FRAMEWORK OF

NATIONAL CANCER CONTROL

PROGRAM IN INDONESIA

Prof. dr. Tjandra Yoga Aditama, Sp.P (K), MARS, DTMH

ACTING DIRECTOR GENERAL OF
DISEASE CONTROL AND ENVIRONMENTAL HEALTH
MINISTRY OF HEALTH, REPUBLIC OF INDONESIA
 GLOBAL MORTALITY BY CAUSE, TREND OF MORTALITY IN INDONESIA BY
ALL AGES 2005
CAUSE, ALL AGES IN 1992 – 2001
HOUSE HOLD HEALTH SURVEY 1992, 1995, 2001
Percentage
35
30
25
CARDIO-VASCULAR
20
DISEASES

15
10
CANCER

5
COPD

0
HIV Infection- Circulation Digestive Injury
AIDS TB DIABETES parasite Respiratory Neoplasma Perinatal
MALARIA
1992 1995 2001
* NCD is the most common cause of death in the world
**Source: WHO and World Bank 2005

Disease Burden in Indonesia

 House hold health survey, 2001 : cancer is the 5th cause of death
 Pathology based data from 13 main hospitals in Indonesia, 1998:
cervical ca is the highest among ca cases (17,2%) followed by breast
ca (12,8%)
 Indonesia hospital admission in 2005: Breast cancer is the highest and
followed by cervical cancer.
 The Ten Commonest Malignancy in Female
in 31 Hospitals in Jakarta, 2005
Breast Ca
Cervix Ca
Ca Ovarium
Leukaemia
TOPO

Colorectal Ca
Thyroid Ca
Nasopharynx Ca
Lung Ca
Skin Ca
Liver Ca

0.00 5.00 10.00 15.00 20.00 25.00 30.00 35.00

Percent
 The Ten Commonest Malignancy in Male in
31 Hospitals in Jakarta, 2005
Nasopharynx Ca 12.00
Lung Ca 11.50
Leukemia 11.10
Colorectal Ca 10.80
TOPO

Lymphoma 6.90
Prostate Ca 6.00
Liver Ca 4.70
Skin Ca 2.90
Brain Ca 2.60
Gaster Ca 2.00

0.00 2.00 4.00 6.00 8.00 10.00 12.00 14.00

Percent
 Cancer control program was known since 1989 stated
in Integrated & Comprehensive Cancer Control
Program (SK Menkes No 604/Menkes/ SK/1989)
 Every hospital should develop their own cancer
control program based on their resources & capacity
(SK Menkes No 10/Menkes/SK/I/1994)
 Indonesia participated in developing Jakarta
Statement on Cancer Control Program  the
statement of strategic effort toward optimal cancer
control and care (initiated by UICC & WHO)
 Establishment of Dharmais Cancer Hospital (1993) in
the future hopefully will become National Cancer
Center
 Establishment of Directorate of NCD Control, including
Sub Directorate of Cancer Control in 2005 (SK
Menkes No 1575/Per/Menkes/XI/2005)
 VISION of MoH-RI
SELF MOTIVATED COMMUNITY
TO LIVE HEALTHY LIFE

MISSION
MAKE PEOPLE HEALTHY

MoH of RI
Organization
Ministry of Health
Structure
Secretary General

DG of Medical DG of DG of Disease DG of Public Inspectorate

Services Farmacies& Health General
Control & EH
med-supp
Secretary of DG of DC & EH

Directorate of Directorate Directorate Directorate of Directorate of

SESPIM of DCDC VBDC EH
NCDC

Subdit Subdit. DM & Other Subdit. Chronis Subdit Subdit. Violence &
Cardiovas Metabolic disease Injury
& degeneratif Cancer
 UU No : 23/1992  Kesehatan
PP No : 19/2003 Pengamanan rokok bagi kes
Kepmenkes:
•No : 1575/2005  Organization & Tasks of MoH
•No : 1468/2006  RPJPK 2005-2009
•No : 1116/2003  Gudeline of Health Surveillance System
•No : 1479/2003  Guideline of Epid-Surveil of CD & NCD
•No : 430/2007  Guideline of Cancer Control
•No : 1163/2007  Working group on Cervical and Breast
Cancer Control

