TECHNICAL SERVICES CONTRACT : Community Awareness on Cervical Cancer Prevention

TECHNICAL SERVICES CONTRACT

SCOPE OF WORK

Background

Indonesia is making critical progress towards cervical cancer prevention. The Government of Indonesia has demonstrated strong political commitment with the recent 2023 launch of the National Cervical Cancer Elimination Plan and National Action Plan for Cancer. These initiatives underscore the urgency of addressing cervical cancer, which remains a significant public health challenge in Indonesia as the second cause of cancer death among women, and with almost double the mortality rate as the world average.

Recently, at the Global Cervical Cancer Elimination Forum in Cartagena, the Indonesian government made a key commitment to elimination and highlighted the four pillars of the action plan for cervical cancer elimination: service delivery, education training and outreach, key enablers of progress, and governance and policy, as well as the following focal areas:

• Scaling Up Screening: Expanding access to HPV DNA-based cervical cancer screening services across regions and communities.
• Vaccination Programs: Strengthening and scaling HPV vaccination programs to prevent new infections.
• Treatment and Palliative Care: Ensuring timely treatment for precancers and cancers, and palliative care for affected women.

With specific regard to scale up of screening, Indonesia’s national cervical cancer elimination plan calls for “phasing scale-up of screening from opportunistic to population-based screening and also notes the need to “consider…alternative strategies, such as point-of-care screening and self-sampling methods.^[1]“

Indonesia’s Ministry of Health is currently piloting introduction of HPV DNA testing in Jakarta to make use of existing open system lab infrastructure established during the COVID-19 pandemic.  As the government moves towards operationalization of its national cervical cancer elimination plan, with ambitious coverage targets, it will be important to have sufficient evidence on multiple screening approaches to determine how best to support population-based coverage with quality testing in the various geographic contexts of the country.

Context

Jhpiego is working to strengthen primary health care (PHC) in Indonesia with support from the US Government under the MOMENTUM Country and Global Leadership (MCGL) program, which includes a strong implementation research agenda for designing, incubating and testing innovative solutions to address some of the key barriers that impede the delivery of PHC in Indonesia, and uses research results to inform the Ministry of Health (MoH) regarding refinements to the overall design of the national PHC model.  As it will take a strong focus on PHC and community to achieve effective coverage of cervical cancer screening, Jhpiego proposes to incorporate an additional implementation research under the MCGL/PHC umbrella to design, implement, and evaluate effective cervical cancer  education, screening, treatment and referral pathways, aligned with the objectives and strategies of the national cervical cancer elimination plan.

In collaboration with Roche Diagnostics and Biofarma, Jhpiego aims to support Indonesia to accelerate progress toward their 90:75:90 targets for cervical cancer elimination. Our partnership is guided by a global Memorandum of Understanding (MOU) that emphasizes evidence-based approaches and knowledge sharing across countries to support WHO women’s cancer targets.

Jhpiego, in consultation with stakeholders, has developed a learning agenda, which focuses on answering critical questions related to optimal service delivery and scalable programming approaches for secondary prevention of cervical cancer through HPV DNA-based screening programs. We recognize that real-world settings present unique challenges, and our research aims to build an evidence base for effective interventions.  We also aim to generate additional evidence for alternative screening approaches for consideration by the MoH in effective and efficient national scale up, understanding that different geographical contexts may call for different tactics.

With the support of the MoH, we have designed a concept for the following demonstration and implementation research concept.

Objectives

The focus of this project is to demonstrate and test effective HPV testing introduction and treatment service delivery pathways to prevent cervical cancer, evaluating such questions as:

• How do we effectively and efficiently increase access and coverage for cervical cancer screening with HPV testing through different strategies, including self-sampled collection, hub and spoke models and centralized laboratory testing?
• What are effective strategies for ensuring the most efficient workflow and testing processes, including centralization and automation of HPV DNA testing with high throughput testing in urban areas?
• What are effective approaches to educate and mobilize communities around the issue of cervical cancer and the importance of prevention and screening?
• What are appropriate HPV testing and treatment models to ensure equity and population-based coverage in a district setting?
• How can we best ensure flow of information between/among facilities and women who come for testing so that no woman is lost to follow-up and there is continuity of care?

It is expected that this project will add to the MoH’s evidence base on cervical cancer HPV DNA-based screening approaches and provide the MoH with the relevant information needed to make decisions about in what geographic context particular screening approaches may be more effective/efficient.  The project will include implementation of high volume and low volume testing in two different districts as a means of demonstrating feasibility of volume-based approaches within specified geographies.  As part of project evaluation, Jhpiego will implement the WHO Cervical Cancer Prevention and Control Costing Tool to explore the feasibility and role of high and low volume solutions at scale for the healthcare system.  Jhpiego will also consider conducting a diagnostic network optimization assessment to identify opportunities to maximize and expedite scale-up of desired screening solutions.

