ANALYSIS OF POST INTRODUCTION EVALUATION OF HPV VACCINE PROGRAM FOR CERVICAL CANCER PREVENTION IN INDONESIA
Keywords:Cervical Cancer, HPV, Immunization, Post Introduction Evaluation
Background: In Indonesia, cervical cancer is the second most frequent type of cancer among women. As a primary prevention for cervical cancer, Ministry of Health in cooperation with GAVI and local government introduced HPV vaccine under The Demonstration Program of HPV immunization for female students grade 5 and 6 since 2016 in DKI Jakarta, Surabaya, and 2 districts in Yogyakarta. The aim of this study was to identify positive findings and address challenges of the HPV immunization program. Subjects and Methods: Post introduction evaluation (PIE) was conducted using WHO standardized tools for New Vaccine PIE Tool adapted for Indonesia context in Jakarta Province, Yogyakarta Province, and East Java Province. Evaluation was carried out at all levels of the health system in national, provincial, district, and health facility levels and include all key stakeholders and at all sectors including health, education, religious affairs and community. The study used purposeful sampling to provide a representative sample, consisting 6 districts in 3 provinces were selected for the evaluation. Data collection consisted of three parts: 1) desk review of planning and monitoring documents, 2) observation at vaccination session at schools (wherever vaccination ongoing), vaccines cold & dry storage, and waste management facilities, 3) interviews with key stakeholders, including officers at all levels of health system, girls, teachers, community leaders, and caregivers using standard questionnaires. All the information and data were compiled, analysed and consolidated through meeting. Results: The main best practices are: 1) HPV vaccine are well accepted; 2) Introduction was well integrated and perceived to have improved school health program; 3) Coverage was very high; 4) Good cold chain, injection safety, and waste management practices. The challenges are: 1) Inconsistent engagement with religious leaders and MORA; 2) Multiple gaps in policies, resulting in girls missing vaccination; 3) Errors in data quality; 4) Insufficient socialization to manage and respond to rumor. Conclusion: HPV immunization program are well accepted, but for better implementation in the future, the recommendations are: 1) Consider revising national HPV vaccination policy to include vaccination of girls not in school, and clarify policy on girls missing vaccination in Class 5; 2) Engage religious leaders and MORA in planning process and development of key messages to address rumors about halal/haram; 3) Increase socialization for teachers/health workers/community leaders on responding to rumors; 4) Reinforce guidance on enumerating target population and calculating coverage.