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GHF 2014 – PS01

10:45
12:15
PS01 TUESDAY, 15 APRIL 2014 ROOM: MOTTA ICON_Fishbowl
Public Hospitals Can Innovate Too!
MODERATORS:
Prof. Louis Loutan
Former head of the division of International and Humanitarian Medicine at the Geneva University Hospitals
Prof. Didier Pittet
Head of the infection control unit and president of the commission on innovation at the Geneva university Hospitals
SPEAKERS:
Prof. Brigitte Pittet
Chief of Division, Geneva University Hospitals, Switzerland
Prof. François Mach
Chief of Division, Geneva University Hospitals, Switzerland
Prof. Patrick Petignat
Chief of Division, Geneva University Hospitals, Switzerland
Ms. Anne Bourgeois
Physiotherapist, Geneva University Hospitals, Switzerland
Prof. François Chappuis
Chief of Division, Geneva University Hospitals, Switzerland
Dr. François Gilardoni
World Innovation Day, Innovation 4 Health, co-founder Special Advisor at Fongit Seed Invest, Switzerland
OUTLINE:
Public institutions often convey the image of being slow in responding to needs, plagued by inertia and leaving innovation to the private sector. This session will illustrate through numerous examples of projects implemented locally or abroad that innovation can be integrated in the overall strategy development of a public institution, such as a university hospital. It brings added value to the institution, strengthens its reputation, motivates its employees and retains them, it creates public value and a sense of satisfaction. Innovation can be built in at all levels of the institution and become a driving force. Partnerships with institutions abroad also play a significant role in developing and sharing new expertise, values and social responsibility.
PROFILES:

Prof. Louis LoutanProf. Louis Loutan

Louis is the founder of the Geneva Health Forum and has been its President since 2006. In this capacity Louis is responsible for providing strategic guidance to the initiative and ensures that it continues to enjoy wide institutional support.

Louis is Head of the Division of International and Humanitarian Medicine in the Department of Community Medicine and Primary Care and a practicing clinician at the Geneva University Hospitals in Geneva, Switzerland. He also serves the University of Geneva as Associate Professor in International and Humanitarian Medicine.

Louis is a specialist in internal medicine and tropical medicine. Louis has extensive field experience in Africa, Asia, North America and Eastern Europe. Louis is the former president of the Swiss Society of Tropical Medicine and Parasitology; President of the International Society of Travel Medicine (2001-2003). He serves on the boards of public and academic organisations that are committed to advancing the cause of global access to health.

ProfPittet(2-Black)Prof. Didier Pittet

Didier Pittet, MD, MS, is the Hospital Epidemiologist and the Director of the Infection Control Programme at the University of Geneva Hospitals and Clinics (2500 beds), Geneva, Switzerland; Professor of Medicine and Hospital Epidemiology at the University of Geneva; and Attending Physician in Adult and Paediatric Infectious Diseases, University of Geneva Hospitals. He is also Visiting Professor, Division of Investigative Sciences and School of Medicine, Imperial College London, London, UK. Professor Pittet serves on the editorial boards of the American Journal of Infection Control, the American Journal of Respiratory and Critical Care Medecine, The Lancet Infectious Diseases and Infection Control and Hospital Epidemiology. He is also an editorial consultant of the Lancet. Professor Pittet currently leads the First Global Patient Safety Challenge “Clean Care is Safer Care” of the WHO World Alliance for Patient Safety. He was awarded the CBE in 2007 by Her Majesty Queen Elisabeth II for services to the prevention of healthcare-associated infection in the UK. Current major research interests include the epidemiology and prevention of nosocomial infections, methods for improving compliance with hand hygiene practices, and methods for improving the quality of patient care and patient safety.

PS01_Brigitte_PittetProf. Brigitte Pittet

Prof. Brigitte Pittet est médecin-cheffe du service de Chirurgie plastique, reconstructive et esthétique des Hôpitaux Universitaires de Genève. Ses principaux domaines d’intérêt sont la reconstruction craniofaciale et la reconstruction mammaire ainsi que les techniques de microchirurgie. Prof. Pittet organise régulièrement des missions humanitaires chirurgicales dédiées au traitement des séquelles de noma. Elle a reçu plusieurs distinctions pour ses activités de recherche axées sur la cicatrisation des plaies.

PS01_Patrick PetignatProf. Patrick Petignat

Prof. Petignat and his research group have experience in running clinical trials and epidemiological studies in the field of cervical cancer and HPV. They are also involved in the development of screening policy and colposcopy practice for the Groupement Romand de la Société Suisse de Gynécologie Obstétrique (GRSSO). They have recently developed and published consensus
guideline for cervical cancer screening and management of cervical dysplasia for the Swiss French Part (available at www.GRSSGO.ch). Patrick Petignat is a co-founder of the Swiss Working Group for
Colposcopy and Cervical Pathology and is member of the WHO Steering Committee on Comprehensive Cervical Cancer Control (C4-GEP).

chappuis_photo_3Prof. François Chappuis

François Chappuis is physician specialized in internal and tropical medicine. He completed a master in clinical tropical medicine at Mahidol University, Bangkok and a PhD in medical sciences at the University of Antwerp. He currently heads the division of tropical and humanitarian medicine of the Geneva University Hospitals and has been medical adviser for neglected tropical diseases at Médecins sans Frontières since 1999. His clinical research activities focus on African and American trypanosomiasis, leishmaniasis and snake bites.

PS01_Francois.Gilardoni.SmallPicMr. François Gilardoni

Francois Gilardoni is a venture capitalist, innovation expert and award-winning scientist educated in Switzerland and the USA with nearly two decades of international experience in the high-tech and financial industries.  Building on the success of the first Innovation Day (ID) held in Geneva in 2007, in 2012 he partnered with Professor Didier, ID founder and world renowned specialist in patient safety, to foster a global culture of innovation in Medical and Healthcare Science by promoting Innovation Days around the world.  In 2013, they launched the World Innovation Day (WID) and the World Innovation Academy (WIA) global initiatives. Francois holds a PhD (cum laude) in Computational Chemistry, as well as advanced degrees in Environmental Science and Computing.  He is the founder of Global Advisory Services (GlobAS), a boutique firm providing non-discretionary investment advisory services to clients seeking to expand their private equity portfolio in the high-tech industry and to ventures raising capital (debt or equity).