To decrease cancer morbidity,

disability,mortality and improve
quality of life of cancer patients

NCD programmer ( center, UPT, district)

Inter program & inter sector related
Professional Org. & NGO
Community & groups at risk
 Policies on Cancer Control
 Based on social participation and
community empowerment through local
enhancement  PKK, DW, etc
 Developing collaboration and partnership
networking  POKJA Kanker
 Integrating program of primary,
secondary and tertiary prevention.
 Performing services delivery by
professionals and qualified healthcare
providers
 Developing surveillance of risk factors and
cancer registry
 Quality Assurance
 STRATEGIES
 Social mobilization and community
empowerment for healthy living  kader,
PKK
 Encouraging health service development
 Encouraging and facilitating community
participation  masyarakat peduli kanker
 Developing early detection program
 Improving health services access
 Developing risk factors surveillance and
cancer registry
 Proposing cancer treatment in the
compulsory health insurance for the poor
payment scheme
 •Polices, Establishment of
•Guidelines, Networking
•Modules

Developing Program
• Advocacy
• Socialization
• Promotion

Budget
development
Monitoring
&Technical
assistance

Logistics
Epidemiological
Human Investment Surveillance &
Information
Technology
 Policies, Guidelines, Modules
1. NCCP Policy
2. Guidelines
• Screening program
• Treatment for cancers
• Risk factors control
• Epidemiological Surveillance
• Community empowerment
• Promotion & campaign
• Etc
3. Modules
• TOT for providers
• TOT for managers
• Training for providers
• Training for managers
• Training for cadres
1. Public Awareness
- Promotion
- Public education
2. Screening  Pilot Project for Cervical & Breast Cancer
- Started in 6 Districts (6 provinces) since 2007, now expanded to
another 2 districts
- Goal : finding pre-cervical cancer lession & breast tumor
- Target : woman age 30-50 yrs
- Coverage target: 80% from target at the population
- Location : 6 Districts (Deli Serdang, Gowa,
Karawang, G. Kidul, Kebumen, Gresik) @ 8 Primary
Health Care each
- Metode : single visit approach with Visual Inspection with Acetic
acid/VIA & Cryotherapy (for VIA+), and Clinical Breast
Examination/CBE
- Provider : well trained MD & midwives in PHC
- Supervisor: 1. Clinician (Obsgyn & Surgeon)
2. Management by District & Province official health
officer
3. Vaccination
- HBV Vaccination : child immunization since 1997  compulsory
- HPV Vaccination : private
Advocacy & Socialization
• Advocacy
 Decision makers : MoH, Min of Finance, National
Planning Bureau, etc
• Socialization
 Traditional & religious leaders
 Professional organizations
 NGOs
 Etc
• Promotion
 Public education
 Mass campaign

Establishment of Networking
• National
 Working group on Cervical and breast cancer control
• International
 UICC and IACR
Human Investment
o TOT & training on Cervical & Breast Ca screening
o TOT on management of NCCP
o Training for cadres PKK

Logistics  For Screening

• VIA set
• Cryo set
• cervicograph,
• Colposcopy
• LEEP
• Mammografi
 To develop national cancer registry, it needs a
model, DKI Jakarta is chosen as the model.
 The budget of the model is still supported by
WHO representative to Indonesia
 Divided 5 regions : East, West, North, Central, &
South Jakarta
 In beginning, there are 40 hospitals chosen to
run cancer registry
Plan of Regional Cancer Centre Indonesia

Regional Cancer Centre

National Cancer Centre
 Cancer control in Indonesia are
already established, which is in
developing stage. It’s need
fundamental system
 NCC is needed to support the
programs on:
• Scientific
• Analytic
• Operational research