Saving Women's Lives From Cervical Cancer: Promoting a Cost-Effective Cervical Cancer Screening Tool in Rural Albania

Abstract

Background and context: The WHO has presented that more than 90% of deaths from cervical cancer happened in low and middle-income countries. Albania is one of them. Albania has a national cervical cancer screening program. However, the program is not well-promoted and the service is not always available at the primary public health care level. The situation worsens when it comes to rural areas. In 2016, to bridge the gap and achieve health equity the Albanian Center for Population and Development (ACPD) initiated a series of activities to promote the utilization of visual inspection with acetic acid (VIA) and cryotherapy for the first time as a pilot study in rural Albania. ACPD sees this as a health priority to strengthen the existing national screening program through advocacy with the Ministry of Health and Social Protection (MoHSP). Aim: To enable VIA and cryotherapy provision in rural Albania to expand cervical cancer screening by advocating for its integration into the national cervical cancer screening program. Strategy/Tactics: The strategy applies a client-centered and bottom-up approach. The changes are driven through four sections, namely: context understanding, providers' engagement, partnership strengthening, and sustainability development (Fig 1). Program/Policy process: Following the proposed strategy, four main approaches were developed. · Demand generation: ACPD promoted relevant cervical cancer prevention and treatment information as well as redressed misconceptions through developing education materials and carrying out education sessions. · Provide services in rural settings: ACPD engaged different health providers into the VIA and cryotherapy training and institutional protocol development. · Collaborate with key stakeholders: ACPD worked closely with stakeholders, such as civil society organizations (CSOs), media, and health facilities. · Provide medical evidence to affect national policy-making processes: ACPD provided strong evidence to support the integration of VIA and cryotherapy into the existing cervical cancer screening program. Outcomes: In line with aforementioned process, the project succeeded to establish an effective model improve national cervical cancer screening program. All achievements and outcomes are summarized in Table 1. What was learned: The proposed strategy enabled VIA and cryotherapy in rural Albania. From clients' perspectives, this cost-effective cervical cancer screening tool is well-accepted, and most women were thrilled by the idea that the precancerous lesions could be screened and eliminated at the same visit. It is evident that ACPD distributed this desired service in rural Albania through collaborating with key stakeholders, including media, CSOs and public health facilities. ACPD still works on integrating VIA and cryotherapy into the national cancer screening program to reduce cervical cancer deaths. [Figure: see text][Table: see text]