PS01_Anne_Bourgeois_HUG_squareMs. Anne Bourgeois

Anne Bourgeois graduated as a physiotherapist in Geneva. After some time in the private sector, she joined the Geneva University Hospitals in 2002, where she worked in various departments, in acute care and rehabilitation services. She has extensive experience in numerous humanitarian projects providing care and training local staff as trainers (South of Marocco 2002, Haiti 2010 with Handicap International (HI) and MSF, Yemen with ICRC 2012-2013). She currently is involved in a training in rehabilitation project in Haiti with HI.

PS01_Francois_Mach_006Prof. François Mach

Prof. François Mach has extensive experience in the field of Cardiology particularly, with respect to the development and progression of atherosclerosis diseases. After obtaining his MD at the University of Geneva, he studied Internal Medicine and Cardiology at Geneva University Hospital. Then, he moved for post-doctoral fellowship in the laboratory of Professor Peter Libby, Brigham and Women’s Hospital, Boston (1995-1999). After his return in 2000, he became full Professor of Cardiology and Head of Cardiology at the Geneva University Hospital. From 2012, he is President of the Swiss Society of Cardiology. François Mach is author of more than 250 publications with high Impact Factor and during his career he has already obtained more than 5 million euros as research grants, all funded by the European Community.

Prof. Mach is the director of the Cardiology Laboratory at School of Medicine of the University of Geneva that offers a number of general facilities.

His research group developed animal models of atherosclerosis, acute myocardial infarction, chronic myocardial ischemia and ischemic stroke. Several knockout mice on inflammatory genes are available in the Cardiovascular Center. In the last 10 years, the group of Prof Mach substantially contributed to better clarify the inflammatory mechanisms underlying atherosclerosis and its acute dramatic complications, such myocardial infarction and ischemic stroke in both human cohort and animal studies. In addition, he contributed to the design and achievement of several clinical research, multi-center studies, as well as establishment of several cohorts of CVD patients

 

 

 

GHF2014 – PS19 – Improving Access to Essential Medicines

10:45
12:15
PS19 WEDNESDAY, 16 APRIL 2014 ROOM: MOTTA
ICON_Fishbowl
Improving Access to Essential Medicines
MODERATOR:
Dr. Gilles Forte
Department for Essential Medicines and Health Products, World Health Organization, Switzerland
SPEAKERS:
Strengthening Health Systems to Achieve Access to Essential Medicines
Ms. Alessandra Ferrario
Research Officer, Department of Social Policy, London School of Economics and Political Science, United Kingdom
Dr. Nicholas Banatvala
Noncommunicable Diseases and Mental Health Dept., World Health Organization, Switzerland
Dr. Nils Billo
International Union Against TB and Lung Disease, Switzerland
Ms. Maria Kathia Cárdenas
CRONICAS Centre, Universidad Peruana Cayetano Heredia, Lima, Peru
Dr. Julie Sarah Torode
Deputy CEO and Advocacy & Programmes Director, Union for International Cancer Control (UICC), Switzerland
Mr. Mario Ottiglio
Director, Public Affaires and Global Health Policy, International Federation of Pharmaceutical Manufacturers & Associations IFPMA, Switzerland
Ms. Margaret Ewen
Coordinator, Global Health Projects (Pricing), Health Action International (HAI), The Netherlands
OUTLINE:
This session at the Geneva Health Forum 2014 will aim to discuss the experience from different countries looking at barriers and facilitators to achieving the 80% target in different contexts and use this experience to see if lessons can be learnt on a global level and inform the implementation of concrete actions by different actors to reach this target. Following the presentation of country experiences different global actors will respond to the challenges presented as detail how they could see the problems being solved at what roles different stakeholders can play.
PROFILES:

PS19_Gilles_ForteDr. Gilles Forte

Dr. Gilles Forte is the Coordinator of the “Essential Medicines and Health Products Policy, Access and Use team” at WHO headquarters. He is also Secretariat of expert committees on selection and use of medicines and on drug dependence.

Dr. Forte leads the development of guidance and tools for improving and monitoring WHO Member States policy, governance, access and use of medicines and health products, including for NCDs. Prior to this, he coordinated WHO medicines policy work in the WHO African Region.

Dr. Forte oversaw WHO collaboration with Countries of Central and Eastern Europe while based in the EURO Office in Copenhagen. He was also Medicines Policy and Supply officer for the WHO emergency operations in the former Yugoslavia. He is one of the authors of the WHO Guidelines for Drug Donations and has developed a series of emergency medical kits including for NCDs. Dr Forte has extensive experience of the NGO sector, having worked with a number of aid agencies involved in development and humanitarian programmes in Africa and Eastern Europe.

Trained in hospital pharmacy and public health, Dr. Forte holds a doctorate in pharmacy and a Master’s degree in pharmacology and nutrition. He has also held senior posts in the French public health system and at the national centre for scientific research.

Alessandra_Ferrario3Ms. Alessandra Ferrario

Alessandra Ferrario is a Research Officer in health policy at London School of Economics. Her research focuses on access to medicines and non-communicable diseases. One of her current research projects looks at improving budget impact and cost-effectiveness of pharmaceutical products through the introduction of managed entry agreements (MEAs). Over the past two years she has been working with the World Health Organization on issues around availability, affordability and quality of medicines in the Republic of Moldova.

Alessandra is also studying the burden and management of diabetes, both from a health and economic perspective, as part of a multi-country study in low- and middle-income countries. In previous projects she has investigated the determinants of price and utilisation differences for prescription medicines across OECD countries and issues related to good governance for medicines in low and middle income countries. She holds an MSc in Health Policy, Planning and Financing (LSE/LSHTM), MSc in Epidemiology (Swiss Tropical and Public Health Institute, University of Basel) and BSc in Molecular Biology (University of Basel).

Nick Banatvala_squareDr. Nicholas Banatvala

Dr Nick Banatvala is currently Senior Adviser to the Assistant Director General (Noncommunicable Diseases and Mental Health) at WHO in Geneva. Current responsibilities include leading development of a global coordination mechanism for the prevention and control of  NCDs, spearheading a newly set up UN NCD Taskforce and leading WHO’s global training programme to build capacity on NCDs for senior policy makers in middle and low-income countries.

Prior to this, Nick was Head of Global Affairs at the Department of Health in England where he led the development and implementation of the UK Government's first-ever global health strategy, its strategy for working with WHO and DH’s bilateral engagement with emerging economies. Before that, he headed up DFID’s work on global health initiatives and scaling up health services. This included leading on the health inputs for the 2005 G8 Gleneagles communiqué. He has represented the UK on a number of international initiatives, including the Global Fund to Fight AIDS, TB and Malaria and GAVI. Prior to this, Nick worked for DFID on health programmes in Pakistan, Afghanistan and the Middle East. Nick has experience of the NGO sector, having worked with the UK aid agency Merlin on development and humanitarian programmes.

