2012 Annual Report - Pink Ribbon | Red Ribbon

2012 Annual Report
Partnering for Progress and Purpose
Foreword from President George W. Bush
Cervical cancer and breast cancer threaten the lives of women around the
world. These cancers take a particularly devastating toll on women in low- and
middle-income countries, and they are the leading causes of cancer deaths in
sub-Saharan Africa. Controlling these cancers is a global challenge — a challenge
that Pink Ribbon Red Ribbon is tackling head-on. I am proud that the George
W. Bush Institute is a member of this partnership.
Laura and I believe that every human life is precious. We believe that of those
to whom much is given, much is required. So America launched the President’s
Emergency Plan for AIDS Relief (PEPFAR) in 2003 to combat the HIV/AIDS crisis
ravaging the continent of Africa. Today, millions live who would have perished.
But it is not acceptable to save a woman from AIDS and leave her to die from
cancer. Through Pink Ribbon Red Ribbon, we are leveraging the PEPFAR platform to save women living with HIV from preventable and treatable cancers.
In 2011 and 2012, Laura and I visited Africa to launch Pink Ribbon Red Ribbon
in Zambia and Botswana. Over the past year and half, we have already seen
steady progress. Thanks to strong local leaders and our Pink Ribbon Red Ribbon
partners, we are saving women’s lives.
We are proud of our results, but there’s more work to do. Laura and I look forward
to continuing to work with our partners to stem the tide of cervical and breast
cancer so that more women can lead long, healthy, productive lives. Thank you.
President George W. Bush
Dallas, Texas
April 2013
Contents
Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
Results Matter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Lessons Learned . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Looking ahead to 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Appendix A: PRRR Steering Committee and Working Group Leadership . . . . . . . . . 12
Appendix B: PRRR Revenues, Expenses, and Resources Facilitated to Countries . . . . 13
Appendix C: 2012 PRRR Secretariat Expenses . . . . . . . . . . . . . . . . . . . . . . . . 14
Overview
Pink Ribbon Red Ribbon was launched on September 13, 2011.
Since its launch at the September 2011 Summit to Save
Lives in Washington, DC, Pink Ribbon Red Ribbon (PRRR)
has evolved from an ambitious vision of public-private sector
collaboration to address women’s cancers in developing
countries to a robust, multi-partner initiative focused on advancing prevention, screening and treatment for breast and
cervical cancer in sub-Saharan Africa and Latin America.
Having been initiated with four organizing members,
including the George W. Bush Institute, the United States
through the U.S. President’s Emergency Plan for AIDS Relief
(PEPFAR), Susan G. Komen, and the Joint United Nations
Programme on HIV/AIDS (UNAIDS), as well as corporate
and foundation members Becton, Dickinson and
Company, Bill & Melinda Gates Foundation, the Bristol-Myers
Squibb Foundation, Caris Foundation, GlaxoSmithKline,
IBM, Merck, and QIAGEN, PRRR now engages a broad range
of organizations in Zambia, Botswana, and elsewhere. In
just sixteen months, an agreed set of clear and concrete
goals, guiding principles and intervention strategies,
work plan and evaluation framework have enabled PRRR
to begin to improve and save women’s lives.
PRRR was launched on September 13, 2011, at a high-profile event at which President and Mrs. George W. Bush,
Secretary of State Hillary Clinton, Komen founder and
CEO Ambassador Nancy G. Brinker, Executive Director
of UNAIDS Mr. Michel Sidibé and others outlined a vision
for building on the historic achievements of PEPFAR to
ensure women treated for HIV infection do not then die from
preventable cervical cancer or breast cancer. Activities
started in earnest in December of 2011, when President
and Mrs. Bush traveled to Zambia to join the First Lady of
Zambia, Dr. Christine Kaseba-Sata, the Zambian Ministry
of Health, U.S. Ambassador Mark Storella, PEPFAR staff,
and partners in announcing the country would be the
first official site of PRRR engagement. The appointment
in February of 2012 of Dr. Doyin Oluwole as Executive
Director energized PRRR momentum, with Oluwole bringing her expertise as an international health expert and
World Health Organization (WHO) leader in Africa to her
work in scaling up PRRR activities, securing funding,
and bringing in additional partners. During a high-level
visit to Zambia and Botswana in July 2012, President and
Mrs. Bush announced Botswana as the second site of
PRRR engagement. In Zambia, the Bushes led a volunteer
project to refurbish the Ngungu Health Center in Kabwe
and joined a ceremony recognizing PRRR local partner,
the Center for Infectious Disease Research in Zambia
(CIDRZ), as an African Center of Excellence for Women’s
Cancer Control.
