Bridging the gap in health systems through task-sharing: A model of PHC workers’ competency for cervical screening

Abstract

BackgroundSeveral developing countries have begun implementing the recently proven ‘Screen and treat’ approach using visual inspection methods and cryotherapy. Nonetheless, a dire lack of established screening programs in Nigeria necessitates proffering effective task sharing to improve the availability of screening at the primary care level thereby making it more accessible to women. MethodsThis study employed a cross-sectional, analytic design with competency-based training of health workers to underscore the competence of primary healthcare (PHC) workers to perform cervical screening. The degree of agreement for the visual inspection with acetic acid (VIA) and visual inspection with Lugol’s iodine (VILI) results between the PHC workers and O & G doctors was determined using Kappa statistics, and indices of validity were used to express the accuracy of results. Results Following training, the PHC workers demonstrated a fair to excellent proficiency at the procedures for VIA and VILI, although the phase of VIA/VILI proper was the best performed. The degree of agreement (kappa) between workers for VILI (k - 0.442) and VIA (k - 0.374) was statistically significant (p < 0.001). The sensitivity of VILI among PHC workers (42.9%) was lower than O & G doctors (78.6%), however, PHC had a higher specificity (45.5% vs. 22.7%). The positive predictive values of VILI and VIA were similarly low for both groups (PHC workers vs. O & G doctors - 33.3% vs. 39.3%; 28.6% vs. 27.3%); whereas the negative predictive values for VILI and VIA were moderately better for PHC workers (PHC workers vs. O & G doctors - 62.5% vs. 55.6%; 58.6% vs. 56.0% respectively). The diagnostic accuracy for VILI was the same for both groups of healthcare workers, however VIA accuracy was slightly higher among PHC workers. The sensitivity of VIA was lower among the PHC workers (PHC workers vs. O & G doctors −14.3% vs. 21.4%), who also had a higher specificity (PHC workers vs. O & G doctors - 77.3% vs. 63.6%). ConclusionThe findings of this study suggest that VIA and VILI as done by trained PHC workers is comparable to those performed by registrars of obstetrics and gynecology, which is in keeping with reports from several other studies. This study thus highlights the value of competency-based training for primary healthcare workers in order to accomplish task sharing for cervical screening using visual inspection methods.