Nick trained in paediatrics and infectious diseases and then did public health and epidemiologic research in the UK and at CDC, Atlanta. Nick has also held senior posts in UK public health. Nick has sat on government, non-government and academic boards, as well as national and international committees. He has undertaken consultancies for a number of agencies including the World Bank.

PS19_Nils_BilloDr. Nils Billo

Dr. Nils E. Billo, MD, MPH was Executive Director of the International Union Against Tuberculosis and Lung Disease (The Union) from 1992 to June 2013.

Under the leadership of Dr. Billo, The Union has grown into a leading international health organisation, with more than 10,000 members and subscribers in 152 countries, and some 300 staff and consultants working from Paris and regional and country offices in 13 countries. The Union's mandate has expanded to include not only tuberculosis and lung disease, but also some of today's most vital interrelated public health issues, such as child lung health, HIV/AIDS, the pandemic of diseases caused by tobacco use and non-communicable diseases (NCDs).

Dr. Billo completed his medical training at the University of Basel, Switzerland and holds a Master's of Public Health from the University of California, Berkeley. He was a member of the Stop TB Coordinating Board and past president of the Forum of International Respiratory Societies (FIRS), which organised the 2010 Year of the Lung campaign. Before joining The Union, he was head of the Epidemiology Section of the Federal Office of Public Health in Switzerland.

Dr. Billo is currently working as Senior Consultant for The Union.

PS06_Maria Kathia CardenasMs. Maria Kathia Cárdenas

Maria Kathia Cárdenas, BA, MSc(c), is a Peruvian investigator at CRONICAS Center of Excellence in Chronic Diseases at Universidad Peruana Cayetano Heredia (UPCH). Maria Kathia graduated from Economics and studied a Master in Epidemiological Research at UPCH through a Fellowship supported by The National Heart, Lung and Blood Institute (NHLBI) . Prior to her move to CRONICAS, she worked in areas devoted to Economic Evaluation of Projects and Public Policy in Social Development at two larger economic and development Think Tanks in Peru: Centro de Investigación de la Universidad del Pacífico and Instituto de Estudios Peruanos. Her area of interest is Health economics applied to chronic diseases.

She is the co-investigator in a research that received a seed grant award from NHLBI on lifestyles and cost of hypertension and she managed a health-system study looking into overcoming barriers to access care and treatment for chronic non-communicable diseases in Peru funded by the Alliance for Health Policy and Systems Research, World Health Organization. Currently, she is in charge of the economic evaluation of a large study launching a salt substitute to reduce blood pressure at the population level supported by the NHLBI under The Global Alliance for Chronic Diseases.

PS19_Julie_TorodeDr. Julie Torode

Based in Geneva, Julie Torode is Deputy CEO and Advocacy & Programmes.

Director of the Union for International Cancer Control (UICC).

In addition to managing some of the UICC flagship publications such as the TNM classification series and the International Journal of Cancer, Dr Torode has been instrumental in developing and instigating the UICC road map spanning global advocacy and 5 lead programmes. Influencing policy at the highest level includes leading UICCs campaign ahead of the High Level Meeting on NCDs in 2011, as well as UICCs work as founding federation of the NCD Alliance and the women’s task force on NCDs and health with partner organizations from the NCD, HIV-AIDs and reproductive health space. Recent work includes establishing programme leads on the Global Access to Pain Relief Initiative and Cervical Cancer Initiative as well as a review of the UICC fellowships and training offer. Dr Torode leads UICCs strategic relationships with key partners IARC (Global Initiative on Cancer registry Development), IAEA (PACT partnership) and WHO (joint work plan as NGO in official relations) as well as UICC members active in international cancer control.

Prior to joining UICC, she spent the last 10 years in Germany working in the pharmaceutical industry including phase I-IV clinical research - with a particular focus on breast and ovarian cancers, professional relations management and working with patient groups in oncology. She has a special interest in cancer prevention and palliative care. Dr Torode holds a PhD in Organic chemistry from the University of Liverpool.

PS19_Mario_Ottiglio_squareMr. Mario Ottiglio

Mario Ottiglio is Director at the IFPMA where he has been working since 2007 in positions of increasing responsibility. Mario leads on global health policy, coordinates IFPMA Members’ policy positions and conveys them to government and UN Specialized Agencies officials.

Mario also heads IFPMA’s public affairs and communications efforts, developing partnerships and promoting active dialogue with key stakeholders from governments, multilateral organizations, and civil society.

Prior to joining the IFPMA, Mario worked as a consultant for both the private sector and governments. Mario holds an MA in Political Science from the Naples Eastern University and is an Italian national.

PS19_Margaret_Ewen_squareMs. Margaret Ewen

Margaret is a pharmacist working on medicine price, availability and affordability issues at Health Action International (HAI) in Amsterdam.

In partnership with the World Health Organization, a methodology manual for measuring medicine prices, availability, affordability and price components was first published in 2003 (with a second edition published in 2008). To date, Marg has led or assisted more than 100 medicine price and availability surveys in all regions of the world, and provided pricing policy advice to numerous national governments.

She is currently looking at prices and affordability of NCD medicines in some Middle Eastern countries, and developing a methodology to compare prices of locally produced and imported medicines. Prior to joining HAI, Marg was a senior advisor at the Medicines Regulatory Authority (Medsafe) in her home country of New Zealand.

