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Situation Analysis Cervical & Breast Cancer prevention, screening, and management in Pakistan
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Purpose of the APW
The purpose of the APW is to assess the current situation and inform current efforts, potential and requirements for addressing women cancers (breast cancer & cervical cancer) in Pakistan (National APW).
Background
Following the launch of the Eastern Mediterranean Regional Cervical Cancer strategy by the WHO Regional Office in January 2023, Pakistan is considered one of the potential countries to lead its implementation within the region. The regional strategy is guided by the WHO Global strategy to accelerate the elimination of Cervical Cancer as a public health problem (2020) which puts forward three overarching goals:
- 90% of girls are fully vaccinated with the human papillomavirus (HPV) vaccine by 15 years of age;
- 70% of women are screened using a high-performance test by 35 years of age and again by 45 years of age;
- 90% of women with pre-cancer are treated, and 90% of women with invasive cancer are managed.
In order for a country to successfully reach these three goals, it is imperative to implement the response in three streams simultaneously as they offer opportunities to prevent death, as well as disability and avoidable suffering among these vulnerable women.
The current situation of cervical cancer prevention, detection, and treatment in Pakistan is dire: The country does not provide the HPV vaccine as part of the national immunization program, fewer than 1% of women have ever been screened, and there are no national cervical cancer management guidelines available.
Pakistan ranks 8th globally in mortality caused by breast cancer. In Asia, Pakistan has the highest rate of breast cancer as approximately 90,000 new cases are diagnosed annually, out of which 40,000 patients lose their lives. On average, at some stage in their life, 1 in 9 Pakistani women have the probability of discovering symptoms of breast cancer. According to a recent study, 77% of invasive breast cancer occurred in women above 50 years of age, but if diagnosed early the survival rates are 90%.
The World Health Organization (WHO) released a new Global Breast Cancer Initiative (GBCI) Framework providing a roadmap to attain the targets to save 2.5 million lives from breast cancer by 2040. The newly published framework leverages proven strategies to design country-specific, resource-appropriate, health systems for the delivery of breast-cancer care in low- and middle-income settings. It outlines three pillars of action with specific key performance indicators:
- Recommending countries to focus on breast cancer early-detection programmes so that at least 60% of the breast cancers are diagnosed and treated as early-stage disease.
- Diagnosing breast cancer within 60 days of initial presentation can improve breast cancer outcomes. Treatment should start within three months of first presentation.
- Managing breast cancer so that at least 80% of patients complete their recommended treatment.
Currently in Pakistan, efforts are being made to promote self-examination of breast through mass awareness raising and strengthening clinical diagnosis. However, there is no breast cancer registry and no national breast cancer management guidelines available.
As Pakistan prepares to integrate women cancers (cervical & breast cancers) into the routine women’s health interventions, an analysis of the current situation is necessary. Currently, the country has a limited overview of both supply and demand side factors, including barriers and enablers for interventions across the three streams. The situation analysis would support the implementation in six ways:
- Understanding the current scenario: Gather existing research and information to inform the current scenario of cervical & breast cancer in Pakistan, including incidence and mortality rates, access to healthcare, available resources and infrastructure, and perceptions regarding cervical & breast cancer among policy makers, healthcare workers and patients. The desk review will also consider research that provides information on the potential acceptance or resistance from policy makers and the general public to the intervention pillars of the two WHO global initiatives addressing cervical and breast cancer.
- Identifying strengths and weaknesses: Identify the strengths and weaknesses of the existing cervical & breast cancer programs, policies and strategies in place, which can be used to improve the implementation of the strategy.
- Stakeholder mapping: Map the stakeholders involved in cervical & breast cancer control, including the government, healthcare providers (public and private, international non-governmental organizations, non-governmental organizations, academia, and patient groups. This information can be used to develop effective partnerships for implementation.
- Resource assessment: Assess the availability of resources, such as human resources, financial resources, infrastructure, and equipment and supplies, which are necessary for implementation.
- Priority setting: Prioritize the interventions that need to be implemented, based on the available resources, the current scenario and burden of disease, and the strengths and weaknesses of the existing programs.