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Member Organizations: Partnering for Progress and Purpose
Cervical and breast cancer take a particularly devastating toll on women in low- and middle-income countries. They are
the leading causes of cancer deaths in sub-Saharan Africa and Latin America.
PRRR faces this challenge head-on through a multi-partner, public-private sector collaboration focused on advancing
prevention, screening and treatment for breast and cervical cancer in sub-Saharan Africa and Latin America.
Organizing Members
Corporate and Foundation Members
•
•
•
•
•
•
•
•
George W. Bush Institute
PEPFAR
Susan G. Komen
UNAIDS
Provides training for and deep discounts
on BD products, such as liquid based
diagnostics (assays, equipment,
maintenance) and slide processors.
Becton, Dickinson and Company
Bill & Melinda Gates Foundation
Bristol-Myers Squibb
Caris Foundation
•
•
•
•
Provides informatics and data systems
technical support through IBM Corporate
Service Corps.
Provides technical expertise on
integration with HIV, and plays an
active role in PRRR leadership.
GlaxoSmithKline
IBM
Merck
Qiagen
Provides financial support to the PRRR
Secretariat, as well as to reproductive
health care networks, NGOs, and other
international organizations engaged in
cervical cancer prevention and control
programming.
Provides HPV vaccines and training. Also
provides financial support to Komen for
community sensitization, for the African
Center of Excellence for Women’s
Cancer Control, and for Secretariat
communications.
Provides training and deep discounts for
careHPV as well as Secretariat financial
support.
Provides training of community based
lay workers and staff at primary health
facilities to improve screening and
early diagnosis of cervical and breast
cancer. Capacity building for NGOs in
monitoring, evaluation and financial
management. Also provides the
Secretariat financial support.
Provides support for pathology
diagnostics and training and
Secretariat financial support.
Houses the PRRR Secretariat and
plays an active role in PRRR leadership.
Works to promote global awareness
raising; provides event planning
support and funding for Africa trips;
financial reporting, distribution of PRRR
funds, and contract processing for
the Secretariat. HR and administrative
support for the Secretariat employees;
grant tracking; co-leads Strategic
Communications and Marketing and
Development working groups.
2
Leads PRRR breast cancer activity
coordination and cervical and breast
cancer awareness raising/education.
Provides health provider training on breast
cancer detection and management. Plays
an active role in PRRR leadership and
co-leads Strategic Communications and
Marketing working group.
Provides HPV vaccines and pain
medication for women with cancer and
capacity building for its management.
Also provides Secretariat financial
support.
Supports screening and treatment to
prevent cervical cancer in high-risk HIVpositive women, and plays an active role
in PRRR leadership.
PRRR Featured at Key Events
During the past year the profile of PRRR has been raised
considerably, with PRRR’s efforts to scale up activities
to prevent, screen, and treat cervical and breast cancer
in developing countries featured at several high-level
events. In July 2012, at the International AIDS Conference
in Washington, DC, a high-level panel moderated by
George W. Bush Institute Executive Director Ambassador
James Glassman featured Ambassador Eric Goosby,
U.S. Global AIDS Coordinator, UNAIDS’ Sidibé, Zambia’s
Permanent Secretary for Health Peter Mwaba, BD Vice
President for Global Health Renuka Gadde, the former
President of Susan G. Komen Elizabeth Thompson, and
PRRR Executive Director Doyin Oluwole in a discussion
about the case for investing in breast and cervical cancer
prevention, screening, and treatment in countries with
high HIV/AIDS burdens. In September 2012, Oluwole
moderated a discussion about women’s health in Africa
for the RAND-sponsored meeting of African First Ladies
in New York, on the margins of the United Nations General
Assembly. The October 2012 National Cervical Cancer
Planning meeting in Zambia offered members of the
PRRR Targets, Indicators and Evaluation Working Group
a chance to exchange information about approaches to
monitoring and evaluating cancer prevention, screening,
and treatment programs with Zambian counterparts.
PRRR Staffing and Logistics
With four full-time employees and one consultant on
board by the end of 2012, the PRRR Secretariat is fully
staffed and works with partners in the U.S. and Europe
as well as at the country level to facilitate communication
among engaged stakeholders. Generous support from Bill
& Melinda Gates Foundation, the Bristol-Myers Squibb
Foundation, the George W. Bush Institute, Caris Foundation,
QIAGEN, and GlaxoSmithKline has enabled the Secretariat
to become operational and to manage working groups
focused on such key issues as governance, monitoring
and evaluation, development, strategic communications
and marketing, as well as mapping commitments and
achievements.
Pink Ribbon Red Ribbon
Guiding Principles
The success and sustainability of the partnership
are guided by the following principles:
1. Results matter: The focus of the work of the
partnership is to save lives of women in Africa and Latin America, and all activities are
planned to achieve that goal.