Taps: A Challenge For Tobacco Companies And For Tobacco Control Advocates

Author(s) Shelly Himani1.
Affiliation(s) 1Individual, Shimla, Himachal Pradesh India, India.
Country - ies of focus India
Relevant to the conference tracks Advocacy and Communication
Summary Tobacco use in Himachal Pradesh (HP) India is prevalent mainly in rural areas. It is served to guests as a token of honour. Smoking at Public Places is reduced by community sensitisation, setting of effective enforcement mechanisms, raids & inspections for illegal tobacco, reporting of violations, and fines & punishments.
Selling of Gutka was banned in HP in July 2012. TAPS is a big challenge for both tobacco companies as well as for tobacco control advocates. Big events like IPL, international fairs & festivals are of great attraction to tobacco companies who use these opportunities for advertising. It is being addressed by imposing fine and punishment on violators followed by the above mentioned strategies. Almost all vendors removed tobacco promotional boards and display at POS.
Background HP is a state formed on 25 January 1971.
The economy of the Himachal Pradesh is currently the third fastest growing economy in India. Himachal Pradesh has been ranked fourth in the list of the highest per capita incomes of Indian states. It is the least urbanized state in India with nearly 90% of population living in rural area, but Shimla district is comparatively urbanized with nearly 25% population living in an urban area.
It has a total population of 6,856,509 including 3,473,892 males and 3,382,617 females .
Himachal Pradesh has one of the highest literacy rates in India next to Kerala. Tobacco consumption in Himachal Pradesh is prevalent mainly in rural areas. In some districts like Kinnaur tobacco is being served to guests as a token of honour. In rural and semi urban areas smoking is associated with tradition and culture.
Tobacco related diseases in Himachal Pradesh are increasing. To reduce disease burden, the root cause needs to be addressed on a priority basis. Prohibition of active smoking in public places and the effective implementation of smoke free laws and education are preferable solutions.
Objectives OBJECTIVE:
To analyze the trend in terms of tobacco use, disease burden, tobacco cessation, awareness level and enforcement level.
AIM:
To ensure effective implementation of smoke free laws at public places to reduce disease burden, to offer to help to current tobacco users, to prevent initiation of new users especially by children and to spread awareness up to Panchayat level. To provide solutions to threats and challenges in tobacco control drive.
TOBACCO USE AND DISEASE BURDEN IN HIMACHAL PRADESH:
The percentage of tobacco users in Himachal is high (21%) as compared to nearby states like Punjab (12%) and Chandigarh (14%).
The percentage of male tobacco users is 38.7% and that of female is 3.7%. The mean age of initiation of tobacco use in Himachal is 20.5 years. Himachal continues to report the maximum number of lung cancers cases followed by head and cervical cancer. The reason may be attributed to the trend of bidi smoking in rural areas.The most common type of cancer in Himachal is lung cancer. As per figures obtained from the Cancer Hospital IGMC Shimla it is found that 33% of the males are suffering from lung cancer in HP. The percentage of female cases is also high compared to other states. The reason is the tradition of smoking in rural areas, especially bidi by women.Head and neck Cancer is another common type of cancer observed in Himachal. 25% of the males and 6 % of the females are suffering from head and neck cancers in Himachal Pradesh.Oral cancer is not prevalent as the habit of chewing tobacco is not very common in Himachal. The percentage of oral cancers is 4-5-%.

Few cases of Kidney and Urinary bladder cancer have been reported at IGMC.
Considering tobacco is a major health hazard, Himachal Government has recently raised taxes on all tobacco products such as bidis and cigarettes.
As per information given by the Department of Psychiatry IGMC Shimla, every year approximately 400-500 new cases seek advice and opt for quit therapy.
Education raises awareness level and an increased number of tobacco users want to quit. According to information there is a rise in tobacco cessation cases by approximately 20% (2009-2012).
AMCT concept may be considered as a preventive tool. AMCT can be defined as awareness, motivation, counselling and treatment.

Methodology COTPA? What does it mean?
COPTA? We don’t know.
These words were quite common in Himachal Pradesh two years ago.
In 2011 a revolution was started by the community to address the tobacco related issues and smoke free laws.
Corporate, administration, political leaders, media and community joined hands and supported the drive against tobacco use with full enthusiasm and dedication.
The combined efforts resulted in increased awareness level, increase in effective implementation of smoke free laws followed by an increase in compliance.
A strong Anti TAPS Campaign and anti tobacco Campaign in Himachal Pradesh resulted in removal of the display of tobacco product accessories and promotional boards.
Community awareness on all sections of COTPA by various means and at various platforms especially in rural areas has raised the level of knowledge regarding hazards of tobacco consumption and passive smoking.
IEC was distributed in terms of folders brochures reports, CD’s to key stakeholders, law makers, law enforcers, implementers, administration and other concerned.
Nodal Officers appointed by various Departments are authorized to take corrective and sustainability measures and can penalize a violator within jurisdiction.
Discussion in Gram Sabha Meetings and Departmental meetings. Organisation of District Steering and Monitoring Committee Meetings.
Implementation and enforcement by issuing notices and warnings to violators.
More than 20,000 challans were collected in fines in Himachal during financial year 2012-2013 with a fine collection of more than Rs. 20 lakh.
Frequent raids under all sections of COTPA up to block level. There was a seizure of illegal gutka in large quantities. As a result of aggressive tobacco drive in Himachal by administration, community and volunteers, Public Place Managers are moving ahead and setting an example for the whole world and declaring their premises and public places within the jurisdiction as smoke free by signing a certificate/letter/Resolution.
Indorama is an industrial unit is absolutely smoke free and tobacco free since the foundation of the Unit.
Tobacco Control Campaign, sustainable measures, countering new strategies of Tobacco Companies needs to be prioritised to safeguard public health.
It is a continuous process and is a long drive. Tobacco control advocates needs to be very careful as a little negligence can ruin all efforts.
Results MAJOR ACHIEVEMENTS:
SMOKE FREE PUBLIC PLACES AND EFFECTIVE BAN ON TAPS
Corporate, Administration, Political Leaders, Media and Community joined hands and supported the noble drive against tobacco with full enthusiasm and dedication.
As a result of aggressive tobacco drive in Himachal by Administration, Community, Volunteers, Public Place Managers are moving ahead and setting an example for the whole world. The Public Place Managers have started declaring their premises and public places within jurisdiction as smoke free by signing a certificate/letter/Resolution.
In many industrial units like Torrent Pharma and Glenmark smoking is prohibited at work places, reducing the risk of second hand smoke. A unique example can be seen in District Solan where an industrial unit
Named Indorama is absolutely smoke free and tobacco free since the foundation of the Unit.
Recently almost all Districts of HP were declared as smoke free (under section 4 of COTPA). A Smoke Free Declaration Certificate was signed by respective Deputy Commissioners in the presence of officials, community and stakeholder thus setting an example for whole World. It is believed that declaration of smoke free districts with zeal to protect community from hazards of tobacco will reduce disease burden and will reduce tobacco consumption in Himachal.
Conclusion RECOMMENDATIONS BASED ON FINDINGS:
• Effective Implementation of Smoke Free Laws at Public Places
• Strong and Effective Enforcement Mechanism up to Panchayat level. Monitoring, Evaluation and Frequent raids especially at Tobacco seller shops to check pack warnings and illegal selling of gutka.
• Reporting of violations.
• Education, Information and distribution of resource material to community. Development and implementation of sustainable measures.
• A systematic Tobacco cessation consultation up to Panchayat level.
• A well equipped lab to check nicotine level in tobacco products at the district level. Fine and punishment for violations.
• It is suggested to start a 24 hrs Helpline to provide consultation at the village level as the problem persists in rural areas. Preferably toll free number.
• More TCC’s are being recommended, as in Himachal the number of TCC are less. Lesser number of centers and uneasy access to these centers by rural people may be considered a challenge.
• Early detection of disease is preventable. It is recommended that tobacco users should frequently seek Medical Advice and should opt for relevant tests.
• Good monitoring systems must track several indicators, including (i) prevalence of tobacco use; (ii) impact of policy interventions; and (iii) tobacco industry marketing, promotion and lobbying etc.
• Research and Development
• Anti Tobacco events on regular basis
• Live shows and talk shows and involvement of Media can have positive impact on tobacco users.
• Display of tobacco damage in visual form at educational institutes.
• Discussion and interaction with children in morning assemblies.
• Display of Do’s and Don’ts at notice boards of educational institutions.
• Findings and updates must be effectively disseminated so that administration and civil society can use them effectively.
• Frequent capacity building programmes for tobacco control advocates throughout world. Exposure to best strategies adopted by other countries/states can provide technical guidance to tackle tobacco menace.

