Technological Development
At Movicancer we believe that technologies are a great ally to bring communities closer to health care and save lives. Although new techniques have been incorporated to improve cervical cancer screening in recent years, the incidence and mortality reduction goal for this type of cancer have not been achieved in the Americas.
This is partially explained, because of very few or none technological tools available to health professionals to evaluate objectively the performance of the national cervical cancer prevention program. This type of evaluation is decisive to adapt and provide health services according to women needs, including the detection of sickness in early stages and completition of low-cost treatment at the nearest health center. That’s why it is important to strengthening a quality culture where follow-up and “management monitoring” is going to let us recognize if efforts made at health services are sufficient or deficient.
One of the main challenges of Latin American countries is quality and information management for cervical cancer Control. In 2011, Central American countries pledged to improve records for evidence-based decision-making. Nicaragua has taken an important step in the scope of this commitment.
To meet this challenge, we have developed a specialized Surveillance System for Women Cancer Prevention (SIVIPCAN®), a software to record the different screening, diagnosis and treatment techniques applied to affected women. The primary health services goal is achieved when all identified patients manage to complete the appropriate treatment according to their needs. Moreover, the data obtained is used to follow-up women in the long term, as well as to monitor and evaluate the cancer control programs to continuously improve at local, regional and national levels.
SIVIPCAN® transcendence was key for a gradual reduction of incidence and mortality rates in recent years along with other Ministry of Health strategies. As a result, the Ministry of Health decided to adopt it progressively as a tool for “management” in the cervical and breast cancer control component throughout the country, achieving a substantial improvement in care and follow-up of positive cases. The most relevant aspect of this new model is to transcend the “surveillance” concept from cancer registration to “precursor events” of the disease, which is achieved when women are detected before they presents advanced symptoms. If we reach this paradigm shift, the reduction will be sustainable.
SIVIPCAN®, Innovation that saves lives
In Nicaragua, there is a estimated average of 1.600 new cervical cancer cases per year and approximately 600 die from this cause, being the main reason of death related to the sexual and reproductive health within women. In 2011, the crude incidence rate was 33.80 cases per 100.000 women according to estimates from the National Statistical Office of the Ministry of Health (MINSA). The goal of this specialized technology is to ensure doctors and nurses involved in the prevention of this type of cancer develop skills in planning, organization and monitoring of strategies used at local level in order to evaluate whether efforts accomplish the desired goals.
Our experience in Nicaragua was initially based as a pilot project in 5 health regions. Subsequently, in 2011 escalated to 84 health regions and by 2016 had already been implemented at national level in 153 health regions; And, from 2016, it cotinued escalating to 34 public hospitals. Although in the first 5 years (2007-2015) the amount new cases increased, from 2012 we began to experience a sustained decrement. In 2012-2016 the incidence of this cancer type has been reduced by more than 24% (look at the chart) and the mortality rate has gone from 26.1 to 14 per 100,000 women, in the same period.
The introduction of HPV test for early cervical cancer detection in 4 Local Regions for Integral Health Care (SILAIS) made it necessary to re-innovate SIVIPCAN®. The strategy involved removing all the screening, diagnosis and treatment formats used throughout the public and private health system, unifying them in “a single format” to be used nationwide.
This new format would merge different screening, diagnosis and treatment needs for cervical cancer prevention based on updated international guidelines (Bethesda 2014); and, the same form would be used to ensure women over 40 years were benefited from a clinical breast exam, at least once a year. This unified two comprehensive care services for women in a single consultation, which would increase opportunity for early detection of breast cancer, but also significantly reduced the printing costs existed when using different formats related to cervical cancer prevention. This new tool together with the training of health professionals in “management” of cancer control program in women, forced to revise the standards and indicators used in the past, and promoted change towards new measurable indicators but especially useful for making decisions in real time.
Due to the network availability of this new technology, it made necessary the decentralization of the register at each municipality level, in such a way that when the sample (HPV – Test or Cervical Cytology) arrived at Cytopathology Department in the Headings Department already data of each woman screened is already online in order to encourage rapid reading and reporting results; All this favored expectations of women from 3 months to less than 1 month in obtaining results from their exams, in case of HPV testing time was reduced to less than 15 days.
By encouraging the registration of all actions of attention to women, production of statistical data has been favored, as planners, administrators, statisticians and others have reliable information for decision-making to all levels.
National & International Recongnitions
2008
"Latin Excellence 2008" by the American Cancer Society.
2011
"Development of Nicaraguan Public Health" by the NIcaraguan Association of Publication of Public Health (ANSAP)
2011
Ranked among the three best innovations in the category of science and technology by Innovators of America®
2013
Special Recognition to Innovation by Regional Fund for Digital Innovation in Latin America and Caribbean (FRIDA - LACNIC)
2014
"Contribution to the National Human Development Plan (2012 - 2016)" by the NIcaraguan Council of Science and Technology
2017
Alianza Latina Award 2017. Use of data to improve cause understanding and assitance.
SIVIPCAN® 10 years of experience
A national cervical cancer control program can be successful if uses cost-effective screening techniques and, in addition, ensures proper follow-up and treatment for all women detected with pre-cancer lesions and early stage cancer. However, the success of these tasks will be based mainly on the strength of health care system to cover the people at risk which requires them to have a robust information system that facilitates the fulfillment of these tasks.
SIVIPCAN® has been internationally recognized for its potential to support the follow-up of affected women; As well as by the contribution of statistical data to support descriptive, analytical and evaluative interventions studies for cervical cancer reduction.
Today, most Latin American countries do not have well-designed information systems to monitor and evaluate the effectiveness of their programs. In this field Movicancer is a regional pioneer in technology development and has systematized the lessons learned in order to share experience that may be useful for initiatives that could develop in other Latin American countries, except for Brazil, Chile, Colombia, Costa Rica, Cuba and Argentina, who have been working from their health institutions in development of SIS for pathology control.
Movicancer’s work together with the Nicaraguan public health system has demonstrated the value of the “third sector” not only in supporting the less fortunate, but also contributing in the development of health system in order to make them more sustainable, adapting their prevention and promotion services.
SIVIPCAN® A future without cervical cancer
A recent report published by the International Union Against Cancer (UICC) on Cervical Cancer Control Policies in Latin America and the Caribbean, suggested that countries have identified the need for Systems Information as a priority to monitor and evaluate prevention programs for this type of neoplasm. Despite this, the report on Systems Information for Cervical Cancer Prevention Programs in Latin America and the Caribbean, published in 2016 by the network of National Cancer institutes and institutions (RINC-UNASUR), pointed that only 31% (6/19) of Latin American countries have a basic system for monitoring their prevention programs.
The Regional Plan for Integrated Actions for Cervical Cancer Elimination was then developed out of this need, which propose to design and implement generic software to establish a Latin American information system based in MOVICANCER’s experience with SIVIPCAN® in Nicaragua. This plan has been adopted as part of the synergies and coordination of efforts in the new PAHO initiative called: “Action Plan on Cervical Cancer Prevention and Control” of PAHO 2018-2030 at their 162 session, the Executive Committee of the Panamerican Health Organization (PAHO).
The goal will contribute to achieving WHO’s commitments with 25/25 Plan which involves reducing NCDs and cancer mortality by 25% by 2025 and its subsequent evaluation (33%) by 2030, according to the United Nations Sustainable Development Goals, assumed by the Latin American countries in 2015.
It is clear that in the last five years information systems have reached a greater relevance to improve the public health system and achieve effectiveness with efficiency, SIVIPCAN® is a clear example.