Setting Up a Cytology Laboratory for Cervical Cancer Screening in a Developing Country: A One Year’s Early Experience at a Private Facility

Abstract

Introduction: Widespread cytology-based method of screening such as Pap smear test has significantly led to a reduction in the incidence and mortality associated with cervical cancer in many developed countries. In these countries, facilities needed for early detection of cervical cancer such as cytology laboratories are existent and generally available to their population. In a developing country like Somalia, access to cytology services for cervical cancer screening remains limited and as result majority of patients present with advanced stage disease (stage III & IV) that is too difficult to treat. Intervention: To address this challenge, the management of AL-Zahra Specialty Hospital contracted a cytologist based in Uganda to guide in setting-up of cytology laboratory in the heart of Mogadishu, Somalia so as to provide cervical cancer screening and diagnostics services to the population. Other interventions made by the visiting cytologist involved guiding the procurement officer in the purchase of basic equipment, reagents, consumables and training of health care staff. This resulted into conducting 1020 cervical cytological tests over a period of 12months (1st September, 2018 to 30th September 2019). Lesions learnt: In order to increase access to cytology services, we learnt that the federal government of Somalia should consider making cervical cytology (pap smear test) as part of routine screening policy for all sexually active women as part of health care package. An increase in sample volume may be improved through awareness campaigns and conducting community screening activities. Conclusion: Somalia, a developing country has made great strides towards addressing the limited facilities for cervical cancer screening by using very limited funding. We hope that our experiences shall provide technical guidance & direction to physicians, laboratory managers and investors who wish to establish similar cervical cytology laboratories in an economically constrained low-resource setting.