Vaccination against Human Papillomavirus: Knowledge, attitudes, and beliefs of Medical Students in Sth Africa.

Author(s) Muhammad Hoque1, Sam Monokoane2, Guido Van Hal3.
Affiliation(s) 1Graduate School of Business and Leadership, University of KwaZulu-Natal, Durban, South Africa, 2Obstetrics and Gynaecology, University of Limpopo (Medunsa Campus), Pretoria, South Africa, 3Medical Sociology and Health Policy, University of Antwerp, Antwerp, Belgium.
Country - ies of focus South Africa
Relevant to the conference tracks Women and Children
Summary The majority of the medical students in South Africa intend to prescribe human papillomavirus vaccines even though they have little knowledge of the human papillomavirus vaccine.
Background In South Africa cervical cancer is one of the leading causes of death among women. Currently there are two vaccines available in South Africa. These vaccines are currently being considered for a national vaccination programme. A nationwide vaccination programme in South Africa will almost certainly make a significant difference in the cervical pre-cancer and cancer incidence in the future.
Objectives The purposes of the study are to investigate the knowledge, attitude and beliefs of medical students in South Africa concerning vaccination against the human papillomavirus.
Methodology This was a cross-sectional study conducted among 100 medical students using a self-administered questionnaire.
Results More than two-thirds (71%) of the respondents were aware of HPV and among them 81.2% mentioned vaccination against HPV. The majority (81.7%) were aware that persistent HPV infection is a necessary cause of cervical cancer. The fact that between 60 – 80% of cervical cancer incidents are caused by HPV types 16 and 18 is only known by 14.5% of the medical students. Overall, knowledge regarding HPV infection was low among the medical students as the average score was 3.23 (possible range was 0 to 9). The majority (87.7%) of the students reported that they have not received sufficient information regarding HPV infection. The majority of the students (72.9%) indicated that the vaccine should be given to girls before the onset of sexual activity. More than 90% of the students believe that physicians will support HPV vaccination and adolescents and young adults will accept HPV vaccination and 82.9% intend to recommend HPV vaccination if it is publicly funded. Overall, 86.7% of respondents intend to prescribe HPV vaccines.
Conclusion HPV vaccination is a relatively new concept for the primary prevention of cervical cancer. Overall, knowledge regarding HPV vaccination among the medical students is low, but there was a positive attitude towards it. There is a strong need to provide more education for medical students about the relationship of HPV infection and cervical cancer and the benefits of vaccinating adolescent girls to prevent cervical cancer in the future.

Human papillomavirus vaccination acceptability among university students in South Africa.

Author(s) Muhammad Hoque1, Shanaz Ghuman2, Guido Van Hal3.
Affiliation(s) 1Graduate School of Business and Leadership, University of KwaZulu-Natal, Durban, South Africa, 2Department of Community Health Studies, Durban University of Technology, Durban, South Africa, 32Medical Sociology and Health Policy, University of Antwerp, Antwerp, Belgium, 4.
Country - ies of focus South Africa
Relevant to the conference tracks Women and Children
Summary Very few students were aware of the link between HPV and cervical cancer. The majority were willing to accept HPV vaccination. University students needs to be educated regarding cervical cancer and effectiveness of HPV vaccine.
Background Cervical cancer is the second most common cancer after breast cancer in South Africa. Every year, over 3,000 women in South Africa die from cervical cancer. It is reported that 21.0% of women in the general population are estimated to harbor cervical HPV infection at any given time in South Africa. The incidence of cervical cancer is unacceptably high and most cases of invasive carcinoma present late with a high case-fatality. In South Africa the two vaccines (Gardasil® and Cervarix®) are registered but are not freely available. The effectiveness of vaccination programs against HPV will largely depend on how different population groups have been oriented.
Objectives The objectives of this present study are to assess the awareness of cervical cancer and its risk factors among female undergraduates in South Africa, and to determine the level of acceptability of HPV vaccination among these students.
Methodology This was a cross-sectional study which was conducted in March 2013 among 440 full time undergraduate female students using a self-administered anonymous questionnaire.
Results Results indicated that of those students who had never had sex (n=163), 96 (58.9%) hadn't heard of cervical cancer and only 12 students (12.5%) knew that HPV causes cervical cancer. More than a third (35.4%) of the students correctly stated that sexual intercourse before age of 18 years is a risk factor for cervical cancer and 55.2% of the students knew about Pap smear tests which is used for screening cervical cancer. The majority (77.3%) were willing to accept HPV vaccination. Results revealed that students who knew about the Pap smear test knew that having multiple sex partners, sexual intercourse before the age of 18 years, smoking and having contracted any STDs are risk factors for cervical cancer and were more likely to accept HPV vaccination compared to other groups.
Conclusion The general knowledge of South African female university students about cervical cancer is not sufficient but they have positive attitudes toward getting vaccinated against HPV.

Knowledge of and Attitudes to Cervical Cancer Screening among Cameroonian Healthcare Professionals

Author(s): D. Pirek*1, C. McCarey2, P. Petignat3, M. Boulvain4, P. Tebeu5, A. Doh6
Affiliation(s): 1Gynecology, Geneva University School of Medicine, Geneva 4, 2Gynecology, Geneva University School of Medicine, 3Gynecology, 4Obstetrics, Geneva University Hospitals, Geneva, Switzerland, 5Gynecology and Obstetrics, Yaounde University Faculty of Medicine, 6Gynecology and Obstetrics, Yaounde Gyneco-Obstetric and Pediatric Hospital, Yaounde, Cameroon
Keywords: Cameroon, health professionals, knowledge assessment, screening and prevention, HPV, cervical cancer.
Background:

The cervical cancer is the leading cause of cancer among the women in Cameroon, mainly due to the absence of systematic screening. The purpose of this study was to evaluate knowledge of and attitudes to cervical cancer among Cameroonian healthcare professionals who are best able to convey informations about risk factors, screening and prevention of cervical cancer.