- Monitoring and evaluation: Provide a baseline for monitoring and evaluating the implementation of the WHO strategy and measuring its impact on cervical & breast cancer control in Pakistan. Exploring feasibility of adopting KPIs of the GBCI as well as indicators set out in the Regional Cervical Cancer Elimination Strategy for the EMR
Planned timelines (Tentative):
Start: 05 August 2023
Number of days: 30 working days spread over 10 weeks duration.
Geographical coverage (to be decided in consultation with the WCO and national authorities)
This situation analysis will be undertaken at both national and subnational level
Work to be performed
The firm aims conduct a desk review and key informant interviews towards achieving the following objectives:
- Assess the current situation of cervical & breast cancer burden and services in Pakistan, including both medical and social/non-medical factors.
- Explore the potential acceptance or resistance from policy makers and the general public to the intervention pillars of the strategy
- Identify the strengths and weaknesses of existing cervical & breast cancer services.
- List prioritized interventions and propose a roadmap for successful implementation of the cervical & breast cancer strategy, based on the above findings.
A multi-step process will be utilized to evaluate the current situation, provide an overview of strengths and weaknesses, and identify the prioritized interventions.
Deliverable 1: Inception report detailing the methodology, tools, workplan with timelines of undertaking the assignment (By week 01)
Deliverable 2: Develop and submit a report that analyses the collated information to identify trends, patterns, and gaps in cervical & breast cancer control efforts, as well as the weaknesses and strengths in the existing cervical & breast cancer programs in Pakistan at national and provincial levels (data to be segregated by national and all four provinces separately). (By Week 3-8)
o Literature review of the existing data including the existing cancer registries and information on cervical & breast cancer in Pakistan, including government reports, academic articles, research (published and unpublished) and international studies.
o Stakeholder mapping to assess the stakeholders’ relevance and influence for the implementation of the strategy. Stakeholders should be categorized based on province, and represent academia, professional societies, NGOs, IOs, and other partners.
o Identify demand side barrier and facilitators to improve utilization of cervical & breast cancer services.
o Review of existing implementation arrangements at supply side and identifying strengths and weaknesses.
o Results of key informant interviews to complement the findings of the literature review. The key informants are key stakeholders, including the government, healthcare providers (public & private sectors including laboratory personnel), non-government organizations, and patient groups.
o Priority actions needed to address cervical & breast cancer in Pakistan
This report will later be presented to and vetted with relevant stakeholders such as MoH and healthcare providers and the priority actions agreed upon.
Deliverable 3: Facilitate a national technical consultation with national and provincial level stakeholders to discuss the findings and finalize the report. (By week 9)
Deliverable 4: Final report including a proposed implementation roadmap that outlines proposed priority interventions based on the analysis building on the desk review, informant interviews, SWOT analysis, and stakeholder mapping, in addition to an assessment of existing potential (availability of resources, such as human resources, financial resources, demand side needs and equipment and supplies) for their adequacy for implementing the strategy. (By week 10)
Payment Schedule:
Payments will be made on received deliverables according to the following schedule:
- Completion and Submission of Deliverable 1 (25%)
- Completion and Submission of Deliverable 2 (25%)
- Completion and Submission of Deliverable 3 (25%)
- Completion and Submission of Deliverable 4 (25%)
Technical Supervision
- The selected APW will work on the supervision of Team Lead HPLC, WHO Pakistan
Specific requirements
Qualifications required for APW/firm:
- University Degree in Medical Sciences with preferably public health qualification.
Experience required:
- At least 7 years’ experience in gynaecological oncology including cervical & breast cancer.
- Experience in conducting similar assessment / reproductive health research.
Skills / Technical skills and knowledge:
- Very good knowledge and skills on cervical & breast cancer prevention, control and management.
- Skills in conducting similar assessments
Language requirements:
- English
- Working knowledge of Urdu to facilitate communication
Place of assignment
- Islamabad with a requirement for frequent domestic travel.
To Apply:
Interested applicants are required to submit a technical proposal with writing sample and work plan for the assignment deliverables along with updated CVs of team as well as financial proposal including realistic budget breakdown.
Do not apply online. The Proposals are required to be submitted in sealed envelopes on the following address with the title of assignment on envelope by 05th August 2023.
Address: c/o Team Lead HPLC, Promoting Health through the Life Course (Room No .6), WHO Country Office Pakistan, Park Road, Chak Shahzad, Islamabad-Pakistan