2. Accountability: The Secretariat developed
an accountability framework that monitors
each partner’s commitment against results
achieved within a specified timeframe.
3. Country leadership and ownership: Pink
Ribbon Red Ribbon empowers countries to
design, lead, own, and account for their own
programs.
4. Phased approach: The involvement of the partnership in countries is incremental. Beginning
with a number of selected countries and
expanding to more as lessons are learned,
successful models for replication are documented, and resources become available.
5. Sustainability: Sustainable models that take
advantage of country-level resources, platforms, and partnerships are promoted and
scaled-up.
6. Health systems strengthening: Local capacity
strengthening at all levels of service delivery
are a part of the partnership’s sustainability
principle.
During 2012, regular steering committee meetings and conference calls have enabled partners to interact in person and
virtually, allowing organizations to share approaches and
identify opportunities for synergy and forward momentum.
In 2013, PRRR anticipates deepening its commitments
with existing partners, engaging in new countries and
learning from recent experiences during its first year of
operations to strengthen and improve approaches to address women’s cancers in sub-Saharan Africa.
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PRRR-Supported Country: Botswana
Demographics1
HIV and Cancer
Burden
Total population
2.06 million (2011)
# female
1.02 million (2011)
HIV prevalence, 15–49 years old
Women aged 15 and up living with HIV
Cervical cancer
Breast cancer prevalence
23.4% (2011)
160,000 (2011)2
2nd most common cancer; accounted
for 24% of all cancers in women
between 1998–20083
Unknown
1. CIA, The World Factbook: Botswana, https://www.cia.gov/library/publications/the-world-factbook/geos/bc.html
2. UNAIDS, “Botswana”; http://www.unaids.org/en/regionscountries/countries/botswana/
3. Botswana National Cancer Registry
PRRR-Supported Country: Zambia
Demographics4
HIV and Cancer
Burden
Total population
13.8 million (2012)
# female
6.91 million (2012)
HIV prevalence, 15–49 years old
Women aged 15 and up living with HIV
12.5% (2011)5
460,000 (2011)5
Cervical cancer
Estimated cervical cancer incidence
rate of 52.8 per 100,0006 is one of the
highest in the world
Breast cancer prevalence
Estimated to be 2nd most common
cause of cancer-related morbidity and
mortality in Zambia7
4. CIA, The World Factbook: Zambia, https://www.cia.gov/library/publications/the-world-factbook/geos/za.html
5. UNAIDS, “Zambia”, http://www.unaids.org/en/regionscountries/countries/zambia/
6. Globocan (IARC) 2008; http://globocan.iarc.fr/factsheets/cancers/cervix.asp#INCIDENCE
7. Globocan (IARC) 2008; http://globocan.iarc.fr/factsheets/cancers/breast.asp
PRRR and Global Health
Dr. Mark Dybul, who served as the first PRRR Steering
Committee Chairman, was appointed Executive Director of the Global Fund to Fight AIDS, Tuberculosis and
Malaria in November of 2012. Dybul was the Inaugural
Fellow in Global Health at the George W. Bush Institute
and co-director of the Global Health Law Program at
the O’Neill Institute for National and Global Health Law
at Georgetown University. A physician, he served as
the Assistant Director for Medical Affairs at the National Institute of Allergy and Infectious Diseases, National
Institutes of Health before assuming the position of
4
U.S. Global AIDS Coordinator, leading the implementation of the U.S. President’s Emergency Plan for AIDS
Relief (PEPFAR) from 2006 to 2009.
In his role as PRRR Steering Committee Chairman,
Dybul has provided vision to the initiative and helped
guide PRRR partnerships and programs in sub-Saharan Africa, including in Zambia and Botswana. At the
Global Fund Dr. Dybul will oversee the organization’s
support for global efforts to address HIV/AIDS, tuberculosis and malaria within the hardest hit countries.
Results Matter
“And as we aim at the goal of reducing cervical cancer deaths among women, we hope that
we will see results very quickly. As President Bush said, we see results from the President’s
Initiative on Malaria. We want to see results equally from this effort to reduce deaths from
—Hillary Rodham Clinton, U.S. Secretary of State, September 13, 2011
cervical cancer.” “Results matter” is a guiding principle of PRRR. PRRR,
through its partners, emphasizes results and focuses on
achieving three goals:
• Reduce deaths from cervical cancer by 25 percent among
women screened and treated through the initiative
• Increase access to HPV vaccinations, as well as awareness of breast and cervical cancer prevention, diagnosis
and treatment, and reduce stigma
• Create innovative models that can be scaled-up and
used globally
PRRR holds central to its mission exploring and developing
affordable and sustainable solutions to women’s cancer
prevention and treatment for the world’s neediest women
in resource-poor regions. A combination of donated, atcost, and profitable provision for access to diagnostics,
treatments, and vaccines is employed. This approach is
designed to facilitate rapid uptake at the same time as
creating a viable, long-term market for products to combat
women’s cancers.