Methods:

Anonymous questionnaire survey regarding cervical cancer epidemiology, its natural history, relation to HPV and the various screening methods available. Between 1 June and 30 June 2009, 850 questionnaires were distributed in Yaoundé, Cameroon.

Results/Conclusions:

401 questionnaires were collected (medical students (n = 71), nursing and midwifery students ( n = 38 ), general practitioners and pediatricians (n = 45), gynecologists (n = 13), nurses (n = 214) and midwives (n = 20)). The average age of the respondents was 37 years. Most of the healthcare professionals are aware that cervical cancer is a major public health concern (86%) about which the general public is ill-informed (75%). The vast majority (90%) believe that early screening helps prevent cervical cancer, but 59%of the women surveyed didn’t undergo regular (at least once every five years) gynecological examinations. The link between HPV and cervical cancer is understood (70%) as is the fact that HPV is sexually transmitted. Knowledge about the vaccine is still lacking, but most healthcare professionals (75%) would encourage young women to be vaccinated. Most healthcare professionals are aware of the causes of cervical cancer and are familiar with the screening methods. They will be important actors in the screening campaigns to be set up in the near future.

Prevalence of HPV Serotypes in High Grade Intraepithelial Cervico-Uterine Lesions in Cameroon: A Pilot Study

Author(s): Z. Sando*1, J. Pache2, A. Doh3, O. Folem3, L. Rubbia-Brandt2, T. Mc Kee4
Affiliation(s): 1Ministry of public health Yaounde-Cameroon, Gyneco-obstetric and paediatric hospital, Yaounde, Cameroon, 2Pathology, Hôpital Cantonal Universitaire, Geneva, Switzerland, 3Ministry of Public Health, Gynaeco-obstetric and paediatric hospital, Yaounde, Cameroon, 4Pathology, Gyneco-obstetric and paediatric hospital, Hôpital cantonal Universitaire, Switzerland
Keywords: Human papilloma virus, serotypes, Cervical cancer
Background:

Malignant lesions of the uterine cervix constitute a major public health problem in the world, especially in the developping countries.Human papilloma virus (HPV) was first associated to cervical cancer more than twenty years ago. There are about twenty serotypes of HPV implicated in the pathogenesis of cervical cancer. Variations are observed in the geographic distribution of these serotypes even in most area types 16 and 18 are to be found.In the absence of data from Cameroon on HPV types, we deem it great importance to carry out a study before the introduction of a vaccine into our immunization program.The main objective was to determine the prevalence of the serotypes of HPV in high grade intraepithelial lesions of the uterine cervix in Cameroon

Methods:

Recruitment of patients took place from 1st January to 31 st December 2008. Patients with routine conventional pap smear requested for check up, chowing high grade lesions were invited for sample collection. After accepting the consent form, the trained pathologist or gynaecologist carried out visual description of the cervix, and collects exo and endocervical samples. Collected samples were introduced into a transport medium (Thin prep sollution). The transport medium was sent to the service of Pathology, Hôpitaux universitaires de Genève for a control smear using monolayer technique and for determination of sample with oncogenic patential HPV, hybrid capture. Then sequencing of all types of HPV was done.

Results/Conclusions:

31 samples were transported, with 2 samples used as control. The 2 samples had no dysplasia on conventional smear, and on thin prep. Of the 29 remaining samples with high grade lesions, there was no HPV detected on one case. For the 28 samples, the HPV serotypes were detected with the following frequency: 36% for HPV 16, 32% for HPV 18, 8% for HPV 45, 4% for HPV 33, 4% for HPV 35, 4% for HPV 68. The association HPV 16, 45 was seen on 4% of cases and the association HPV 35,53,74 also in 4% of cases. HPV 16 and HPV 18 association was seen in 69,23% of cases. In conclusion, HPV serotypes 16 and 18 are predominantly detected in high grade lesions of the uterine cervix in Cameroon, their association are seen in 69,23% of case. The vaccines against those serotypes may be useful for population. There is also a variety of HPV serotypes, HPV 45 being among the other most frequent types.

GHF2008 – PS03 – Oncology: Only for the Rich?

Session Outline

Parallel session PS03, Tuesday, May 27 2008, 11:00-12:30, Room 16
Chair(s): André-Pascal Sappino, Head of Oncology Division, Department of Internal Medicine, University Hospitals of Geneva, Switzerland, Alexandre Bodmer, Chief Resident, Oncology Division, Department of Internal Medicine, University Hospitals of Geneva, Switzerland
Cancer in Developing Countries 
Paolo Hartmann, Medical Officer, Chronic Diseases and Health Promotion, WHO, Switzerland 
Cancer Control in Developing Countries: Meeting the Challenge
Ketayun Dinshaw, Director, Tata Memorial Centre, India
PACT: Using Radiotherapy as an Anchor to Build Self-Sustaining Cancer Cure and Care Capacity in Low and Middle Income Countries
Massoud Samiei, Programme Director, Programme for Action for Cancer Therapy, and Head of Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Austria 
The Role of the Global Community in Cancer Control 
Isabel Mortara, Executive Director, International Union against Cancer, Switzerland

Session Documents

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Session Report

Submitted by: Reem Ibrahim (ICVolunteers)

4 February is World Cancer Day. This year, the campaign poster focused on smoking: "I love my smoke-free childhood". Image: www.uicc.org

The global incidence of cancer is on a rise with over 10 million new cancer cases diagnosed per year. More than 6 million annual deaths are attributable to cancer with over 20 million people considered to be living cases of the disease. It is predicted that over the next 20 years, there will be an approximate 200% increase in death rates due to cancer in low-middle income countries. Although the global incidence in high income countries is also rising, the mortality rate is at a slight decline. It is the first time that cancer is on the agenda of this forum, and as the speeches illustrate, the global community has an important role to act upon cancer control.

Chair André-Pascal Sappino, Head of Oncology Division, Department of Internal Medicine, University Hospitals of Geneva, Switzerland & Alexandre Bodmer, Chief Resident, Oncology Division, Department of Internal Medicine, University Hospitals of Geneva, Switzerland opened the session with statistics reflecting the need to address cancer, the second-leading cause of death, at a global scale and raise awareness to the misconception that it is a disease of the rich.

