1

• Improving RH status of Vlora Women through
  Promotion of Cervical Cancer Prevention
• and
• Improving coverage of cervical cancer screening
  in Vlora district through information, education,
  and communication efforts designed for women

2
Some data on Albania
Indicators Year Estimate Source
Total Population ( millions) 2001 3.145 UNPOP
Population aged 15-49 ( millions) 2001 1.692 UNPOP
of urban population 2000 42 UNPOP
Crude birth rate per 1000 pop 1995-2000 21 UNPOP
Crude death rate per 1000 pop 1995-2000 5 UNPOP
Maternal mortality rate per 100 000 live births 2000 18.0 IPH and MoH
Life expectancy at birth 1995-2000 74 UNPOP
Total fertility rate 2000 2.4 MoH
Infant mortality rate per 1000 live births 2000 28 IPH and MoH
Under 5 mortality rate per 1000 live births 2000 33 IPH and MoH
Abortion per 100 live births 2000 34.9 MoH
CPR 2000 11.8 MoH
3
Sexually transmitted infectionsSyphilis and
Gonorrhea

• Cases of Syphilis and Gonorrhea

1990 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
Syphilis - - - - 3 3 17 36 30 14 20
Gonorrhea 130 98 14 52 20 11 7 5 11 na na
4
Albania is aligned in the countries with the
lowest prevalence of HIV/AIDS despite the
tendency of the growth in recent years. The
percentage of infected population less than 0,1.
But increasing rates of infection, however, are
disturbing, especially considering the fact that
the number of infected persons in 2001 was five
times more than the figures reported in
1999.HIV/AIDS cases
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 - June 2003 Total
HIV 2 9 12 7 3 5 4 10 20 35 107
AIDS - 1 4 3 2 1 - 4 - 21 36
5

• The estimated population of the Vlora district,
  including urban rural areas, is approximately
  173,259 people.
• Twenty eight percent (28) are women in
  reproductive age (i.e. 15 - 49 years of age), 15
  of population are women age 35-59.
• This means that at least 26,162 women in Vlora
  district are at risk of development of the
  cervical cancer (INSTAT, 1998).
• Public health services in Albania, except the
  Hospital of Obstetrics and Gynecology in Tirana,
  do not provide Pap smear testing. Few private
  clinics offer such services in change of a very
  high price i.e. 30 USD.

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• 51 of the Albanian population are women (INSTAT
  1998) and according to the LSMS (Living Standards
  Measurement Survey 2002), unemployment rate is
  close to 10 ( based on the standard ILO
  definition for employment), but the figure hide
  wide underemployment in rural areas
• The national unemployment rate virtually doubles
  if we include among the unemployed the portion of
  underemployed agricultural workers who reported
  working few hours a week.
• Gender disparities are observed in the labor
  market. According to the LSMS the share of women
  holding full time jobs is much lower, with only
  one woman in five reporting to work full time
  (one in two among men). Also, womens labor
  force participation is only about two thirds that
  of mens.

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• While the numbers of the reported cases of HIV
  positive are relatively low, prevalence of
  sexually transmitted disease has been estimated
  at 5 of the adult population, and is increasing
  each year.
• Health care providers demonstrate a low level of
  knowledge and skills in many areas of
  reproductive health care including genital
  cancer prevention and Pap smear testing is viewed
  mainly as a diagnostic tool.

8

• Vlora is chosen as the place for the intervention
  because
• It is one of the biggest districts of Albania
• It is a coastal districts with a high level of
  irregular emigration, center of trafficking with
  considerable number of illegal brothels, and the
  population is at high risk of the STIs
• The public health structures of this district are
  not offering any kind of cervical cancer
  prevention services
• AFPA has a existent service center in this
  district, which offers superior sustainability
  premises.
• It was evident that there was a significant lack
  of information with regard to the cervical cancer
  prevention among women. Efforts from the public
  health workers and other health bodies were
  missing.