Goal 1: Reduce deaths from cervical cancer by 25
percent among women screened and treated through
the initiative
“It is heart-wrenching to save a woman from AIDS only to
watch her die from cervical cancer, which is more prevalent
in women with HIV.”
—President George W. Bush, July 22, 2012
Women living with HIV are at a greater risk of developing
cervical cancer than those not infected with HIV. In many
countries in Africa, HIV-positive women are living longer,
but are now dying of cervical cancer with cervical cancer
becoming the most common cancer among those women. One of the objectives of PRRR is to help in increasing
survival of women living with HIV and improving quality of
their lives through wider scale and improved cervical cancer prevention, early diagnosis, treatment and care efforts.
To prevent women from dying from cervical cancer in developing countries, it is essential to augment efforts at
every level of the cancer care continuum. PRRR focuses
on intervention strategies that target the prevention of
cervical cancer, screening for breast cancer and cervical
pre-cancer and cancer, treatment of women’s cancers,
and training and equipping healthcare providers to carry
out cancer prevention, screening and treatment. Since the
launch of PRRR in sub-Saharan Africa in December 2011,
progress has been made on all fronts. According to the
African Center of Excellence for Women’s Cancer Control,
more than 22,000 women have been screened for cervical pre-cancer and cancer in PRRR-affiliated programs
in Zambia between December 2011 and the end of 2012
with PEPFAR support. Since PEPFAR began supporting
screening in 2006, more than 98,000 women have been
screened. More than 1,000 in Botswana, a country with
a much smaller population, have been screened through
PRRR-affiliated programs with support from PEPFAR,
according to the PEPFAR/U.S. Centers for Disease Control and Prevention country office, though PRRR-specific
PEPFAR funding was not distributed until January 2013.
Nearly all of the women who screened positive for cancer
or pre-cancer (approximately 18 percent of the total number screened) have received cryotherapy or loop electrosurgical excision procedure (LEEP), or were referred for
advanced diagnostics and treatment. In Zambia, more
than 40 health workers have been trained in cervical cancer “screen and treat” (S&T) procedures, which consist of
a visual inspection with acetic acid (VIA) test, followed
by treatment with cryotherapy, if necessary, often on the
same day. More than a dozen of these recently trained
practitioners work in other countries in the region.
PRRR partners making key contributions to support
efforts in reducing deaths from cervical cancer in 2012
included the following organizations:
The George W. Bush Institute supported visits by President
and Mrs. Bush to Zambia in 2011 and 2012, and one to
Botswana, in July 2012. These visits have significantly
enhanced PRRR’s visibility and credibility globally and at the
country level. The team from the Institute, along with additional volunteers and PRRR partners, refurbished the rural
Ngungu Health Center in Kabwe, Zambia, which now offers
cervical cancer screening and pre-cancer treatment, as well
5
as clinical breast examinations (CBE). The Bush Institute also
houses the PRRR Secretariat, and provides administrative,
operations and legal support to the partnership.
Ngungu Health Center
National Breast Cancer Foundation provided $100,000 to
PRRR, part of which will be used to hire a National Health
Promotion Manager in Zambia. The selection process is
on course and will be completed in early 2013. The position will be funded for five years, after which the government will assume full responsibility.
Susan G. Komen supported Zambia with $200,000 to train
high-level providers in breast cancer early detection, diagnosis and management, through a specialized training and
technical assistance partnership with a U.S. based university. Susan G. Komen also supported a CBE training session
administered in August 2012 to 17 Zambian nurses who
were already providing cervical cancer screening services.
The United States through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and PEPFAR partners in-country, supports cervical cancer screening and
treatment programs in Botswana and Zambia described
above, along with programs in nine other African countries. In Zambia, PEPFAR has worked with the Center for
Infectious Disease Research in Zambia and the Zambian
Ministry of Health to provide cervical cancer screening and
treatment since 2006. In Botswana, PEPFAR has worked
with the University of Pennsylvania and the Botswana
Ministry of Health since 2009 to support cervical cancer
screening and treatment. As a founding member of PRRR,
PEPFAR has committed an additional $10 million to increase
capacity for cervical cancer screening and treatment in
PEPFAR-supported sites in three countries in Africa. Botswana and Zambia have both received their first tranche
of these additional funds intended to support the scale-up
of cervical cancer screening and treatment, building on existing PEPFAR platforms providing a range of HIV prevention, care and treatment services.