Key points presented by Paulo Hartmann, Medical Officer of Chronic Diseases and Health Promotion at the WHO, Switzerland, include:

  1. Increased prevalence of cancer in developing countries
  2. The major role the WHO and Member states can play in prevention and control
  3. Complexity of cancer as a health problem that requires substantial human and financial resources and strong political commitments

Hartmann highlighted the problem of available and accurate data, especially in developing countries, where less-than-optimal infrastructures and limited human and financial resources pose constraints. Cancer and non-communicable diseases are replacing infectious diseases as the main cause of death, with an evident burden shift on low-middle income countries. Failure to immediately address these issues will increase the current number of cancer deaths from approximating to 7.6 million to at least 11.5 million by 2030.

Furthermore, the types of cancers dominating in developing countries differ from those in developed countries, raising greater need for knowledge sharing and development. Lung, breast and colon cancers have greater incidence in developed countries, in contrast to developing countries, where one fourth of all cancers are associated with chronic diseases (dominant cancers include liver cancer, linked to Heptatis B and cervical cancer, due to the pulmonary virus).

Isabel Mortara, Executive Director for the International Union against Cancer, Switzerland, underlined the fact that if current trends continue, there will be a 50% increase in death from cancer by 2020. Cancer differs in demographics and geographic regions, requiring different tailored approaches. There is significant importance in both the surveillance and collection of accumulated data. One must build on local expertise and knowledge, and the transfer of knowledge remains an essential global challenge.

Core concepts in cancer prevention include awareness, advocacy, scientific exchange and mobilisation, capacity building, and partnerships. The leadership of UICC in increasing cancer awareness is evident in its launch of the World Cancer Campaign on February 4th, 2006. Furthermore, it held a world summit in 2006, where 50 world leaders launched a call for action. A second summit is scheduled to take place in August 2008 to access progress and develop a new set of milestones.

Ketayun Dinshaw, Director at Tata Memorial Centre, drew upon cancer statistics in India to demonstrate the prevalence of cancer in a developing country. Approximately 2.5 million cases exist with over 70% being advanced t3-t4 diseases. It summons a clear objective: to downsize deadly cases. Moreover, goals of cancer care include:

  1. Decreasing mortality and lifestyle related cancers
  2. Decreasing morbidity and increasing quality of life
  3. Increasing the cost effectiveness of treatment (emphasizing effective resource utilization and innovative and adaptive technology)

The main issues governing health care professionals in developing countries entail resource constraints and limited access, accessibility to cost-effective protocols, applicability of evidence based solutions, and the ability to deliver acceptable levels of contemporary clinical care. The decisive factors for cancer treatment progress will include: prevention and screening, early detection, randomized clinical trails, multi-modality therapy, and translation research and novel drug developments.

A contributing factor to treatment success is efficacy versus cost for different treatment modalities. Radiotherapy is the most cost effective method of treatment in late stage presentation of disease. However, low-middle income countries have limited access. The high initial investments needed to setup radiotherapy facilities and demand for human resources hinder progress development and stipulate a call for action.

Program Director of Programme for Action for Cancer Therapy and Head of Department of Nuclear Sciences and Applications for the International Atomic Energy Agency in Austria, Massoud Samiei made the link in his presentation: "Cancer kills more than tuberculosis, AIDS and malaria put together" he pointed out, stressing the need for cost-effective modalities. He then went on to highlight key goals of IAEA:

  1. Introducing and expanding on radiotherapy infrastructure and capacity
  2. Promoting effective use of services
  3. Delivering adequate training and education

The objectives of IAEA are illustrated by the establishment of radiotherapy centres in Tanzania with various achievements:

  1. Effective and sustainable transfer of radiation technology
  2. Suitable, appropriate and affordable technology
  3. Compliance at national level with safety, security and quality standards

A clear discrepancy is apparent in cost-effective cancer treatment access between developing and industrialized nations. For example Switzerland has one radiotherapy machine per 100,000 persons, in comparision with Tanzania, which has one machine to cover a population of 20 million persons.

Management of Cervical Cancer in a Rural Hospital: Tanzania

Author(s): Charles Mbwanji1
Affiliation(s): 1Mbozi Mission Hospital, Mbozi, Tanzania
1st country of focus: Tanzania
Relevant to the conference theme: Non-communicable chronic diseases
Summary (max 100 words): Cancer is one of the chronic illnesses and one of them is cervical cancer. The management of this cancer illustrates disparities between the developing world and the developed world. The leading cancer in women worldwide is breast cancer but in the developing world is that of the cervix. The challenges include unavailabity of screening, late presentation due to awareness, lack or poor pathological backup for diagnosis, inadequate treatment facilities and prevention. Mbozi mission hospital (MMH) in Tanzania has followed up 92 cervical patients in the last three years and with MMH Hosea dispensary also in Mbozi, Tanzania  has screened 43 women for cervical cancer  since the beginning of this year.
Background (max 200 words): Cervical cancer has increasingly been seen at our facility with late presentation. Diagnosis has been delayed in most cases due to lack of pathological support andthe  treatment centre is sometimes far and costly for those who are referred. Palliative care at community level is also a problem and this study addresses all these issues.
Objectives (max 100 words): To look into the scale of cervical cancer in a rural poor area in a hospital with limited resources.
Methodology (max 400 words): The follow up of 92 patients was hospital based and the screening of 43 patients was done at both MMH and Hosea dispensary. Patients were seen at the facility where a history of symptoms and examination was obtained. Biopsy was taken for those who were eligible and were able to contribute cost sharing of Tshs 30,000/= for histology.  Some did not have the money to pay for histology.
Results (max 400 words): Late presentation was seen in 67 of patients and only 25 presented in the initial stages of the disease. Waiting time for histology results was a problem in that it sometimes took three months to get the results and the disease had progressed. Forty five patients progressed from early stages of the disease to late stages because of delay in getting histology results. The only hospital in the country for cancer treatment is in Dar es Salaam and patients had to pay for their fare. This was also a problem in that some patients did not have the fare and ended up with the option of palliative care. Palliative care was only possible at the health facility level and was mainly management of pain and also anaemia and sometimes antibiotics for infections which occur in the genitalia. Screening of patients for cervical cancer was by visual inspection and those who had suspicious lesions were advised to have a biopsy taken. Eleven had suspicious lesions but only five turned up for biopsy and four of them had chronic cervicitis and one had carcinoma insitu and the removal of the uterus was done surgically.
Conclusion (max 400 words): Cancer of the cervix is one of the chronic illnesses which can be prevented by, among others, vaccination which unfortunately is lacking in the rural areas of Tanzania. The issues are late presentation of the disease, lack of diagnostic tools including pathologists, cost sharing which to some is prohibitive, inadequate treatment centres and lastly palliative care mainly at home for those who are in terminal stage is lacking.

