Saidatul Norbaya Buang

Public Health Physician

Family Health Development Division

Ministry of Health Malaysia

Asia Dengue Summit

Shangri La Hotel - Bangkok

13 – 14 January 2016

Lessons Learned:

Building The School-based HPV Program

In Malaysia And

Opportunities For Piggybacking

Rohani Jahis

Public Health Physician

Disease Control Division

Ministry of Health Malaysia

HPV vaccination in Malaysia

Promoting HPV vaccine

Malaysia Performance 2010 – 2014

Lesson learned

Integration of new Program

School Health Service Packages

Factors to consider

1

5

6

7

2

3

4

Presentation

Outline

Why HPV vaccination ?

Stage 1 24%

Stage 2 38%

Stage 3 21%

Stage 4 17%

Cervix, Uteri stage at diagnosis among Malaysian citizen 2008

Why HPV vaccination become

part of Cervical Cancer

strategy?

• Low Cervical smear uptake

among high risk women

• Delay in seeking treatment

• WHO endorsed on safe HPV

vaccine to prevent Ca Cx

Ca Cervix HPV Vaccination

Budget/

Target

1,627 cases (2003) 266,000 girls ( 2009)

Cost RM 381.8 millions

RM 2.8 millions for pre

invasive

RM 285 millions for treating

new cases ( invasive)

RM 94 millions for treating

old cases

RM 322.2 millions

Vaccine RM319.2 million

Additional Cost RM 3

millions (Health

Education, Training and

logistic

Cost/

person

RM 234,665.02 RM 1,211.28

Incidence 19.7 /100,000 women-

unchanged

8/1,000,000

(estimate vaccine efficacy

at 98%)

Aljunid, 2007. HUKM

GOAL: To reduce the incidence of Cervical Cancer related to HPV type 16 and 18 infection

among immunized 13 years old girls over next 20 years.

OPERATIONAL POLICY: Free Voluntary

School Based HPV Vaccination to Form 1

Malaysian girls

STRATEGY: delivered as part of the Cervical Cancer

Prevention and Control Program and the Expended Program of Immunization

(EPI)

• High school attendants in Malaysia

• HPV vaccine as an additional vaccination

to existing EPI program

• Availability of structured comprehensive

school health program

• Strong commitment and support from

Ministry of Education

Overview of the HPV Vaccine Programme

Single type of vaccine utilization during one

procurement cycle

• 2010/11 : Cervarix

• 2012 – 2016 : Gardasil

• Schedule : 0, 1, 6 month

• Shifted to 2 doses in 2015 ( 0, 6 month)

Promoting HPV Vaccine

5

Theme: HPV Vaccine as Cervical Cancer Vaccine

Media Campaign Based on Health Belief Model

1. Cervical cancer is preventable

2. Parental awareness on voluntary vaccination

3. Persuade girls to complete 2 doses of vaccination as scheduled

Public Access to Interactive Information

1. Social Media

- HPV Facebook

- HPV twitter

2. Phone Hot line

3. Email

4. Print and electronic advertisement

Rumours Surveillance and Program Monitoring

1. Response to media and public queries

2. Provide guideline to implementers

3. Monitor potential program threat and proposed counter measures

Addressing the religious and cultural aspect of the HPV vaccination Leading to establishment of Fatwa or religious ruling on HPV vaccination for the Muslim.

Program target: 3

doses completion

at 95%

Factors Contributing

to Success

Political Will and commitment

Public trust in Malaysian Expanded Program in Immunisation

School Health Services Infrastructure

Existing strong relationship with Ministry of Education

Effective Risk Communication Strategy

Addressing Religious Issues

Competitive Procurement Mechanism

7

1

2

3

4

5

6

7

Integration of New Programs into School Health Activities

School Health Program and Services in Malaysia

• School Health Program Established in 1967 in partnership with MOE

School health service is a life course perspective wellness program under Family Health Program

Services in schools are being carried out by School Health Teams

• School Health Team

Doctor, Public Health Nurses, Assistant Medical Officer, Community Nurses and Medic Aid

Provide mobile health services to 10,159 primary and secondary schools

Role and function of each team member is defined by the School Health Service Standard Operating Procedure

• Performance target are being monitored and discussed at districts, states and national meetings on regular basis.

School Health Service Packages in 2006

Grade Service Package

Workload

(student

contact)

Pre school

Growth and development

250,000

Standard 1

Health Education, Health Appraisal, Vision screening, BMI

Monitoring and Immunization

500,000

Standard 6 Health Education, Health Appraisal, 500,000

Form 3

Health Education, Health Appraisal and Immunization

500,000

School Health Service Packages in 2016

Grade Service Package

Workload ( student

contact)

Pre school Growth and development 250,000

Standard 1 Health Education, Health Appraisal, Vision screening, BMI

Monitoring and Immunization 500,000

Standard 3 Assessment and diagnosis of Learning Disability (MOE Key

performance Indicator) 3,000

Standard 6 Health Education, Health Appraisal, Scoliosis Screening and

Adolescent Health screening 500,000

Form 1 HPV Immunisation (2010) 480,000

Form 3 Health Education, Health Appraisal, Color Defect screening,

Adolescent Health Screening and Immunisation 500,000

Form 4 Thalassaemia Carrier Screening ( 2016) ( screening) 900,000

(confirmation) 180,000

Adding New Program Into School Health Service

Additional new service introduction will not affect existing services performance

Implementation approval by Ministry of Education

Implementation will not interfere with school schedule

Voluntary participation

1

2

3

4

Guiding

Principles

Factors To Consider Before Integrating New Program Into School Health Activities

• School health infrastructure and resources Initial budget must include

implementation requirement resource mobilization

• New Program objectives and expected impact Long term/ short term Coverage

• Capacity building Introduction phase Updates

• Monitoring and evaluation

• Dealing with public expectation Health promotion campaigns Crisis management Demand for service

• Parental acceptance Confidence in new program Vaccine safety and efficacy

Vaccine combination ( HPV and Tetanus Toxoid)

• Will the new program effect students performance which cohort to choose from

• Compliance to schedule/ follow-up Completion within one schooling

period

“By failing to prepare, you are preparing to fail”

Benjamin Franklin