Goal 2: Increase access to HPV vaccinations, raise
awareness of breast and cervical cancer prevention,
diagnosis and treatment, and reduce stigma.
“It comes down to this: What a tragedy it is to save a woman
from HIV/AIDS only to lose her to breast or cervical cancer
a couple of years later. Especially when these diseases are
detectable and treatable.”
—Ambassador Nancy Brinker, founder and CEO,
Susan G. Komen, August 29, 2012.
PRRR partners are focused on increasing awareness of
women’s cancer prevention and control and reducing stigma
associated with the disease at all levels. The focus of the
breast cancer awareness raising effort is to down stage the
6
Members of the George W. Bush Institute staff and the U.S.
Embassy in Zambia work alongside President George W. Bush,
Mrs. Laura Bush, and local Kabwe citizens to renovate the
Ngungu Health Center on Saturday, June 30, 2012, in Kabwe,
Zambia. Photo by Shealah Craighead/The Bush Center.
July 2012
President and Mrs. Bush refurbish
the Ngungu Health Center.
After 6 Weeks
More than 500 women screened for
breast and cervical cancer.
• 60 women treated for precancerous lesions
• 100 women with more advanced lesions referred for care at hospitals
End of 2012
1,500 women screened.
• 1 in 4 women had cervical precancerous or
cancerous lesions.
Now
• The clinic is one of the most active in Zambia.
• Its new services have only been promoted
through word-of-mouth: in hair salons and at
churches, and from woman-to-woman.
disease as women seek care early. Over the past year, in addition to publishing numerous blogs and op-eds, PRRR partners
have been prominently featured at a number of international
conferences and summits, including the RAND First Ladies
Summit, the annual meeting of the American Society for Clinical Pathology (ASCP) in Boston, Massachusetts, the 2012 International AIDS Society’s conference in Washington, DC, and
the GAVI Partner’s Forum in Dar es Salaam, Tanzania.
PRRR partners have contributed to efforts to create a
unique identity for the partnership, as well. Led by the
BD communications team, the development of the PRRR
logo was executed in 2012. This was the first step in a
larger effort to create a brand identity for the initiative.
Merck committed $5,000 to support the development of
the PRRR lapel pin as an awareness-building instrument,
the execution of which was carried out by the Susan G.
Komen communications team.
Partners have also made contributions to increase awareness at the local level, such as:
In Zambia, a health center was reroofed, rewired, repainted,
renovated, landscaped and equipped for cervical cancer
screening and treatment through support from The
George W. Bush Institute.
In July 2012, Merck began supporting the Zambian Ministry
of Health’s plans to conduct a demonstration project
across the province of Lusaka by donating 180,000
doses of GARDASIL® [Human Papillomavirus Quadrivalent
(Types 6, 11, 16, and 18) Vaccine, Recombinant] to vaccinate 25,000 eligible girls via the GARDASIL Access
Program in each of two years (2013 and 2014) and is
providing technical support for the program. As part of
its commitment to PRRR, in 2012, Merck also provided
$1,270,000, through a partnership with Susan G. Komen,
to support a variety of women’s cancer awareness and
HPV vaccine introduction activities. Merck’s 2012 contributions included support for the African Center of
Excellence for Women’s Cancer Control. Zambia activities
supported, in coordination with local NGOs, the Zambian
government, the U.S. government and PRRR partners,
include the scale-up of breast and cervical cancer education to increase knowledge and awareness and reduce
stigma throughout Zambia. Merck has also offered to provide
George W. Bush Institute July 2012 trip and Ngungu Health Center
In 2005, coffin making was the most lucrative business
in Zambia because so many people were dying of AIDS.
Today, people have access to lifesaving medicines
and are able to live productive lives. But, the most tragic thing is to save women from HIV/AIDs and watch
them die of cervical cancer.
In July 2012, President and Mrs. Bush traveled to
Zambia’s Kabwe District to refurbish the Ngungu
Health Center, as a labor of love.
Since the clinic opened, the number of women enrolling
for breast and cervical cancer screening has been
astounding. After the first six weeks of operation,
through tremendous leadership and dedication of the
clinic’s staff, more than 500 women were screened.
Of these, more than 60 women were treated for precancerous lesions, restoring hope for a better quality of
life because the lesions were detected early. More than
100 others, whose more-advanced lesions might have
killed them, were referred for care at the Kabwe General
Hospital or the University Teaching Hospital in Lusaka.
By the end of 2012 more than 1,500 women had
been screened, with 1 in 4 women having cervical
precancerous or cancerous lesions, according to
the African Center of Excellence for Women’s
Cancer Control.