Cancer Prevention and Control Training Program: China

Author(s): Hao Liang1, CI Puwa1, Qiao Youlin2
Affiliation(s): 1Peking Union Medical College, Beijing, China, 2Cancer Institute/Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
1st country of focus: China
Relevant to the conference theme: Non-communicable chronic diseases
Summary: As the world’s largest and most rapidly developing country, China is suffering the burden of cancer. Recently the Chinese government has initiated large numbers of national programs on cancer prevention and control. With the help of the training courses program, the cancer registry system in China has been perfected so that the number of cancer registry sites have increased to 193 and the early cancer screening sites have increased to 97. This program provides knowledge and capability to cancer professionals on cancer prevention and control as well as conducting cancer research.
What challenges does your project address and why is it of importance?: Cancer constitutes a serious burden of disease worldwide and has become the second leading cause of death in China. Recently,the  government has realized the serious problem of the cancer burden and initiated a top-down program to provide free breast and cervical cancer screening for 10 million rural women in China as well as a national program for early detection and treatment for the 7 major cancers in China. Two challenges need to be addressed: 1) local health professionals are scarce due to limited academic training and continuing education. 2) the three-level cancer prevention networks which were built in the 1970’s collapsed in the 1990’s due to declining government subsidies for health care and workers’ health insurance, as well as budget deficiency. The statistics at the end of year 2002 showed that only 1/3 of the cancer networks remained and they performed cancer registry and limited work related to cancer prevention and control funded by research projects. Based on the reasons above, capacity building and cancer prevention and control network rebuilding in rural area of China are  a priority.
How have you addressed these challenges? Do you see a solution?: 1) Local health professionals are scarce due to limited academic training and continuing education. Solution: We develop a core training curriculum through a 1 week intensive and didactic training entitled “Cancer Prevention and Control Course”. 40-50 health professionals from cancer hospitals, universities, centers for disease control in 32 provinces are selected each year, and training and logistic are covered by grant. Also, “hands-on” training programs in national demonstration centers of early detection and early treatment for cancers of esophagus, cervix, stomach, colon, lung, liver, nasopharynx respectively are conducted. Hands-on trainings for cancer registry, pathology, cytology, operation approach of endoscope are also available. Specialists in China approved by Technical Expert Committee from MOH train the trainees.  2) Lack of a network for knowledge transform and information collection on cancer prevention. Solution: Trainees are assisted and required to spread what they have learnt to other local health professionals and the community, collect and communicate information of basic local information about cancer prevention.  The “Train the trainer” model has been established. 40-50 health professionals from in 32 provinces in China have been trained each year, and apply for grants to train 500-800 trainees from local cancer prevention systems in China.
How do you know whether you have made a difference?: 1) A network on cancer screening and the collaboration on cancer research has been established and improved. With train the trainer model, 625 health professionals in China have been trained in 2010, and 720 in 2011. They share experiences and learn from each other. More cooperation has been initiated. 2) The program spurred the cancer registry system to be improved in the past few years. In 2002, there were only 30 cancer registry sites. The number of cancer registry sites increased impressively from 2002 (30 sites) to 2010 (193 sites). With the help of the training courses, cancer registry system is equipped and the capability of basic cancer registry sites is improved. 3) Since “Cancer Prevention and Control Training Program in China” was developed in China, general professional ability and technique ability were improved dramatically. Thus the number of early detection and treatment sites in China has impressively increased from 13 to 97 since 2006. NPEDC (National Program for Early Detection of Cancers) started in 2006,and subsidized by the central government in screening, diagnosis and training for clinicians of local hospitals. Before the program developed, in 2006, there were only 5 NPEDC sites for cervical cancer and 13 NPEDC site for all of the cancers. That was because the abilities of medical professionals at basic-level hospitals were too poor to implement National Program for Early Detection of Cancers. Accompanied with the development of “Cancer Prevention and Control Training Program in China”, the number of NPEDC sites increased every year. By the end of 2011, there have been 97 NPEDC sites. In 2012, 107 sites will have the ability to implement NPEDC. Besides, early treatment rate of esophageal cancer increased from 70.7% to 73.3% from 2010 to 2011.
Have you or the project mobilized others and if so, who, why and how?: 1) Government: With the training programexpanding large numbers of health professions have been trained. Not only has it promoted government allocation of funds to establish more cancer registry sites and NPEDC sites, it also helps the government make policy on cancer prevention and control. 2) NGO: Leverage Cancer Foundation of China helps raise funds, motivate social power, and expand the influence of the training program.  3) Within the Health industry generally the following has occured: The capacity of health professionals (epidemiologist, doctors, pathologists, cytologists) on cancer prevention and control has been strengthened. Thanks to the training program, the early detection for cervical cancer has been changed from 93.9% to 95.3%, the early diagnosis rate for esophageal cancer increased from 70.7% to 73.3%, the capacity of health professionals and hospitals on cancer control have been impressively changed. The sites for early cancer detection have increased. The number of NPEDC sites increased impressively from 2006 (13 sites) to 2011 (107 sites)  The sites for cancer registry have increased. The number of cancer registry sites increased impressively from 2002 (30 sites) to 2010 (193 sites). An extensive network of domestic and international partners to support the training course has been leveraged, including: Specialists support: officials from the Ministry of Health in China, International specialists from WHO, IARC, UICC, NCI, AXIOS in France, and Italia are invited to give lectures and offered a forum for communication during the training course.  Resources support: Some medical companies (for example, BD/ Shenzhen Gold Way) support the equipment for local health providers. Local cancer hospitals or universities provided academic, equipment and administrative support when developing the training program. The Journal of China Cancer offered a column to report the training program and expand the impact of the training program.
When your donor funding runs out how will your idea continue to live?: We have obtained the National Key Technology Research and Development Program of China during the “12th Five-Year Plan” in 2010 with the topic of cancer prevention and control in rural areas of China. Skill and capacity building in rural area in China is one aspect. The program will continue under a new national fund. We hope the training program will be the model for the whole country and be transferred into policy, which will enhance the capacity building of cancer prevention and control in rural areas in China. Currently, the grant has been posted publicly, but the funding has not been confirmed. The progress and the result of this training program will influence the policy makers (MOH) to persuade the government to include this project into its public health agenda.