Cervical Cancer Elimination by 2030: Closing the gaps between policy and implementation in Indonesia

Prior to the COVID-19 pandemic an average of 50 Indonesian women were dying each day as a result of this a highly preventable disease. The Global Strategy to Accelerate the Elimination of Cervical Cancer as a Public Health Problem adopted by the World Health Assembly in 2020, called for urgent and bold action to scale up and sustain implementation of the evidence-based interventions for eliminating cervical cancer as a public health problem.

Dozens of countries in our region including Australia and Indonesia, have committed to achieving these WHO targets by 2030:

• 90% of girls will receive full HPV vaccination by the age of 15 years;
• 70% of women will be screened with a high-performance test by 35 years of age and again by 45 years of age;
• 90% of women identified with pre-cancer will be treated;
• and 90% of women diagnosed with cervical cancer will receive treatment appropriate to the cancer stage.

Australia’s progress towards cervical cancer elimination places us first in line to reach the WHO targets. This is the result of the Australia’s introduction of comprehensive national policy for cervical cancer control over two decades ago, and the successful implementation of this policy through free school-based HPV vaccination for adolescent girls and boys, and free screening for women.

The Nossal Institute for Global Health, in collaboration with the Centre for Reproductive Health at Gadjah Mada University, has assessed Indonesia’s progress towards cervical cancer elimination. The team has developed evidence-based, realistic recommendations for action to reduce the incidence and impact of cervical cancer in Indonesia. The policy brief: Recommendations on the implementation of Indonesia’s National Cervical Cancer Prevention and Control Policy, outlines four key objectives and the actions required to close the gaps between policy and implementation.

The proposed objectives and actions recommended have been shaped by the principles of: achieving equity in access to cervical cancer prevention and treatment; synchronisation of primary and secondary prevention efforts; consistency with Government of Indonesia structures and health system transformation; and alignment WHO targets and guidelines.

The four key objectives are to:

1. Enhance the effectiveness of primary prevention by increasing access to and uptake of free HPV vaccination for adolescent girls.
2. Enhance the effectiveness of secondary prevention by increasing access to and uptake of free cervical cancer screening for women.
3. Increase access to timely uptake of cryotherapy among women who test positive for pre-cancer.
4. Scale-up health promotion programs to support appropriate risk perception of cervical cancer and utilisation of prevention and treatment programs and services.

For more detail the specific actions required to realise these objectives please see the full policy brief in Indonesian or in English.

For additional details of the methodology used to assess the gaps between policy and implementation please contact Professor Linda Bennett.

Professor Linda Rae Bennett,  is a medical anthropologist who focuses on reproductive and sexual health and rights, gender based violence, and gendered health inequities. She is passionately committed to capacity building both in Australia and abroad.