Word is spreading about the new cancer services and
the demand for breast and cervical cancer screening
is rising in and beyond town borders. Perhaps most
surprising about this rising demand is that new services
have only been promoted through word of mouth: in
hair salons and at churches, woman-to-woman, neighbor-to-neighbor, peer-to-peer.
The more than 1,500 women who have enrolled in
services in the past six months make Ngungu one
of the most active clinics in the country. Patients are
accessing the clinic from nearby provinces, triggering
local government to call for more health worker training
to keep up with the demand.
This increase in screening has undoubtedly led to an
increase in treatment, and thankfully doctors at the
referral hospital in Kabwe are equipped to perform
LEEP and biopsies. Although pathologists are keen to
do more testing, they face challenges in accessing appropriate laboratory commodities (wax, slides, stain);
PRRR is identifying resources to fill this need.
7
GARDASIL doses to Tanzania to support a phased launch
for their HPV vaccination program. In Botswana, Merck is
providing, or working with other partners, including PRRR,
to provide support for the country’s HPV vaccination
demonstration program.
Susan G. Komen committed $20,000 to support the establishment of the Cancer Prevention Alliance of Zambia
(CAPRAZ), a consortium of seven local cancer advocacy
NGOs that are working together on breast and cervical
cancer community education and sensitization.
Joint United Nations Programme on HIV/AIDS (UNAIDS)
employs its extensive experience in helping guide the provision of HIV prevention, care and treatment programs to
build effective linkages between PRRR and national HIV
and cervical and breast cancer initiatives. By leveraging
the work of its country offices in PRRR focus countries,
UNAIDS has helped build national government support to
advance women’s cancer control efforts while mobilizing
the technical capacities of other UN agencies in support of
PRRR goals. Given UNAIDS’ institutional mandate to work
closely with civil society, it has made a special commitment
to ensuring that PRRR’s work is responsive to and guided
by the needs of community groups and that those groups
are mobilized to action. UNAIDS provided financial support
for the publication of PRRR’s first annual report.
Goal 3: Create innovative models that can be scaledup and used globally
“As a PRRR founding partner, the UNAIDS Secretariat,
through the Joint Programme, will advocate and facilitate
dialogue and re-direct concerted efforts of government, civil
society, particularly WLHIV (women living with HIV) and other
partners, to support an integrated approach to HIV and cervical
cancer prevention and control within a sexual and reproductive health package.”
—Michel Sidibé, Executive Director, UNAIDS, July 25, 2012.
PRRR recognizes the importance of innovative models to
overcome the immense burden of women’s cancers in developing countries. PRRR itself is an innovative partnership,
bringing together the public, private and non-profit sectors
to address pressing issues and barriers to women’s cancer
prevention and control. The latest organization to collaborate with the partnership is the World Bank.
PRRR promotes and supports simple, cost-effective
screening and treatment for precancerous cervical lesions
through visual inspection with acetic acid (VIA) and cryotherapy (freezing treatment applied to the cervix). VIA is
much cheaper than other screening approaches, takes
only a few minutes, and in many cases abnormal findings
can be managed with cryotherapy — a 20 minute treatment — enabling both screening and treatment to take
place on the same day in a single-visit approach. In
PEPFAR’s funds to scale up cervical cancer screen and treat services
There is now extensive evidence confirming the link
between HIV infection and cervical cancer. Infection
with HIV weakens the immune system and reduces
the body’s ability to fight infections that may lead to
cervical cancer. Cervical cancer is 4-5 times more
common among women living with HIV than women
who are HIV-negative.
Given the link between HIV and cervical cancer, PEPFAR
supports screening and treatment to prevent cervical
cancer in women living with HIV, primarily using simple, cost-effective “screen and treat” approaches,
along with support for more complex diagnostic and
treatment modalities including loop electrosurgical
excision procedure (LEEP). PEPFAR currently invests
about $4 million per year in cervical cancer screening
and treatment for women infected with HIV, with services provided at more than 250 clinics in 11 African
countries. Through PRRR, PEPFAR has committed
an additional $10 million, which will bring the total
8
PEPFAR investment to $30 million over the next five
years, expanding access to vital screening and treatment
services, especially for high-risk, HIV-positive women.
PRRR leverages the resources of PEPFAR — established under President Bush, and a cornerstone of
President Obama’s Global Health Initiative (GHI) —
and draws from lessons learned in the significant
scale-up of HIV services in recent years. PEPFAR’s
substantial investments in HIV prevention, care and
treatment programs have also contributed to stronger
overall health systems, resulting in a health systems
platform which can be used to address broader health
issues, including non-communicable diseases such
as women’s cancers. Building on this platform in
partnership with PRRR to address women’s cancers
should expand access to life-saving services, while
maximizing synergies and efficiencies, making the
most of every dollar invested to save as many lives
as possible.
addition, the pioneering PRRR model of leveraging the HIV
platform helps to target at-risk women, screen them, and
identify and treat the pre-cancer and early cancer stages
when these women can still be cured.