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Description of InterventionIEC ACTIVITIES

• IEC materials leaflet and poster on cervical
  cancer prevention
• TV programs
• Educational activities (workshops) with women
  aged 35-60
• Workshops with the health care professionals
  working in the public primary health care centers
  of Vlora district

10

• Awareness meetings with abused and trafficked
  women (women at risk) cooperation with the
  Shelter Center for trafficked women located in
  Vlora
• Workshops with student of nursing Faculty
• Spot publicity
• Educational activities (workshops) with rural
  women aged 35-60

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ADVOCACY

• Two round tables one in Tirana and the other in
  Vlora city will be organized in the framework of
  the second project.
• In these meetings will participate
  representatives of
• Central and Local government,
• Health Sector from both levels,
• local NGOs,
• AFPA staff and activists etc.
• Media will be used for advocating the need for
  intervention for cervical cancer prevention
  programs. The results of the Cervical Cancer
  prevention projects implemented by APFA, women
  opinions, live stories and staff experiences will
  be used for this purpose.

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SERVICES

• Pap smear testing has started to be offered by
  Vlora Women Center since July 2002
• The information system has been adopted in order
  to meet the requirement of the Pap smear
  screening like
• Client records
• Cytological examination form
• A simple registry
• Personal Cards

13
Results

• Access for Pap smear testing is increased in the
  district of Vlora for women pertaining to
  different social strata. The AFPA policy for
  offering the service free of charge for women who
  can not afford has created access for poor women.
• As a result of promoting the benefits of cervical
  cancer prevention information and services the
  clients demand has increased.

14

• More than 2000 copies of the leaflet on Pap smear
  testing and 1000 copies of poster are
  disseminated to women in the district of Vlora
  providing them with a with a simple and very
  useful information on the cervical cancer
  prevention.
• The TV programs revealed to be very successful in
  informing the community on the relevance of the
  pap smear testing. This was showed also by the
  high number of the phone calls during the
  programs.

15

• 3300 women have been consulted on RH issues and
  especially on cervical cancer prevention during
  the project period and out of them 1360 have done
  a pap smear test.
• Workshops organized with women and health care
  providers raised awareness on the cervical cancer
  risk and Pap test procedure. The increased
  percentage of health workers who refer women for
  screening is an indicator of such a raised
  awareness.
• 528 is the number of direct beneficiaries from
  the Pap test workshops( only during the first
  project), but the impact of the workshop is wider
  to the families they belong and to the community
  serve.

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• The increased percentage of women with a positive
  attitude towards screening services is another
  indicator of the effectiveness of the awareness
  activities organized in the framework of this
  project
• Local staff capacities are empowered and this
  will have a long lasting impact. The experience
  gained by the staff during this period will
  create a higher potential for managing similar
  projects in the future
• All the activities of the project have empowered
  the links with the Local Government and community

17
Lessons learned

• Building strong relationships with communities
  which profit from our work is an important factor
  that influence the successful implementation of
  the activities, fulfillment of the organization
  mission and mobilization of local resources
• Strengthening of the collaboration with the
  governmental structures is very important to
  ensure sustainability for services and activities
  and having a higer impact
• Maintaining and improving the quality of services
  is one of the main factors influencing in the
  frequentation of the service centers

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• One of the main lessons learnt by women
  frequenting the Women Center is the strait
  connection existing between social conditions and
  reproductive health and the importance of having
  access to integrated social and health services
• AFPA staff involved in the implementation of the
  project activities has learnt to organize in an
  effective way the activities aiming to have a
  long lasting impact.

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• It is important to find the right approach and
  the right language that is meaningful to
  different parts of the community in order to
  increase the impact
• Involving young people in sexual and
  reproductive health programs aiming at rising
  awareness on preventive health measures has a
  crucial importance for improving the SRH of the
  population
• Ensuring a positive environment for preventing
  genital cancers requires sensitive attitudes,
  policies and legislation at family, community and
  national levels.

20
Acknowledgements

• Alliance of the Cervical Cancer Prevention and
  PATH
• Open Society Foundation Albania
• Directory of Primary Health Care service
  provider working nearby primary health care
  centers in Vlora
• Staff working for the Program implementation
• Especially to all the women that have been very
  receptive regarding all the program activities as
  well as to all the community leaders and Vlora
  Women Center volunteers that have strongly
  contributed in the successful realization of the
  activities