As part of this project, Jhpiego will support the MoH to develop a costed operational plan as a complement to the national cervical cancer elimination plan, reviewing all local screening/treatment evidence generated to date and determining screening and treatment approaches (low volume, high volume, other), implementation timelines and budget considerations for all provinces in the country.

Jhpiego will provide technical assistance to build the capacity of providers and community health workers of 2 puskesmas, 2 pustu and 27 posyandu (20 posyandu associated with one pustu in Surabaya City and 7 posyandu associated with one pustu in Sidoarjo) to provide education, counseling, screening, triage and treatment services, aligned to the relevant level of care. These are facility networks which are being strengthened under MCGL in partnership with the Surabaya and Sidoarjo DHOs for improved quality and continuum of PHC care and thus already have a relationship with Jhpiego.

The project will ensure effective integration of communication strategies and population-based screening services within the newly strengthened PHC system of Indonesia, for sustainability and effectiveness.

The project will work in close partnership with the MoH at the national level through appropriate institutional working groups to ensure that learnings from this demonstration are informing the national elimination strategy of the Government of Indonesia.  Jhpiego will work with the MoH to design and implement dissemination efforts.

Indicative Design and Activities

We propose a 15-month program, with a screening target of 5,500 women in the urban setting (Surabaya) and 1,300 women in the rural setting (Sidoarjo), representing 75% coverage of women aged 30-69 in the targeted facilities’ catchment areas.  Please note that 15 months is an estimated figure to reach these two targets and that these may be achieved sooner depending on demand for screening services.

In partnership with MoH, DHOs, laboratories, and PHC facilities, Jhpiego will generate evidence and program learnings via implementation research on the effective approaches to mobilize women for cervical cancer screening (including a self-sampling approach), strengthen capacity of providers to support women with quality cervical cancer screening and treatment services, use both high volume and low volume lab models for HPV testing, establish a strengthened treatment pathway with ablative treatment for precancerous lesions, and provide timely and responsive referral.

To create community awareness on cervical cancer prevention, USAID MOMENTUM will work with a local  CSO through a technical service contract  to work closely with the community and oncologist practitioners to inform development of a communication strategy, including identification of community-relevant messaging and communication platforms, and supporting materials.  The work will include the development of  EIC  materials and Behavior Change Communication (BCC) strategy, train caders on how to deliver key messages to community regarding cervical cancer and increase community awareness on cervical cancer prevention.

Scope of Work:

• Work with targeted communities to understand their perceptions of cervical cancer, prevention efforts and self-sampling to identify languages and messaging that will be appropriate and effective for building demand for HPV DNA testing and subsequent treatment for those women testing HPV+
• Develop BCC strategy for community regarding cervical cancer prevention to improve screening and treatment.
• Develop and print EIC materials to increase awareness and educate  women and community on cervical cancer prevention and treatment
• Conduct kader training to to deliver key messages to community regarding cervical cancer prevention
• Roll out campaign on cervical cancer prevention in the community led by caders (or Support caders in the campaign on cervical cancer prevention in the community)

Deliverables:

1. EIC materials, poster, leaflet and/or short movie, reels,
2. BCC strategy for cervical cancer prevention document
3. Training on interpersonal communication for kaders on cervical cancer prevention (on how to deliver key message of sensitive issue)
4. Awareness sessions in community led by kaders

Work process:

1. Discuss with relevant stakeholders and target clients regarding cervical cancer current situation and how to increase screening and the support needed
2. Draft report on BCC strategy for cervical cancer prevention in community.
3. Develop draft of EIC materials
4. Train caders
5. Support implementation of SBCC strategy

 Timeline

CONDUCT OF THE WORK

• During the contract, the consultant will report directly to the Senior Technical Specialist, CECAP
• Consultation And Approval Required with Roche and USAID for This Product

CONSULTANT SPECIFICATIONS/QUALIFICATIONS

1. Local CSO’s based in East Java province
2. Supported by Health professional (POGI, HOGI)
3. Proven specific activities for cervical cancer prevention program in East Java province
4. EIC material cervical cancer related product and team to develop EIC material

Timeline

Submission Requirements

Proposal and Company profile. Required information for the proposal:

• The proposal should include
  • an introduction section
  • BCC strategy for cervical cancer prevention
  • A sample/replica/dummy/ Sketch (e-file) of EIC materials, such as posters, leaflets, and/or short movies or reels.
  • a method section on delivery of training of cadres and the community awareness activities
  • a detailed activity and timeline
  • personnel, and a proposed budget.
• Information on budget line items e.g., for the staff who will be involved in the work (daily rates) etc.

Submissions should be no later than  January 10, 2025

Please send to Contract Committee, Jhpiego Corporation, Email: ID-Contracts@jhpiego.org

[1] National Cervical Cancer Elimination Plan for Indonesia, 2023-2030