station and however much poor the household is, it endeavors to buy at least batteries for a radio, mainly possessed by the man.

Capacity building
We shall design and produce information, education and communication materials (IEC) on cervical cancer and prevention that we shall disseminate during these community awareness and sensitization activities. I.E.C materials shall be simplified and tailored to suit the target group

which are the local women and community members and will be aimed at motivating women to come for screening. EVALUATION Evaluation will help us to address ongoing activities (for instance, how well the programs screening and treatment services are functioning and whether women with untreatable disease are receiving palliative care) and long-term impact (for instance, whether the program has helped to reduce cervical cancer incidence rates in Buhweju cost effectively). At the end of each year there will be a one-day participatory review of the project involving all partners and representatives of beneficiaries from all sub-counties. This review will be based on a project status report with input from partners and community health volunteers. This will be an evaluative review of the project and lessons learnt from the process will be used to review the plans for the subsequent year. This Action, Learning and Planning process ensures that the people who are involved with the programme on a day-to-day basis are involved in its review and evaluation. Guidelines for the participatory performance assessment will be prepared by TUMU Foundation. An external evaluation facilitated by an external consultant will be conducted at the end of the 3 year period to assess project effect or impact and to learn lessons.

References
Mateke S. 2003. Cultivation of Native Fruit Trees of Kalahari Sandveld: Studies on the Commercial Potential, Interactions between Soil and Biota in Kalahari Sands of Southern Africa, Veld Products, Botswana. Pp. 49. Mhango J. and Akinnifesi F.K. 2001. On-farm assessment, farmer management and perception of priority indigenous fruit trees in southern Malawi. Pp. 157164 in Kwesiga F., Ayuk E. Mithfer D. 2004. Economics of Indigenous Fruit Tree Crops in Zimbabwe. PhD Thesis, Department of Economics and Business Administration, University of Hannover. Hannover, Germany

ANNEX I: WORK PLAN The project will be implemented for a period of 18 months (December2012-may2014). Major undertakings will include the following:
i. ii. iii.

iv. v. vi. vii. viii. ix. x. xi.

Mobilisation and Identify Beneficiaries to participate in the project (December 2012) Establishment of operational office and a Community Project Committee to oversee and sanction the project (December 2012-january 2013) Carry out major sensitisation and training including sensitisation seminar for Local council leaders in Nabitende; and an orientation workshop for beneficiaries (DecemberJanuary 2013) and Preparation and dissemination of at least 5,000 awareness materials. Organise beneficiaries into 3 groups and further train them in group dynamics Purchase and distribute high value seeds and planting materials (January-June 2013) as well as basic farming equipment Field extension advice and support to establish gardens including a demonstration plot for out reach purposes(January-Sept 2013) Identifying and training of 5 local volunteers/facilitators and place them on the job training (December 2012) Training of beneficiaries in post harvest handling, marketing practices as well as best crop growing practices (June- Nov 2013) Identify potential markets for farmers produce (May 2013- dec 2013) Mid term project reviews (may 2013;December 2013;may 2014) Organise beneficiaries into a Community association ( January-April 2014)

Final project evaluation (April-May 2014) and producing final report.

ANNEX II: ACTIVITY

DETAILED BUDGET FOR THE PLAN UNIT COST 25,000 200,000 TOTAL 17,500,000 400,000 17,900,000

Procurement of seeds/seedlings for 700pupils Transportation of the seeds and seedlings Subtotal

Hoes Watering Cans Spray pumps Sub-total

10,000 7,000 200,000

7,000,000 4,900,000 35,000,000 46,900,000

Printing of brochures and posters T-shirts Production of the video documentary Subtotal 6,000

2,050,000 6,000,000 2,500,000 10,550,000

Venue hire Workshop materials - assorted Workshop facilitator's fees and transport Meals participants and organizers Sub-total

50,000 3,000 150,000 6,000

100,000 120,000 300,000 300,000 820,000

Venue hire Materials assorted Workshop facilitator's fees and transport Meals participants and organizers Sub-total

50,000 5,000 150,000 12,000

500,000 2,500,000 1,500,000 6,300,000 10,800,000

Course fees and cost for the training materials Costs for meals during the course Transport and upkeep in Kampala for a 5-day course Subtotal (training)

190,000 15,000 120,000

950,000 375,000 3,000,000 4,325,000

Project Coordinator

350,000

6,300,000 5,400,000

Agricultural extension officer/community forester Assistant Administrator/ Accounts Assistant (50%) Subtotal

300,000 250,000 4,500,000 16,200,000

Tel./ Fax/ Email / Internet charges Travel for project staff (to the project site and meetings) Office supplies (stationery) - assorted Bicycles for the local technicians Computer and printer Office furniture

100,000 500,000 200,000 150,000

1800,000 9,000,000 3,600,000 450,000 4,000,000

50,000

650,000

Steering committee meetings (transport refund, meals, etc)

100,000

2,400,000

Sub-total

21,900,000

Monitoring and Evaluation End-of-cycle evaluation consultant Sub-total 120,000 2,400,000 2,400,000

120,000/

TOTAL COSTS

153,395,000

Project management fee (7% project cost)

10,737,650

GRAND TOTAL

164,132,650