PRRR partners are making innovative contributions to
women’s cancer control, for example:
GlaxoSmithKline is addressing an under-supported need in
Zambia related to women’s cancer: palliative care. Through
a donation of 3 million treatment doses of morphine
sulfate active powder over three years (1 million doses
per year); GlaxoSmithKline is supporting palliative care, an
important and final component to the cancer continuum.
GlaxoSmithKline’s plans include the development of a
sustainable, and therefore innovative, palliative care program with trained health workers.
IBM Corporate Service Corps (CSC) is an innovative, global
initiative designed to provide small businesses, educational institutions and non-profit organizations in growth
markets with sophisticated business consulting and
skills development to help improve local conditions and
foster job creation. IBM deploys teams of top employees
from around the world representing information technology,
research, marketing, finance, consulting, human resources,
legal and business development to growth markets for a
period of one month. As a contribution to PRRR, in 2012
a team of IBM experts was deployed to Kenya for four
weeks to help improve the medical records system. At
the end of their assignment, they presented a plan and
recommendation to the Kenyan Ministry of Health and the
United States Embassy in Kenya that the Government of
Kenya use its existing HIV care and treatment network to
refer patients for cervical cancer testing. The IBM team
also suggested that the country’s District Health Information Software be used to capture and analyze data
about cervical cancer in Kenya. To that end, IBM advised
that national reporting standards and requirements be
established for this disease so that health facilities can
report statistics. By implementing Electronic Medical
Record (EMR) systems that are flexible enough to add
new data captured for new program areas (HIV, TB,
malaria, cervical cancer, etc.) it will be possible to monitor
cross-program patient flow and accurately track cervical
cancer screening and treatment in Kenya. IBM proposes
to send a second team of its CSC in 2013 to build on its
2012 support to Kenya.
World Bank Collaboration
Patricio Marquez, the World Bank’s Lead Health
Specialist for Southern and Eastern Africa, wrote
on the “Africa Can…End Poverty” blog:
“Frequently, both communicable diseases and
NCDs can co-exist in the same individual, and one
can increase the risk or impact of the other. Some
infections cause or are related to NCDs; for example
cervical cancer, a leading killer of women in Africa, is
caused by the human papilloma virus.”
PRRR is encouraged by the World Bank’s recent
partnership with us to integrate activities to
address communicable and non-communicable
diseases in Botswana. In November 2012, with
support from the World Bank and PRRR, the
government of Botswana took a step to close the
gap between communicable and non-communicable diseases by announcing that funds from
the World Bank, through the country’s National
AIDS Coordinating Agency (NACA) — an agency typically focused on HIV, a communicable
disease — will be used to combat cervical cancer
in the country. This allows HIV-positive women,
whose lives are being saved through ART, to
receive timely cervical cancer screening and
treatment, thus preventing them from dying from
another preventable disease.
This announcement embodies a number of PRRR’s
core principles, including that health should be a
partnership of mutual accountability involving a
variety of partners, that countries should lead and
own their responses, and that fragmentation costs
lives and wastes resources. PRRR is delighted
to have facilitated this support through raising
awareness of our efforts to World Bank staff and
then working with the Bank and key stakeholders
in Botswana. These efforts will enable integration of women’s cancer control into existing platforms, strengthen countries’ capacities to deliver
comprehensive cancer control and address other
chronic diseases, and improve data management.
9
Lessons Learned
Because PRRR’s strategy is an innovative approach to
global health, identifying lessons learned from the first
year of active operations is a priority. Within PRRR, attention to challenges and opportunities and how PRRR’s
structures and processes meet them enables continually
improved efforts to combat women’s cancers. Equally important, sharing lessons is a critical step toward PRRR’s
goal of creating models that can be scaled up and used
globally. Some of the key lessons learned to date include:
• Flexibility is key to successful programming and
partnership with countries. Unexpected challenges and
opportunities arise, and a partnership must be able to
adapt to them. In line with PRRR’s goal of creating innovative models for global scale-up and use, there is no
single model for all countries. Rather, in partnering with
countries, partners must use the model that each country has identified as best.
• Members carry a dual identity and are seen as representing PRRR and also their individual organizations,
both of which are important. Learning to display this
dual identity has been essential.
• While a phased approach to implementation makes
sense, it is important to be cognizant of the need for
partner engagement in countries of focus for particular
member organizations. When partnerships work to
support governments’ own strategic plans, they will
encounter challenges to creating opportunities for all
members’ participation and thus catering to the needs
of all member organizations in their countries of priority.
• Ensuring communication and coordination among
and between all levels of engagement is crucial to the
success of the partnership. Communications must be
active, clear, and responsive within and between countries
and between members at the global level.
• Partnerships need to be results-oriented to succeed, and
it is important that evaluation is informed by country
programs. Monitoring of programs is also crucial and
needs to begin as soon as programs begin.
• An efficient country coordination mechanism is very
important. When the country’s women’s cancer technical
working group is active, communication is much clearer
and programs move forward much more quickly.
Mothers wait with their children to greet President and Mrs. Bush, as well as other Pink Ribbon Red Ribbon partners,
at the George Urban Health Center in Lusaka, Zambia. Photo by Paul Morse.
10
Looking ahead to 2013
As Pink Ribbon Red Ribbon moves into its second full
year of operation, it does so with a robust agenda and
ambitious plans for expansion and intensification of effort.
We envisage intra-country and inter-country expansions.
Countries already engaged will expand services into new
districts/provinces as well as add new components of the
cancer continuum, and new countries will be engaged.
Preliminary conversations with in-country partners hold
promise for expansion into two new sub-Saharan African
countries by the end of 2013.
A partnership with the National Breast Cancer Foundation
and the University of Texas M.D. Anderson Cancer Center in
Houston offers the promise of a North-South collaboration,
such as training for ob-gyn managers and specialists
from Zambia to study state-of-the-art cancer treatment
schemes and strategies, and an exchange visit that will
enable M.D. Anderson faculty to work side-by-side with
African colleagues in Zambia.
Partnering with the World Bank to support non-PRRR
focus countries enables PRRR to provide access to a larger
population of women and girls. This partnership has been
established in Botswana and is being explored for Namibia
and other countries in 2013.
PRRR anticipates responding to requests for support
from at least two additional governments in sub-Saharan
Africa for nationwide comprehensive cervical cancer
programming, and from an additional country to support
a nationwide HPV vaccination program made possible by
recent GAVI funding commitments.
The development and execution of a new communications strategy will offer a new website and opportunities
for continuing to raise awareness of PRRR goals and
achievements and improve the partnership’s visibility.
Anticipated work with Bill & Melinda Gates Foundation
to support the development of a cervical cancer global
monitoring system, in collaboration with other partners,
promises to expand PRRR’s partnership and global access.
During the second full year of operations, partners will
continue to refine interactions and build on lessons learned
to strengthen the effort to support countries in their
quest to provide breast and cervical cancer prevention,
screening and treatment services for women in sub-Saharan Africa and beyond.
A Zambian woman and child. December 3, 2011. Photo by Paul Morse.
11
Appendix A:
PRRR Steering Committee
and Working Group Leadership
Steering Committee
Chair: Mark Dybul, George W. Bush Institute
Co-Chair: British Robinson, Susan G. Komen
Development Working Group
Co-Chair: Amanda Hughes, George W. Bush Presidential Center
Co-Chair: British Robinson, Susan G. Komen
Governance Working Group
Co-Chair: Lisa Carty, Joint United Nations Programme on HIV/AIDS (UNAIDS)
Co-Chair: Renuka Gadde, Becton, Dickinson and Company
Mapping Working Group
Co-Chair: Kevin Brady, Office of the U.S. Global AIDS Coordinator
Co-Chair: Hedia Belhadj, Joint United Nations Programme on HIV/AIDS
Strategic Communications and Marketing Working Group
Co-Chair: Andrea Rader, Susan G. Komen
Co-Chair: Sally McDonough, George W. Bush Presidential Center
Targets, Indicators and Evaluation Working Group
Co-Chair: Laura Porter, Centers for Disease Control and Prevention
Co-Chair: Peter Boyle, International Prevention Research Institute, representing Susan G. Komen
12
Appendix B:
PRRR Revenues, Expenses, and
Resources Facilitated to Countries
2012 PRRR Secretariat Expenses: $654,941
Total resources facilitated to countries: $24,802,659
Total resources facilitated
to countries* (2012)
$24,802,659
Bill & Melinda
Gates Foundation
$200,000
PRRR Secretariat
revenues
$902,500
GlaxoSmithKline
$50,000
Susan G. Komen
$50,000
National Breast Cancer
Foundation, Inc.
$50,000
QIAGEN
$20,000
Becton, Dickinson
and Company
$7,500
Bristol-Myers Squibb
Foundation
$25,000
*Total excludes staff time from PRRR member organizations
Caris Foundation
$500,000
13
Appendix C:
2012 PRRR Secretariat Expenses
14
Wages and Benefits
$381,945
Recruiting/Relocation
$37,523
Fellowships and Support
$31,872
Support to Countries
$53,737
Conferences and Meetings
$21,053
Travel
$128,811
Total
$654,941
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