Strengthening Cervical Cancer Screening Program in Low Resource–Setting Communities: IPPF Success in Employing the Single-Visit Approach

Abstract

Background and context: Cervical cancer is the 2nd most common cancer among women (WHO, 2012). It is estimated that 260,000 women die every year (WHO, 2014). Cervical cancer is preventable and can be treated if detected early, yet, it remains one of the leading causes of cancer-related deaths in the world. Nearly, 90% deaths occur in developing countries (WHO, 2014), and majority of women who suffer cervical cancer in sub-Saharan Africa seek care when the disease has advanced and is beyond the capacity of surgery or other treatment modalities. It is against this background that IPPF Member Associations in Kenya, Nigeria, Tanzania and Uganda, with other reproductive health network implemented the Cervical Cancer Screening and Preventive Therapy (CCS&PT) initiative. In the first 2 years, most women needing cryotherapy were lost to treatment due to referrals made. Aim: The initiative was to institutionalize and scale up the services, using visual inspection with acetic acid (VIA) & cryotherapy, through existing reproductive health networks to reach more people especially, the marginalized and vulnerable people. Strategy/Tactics: Main intervention used was the single visit approach facilitated by • Equipping all sites with cryo-machines to enable cryotherapy services • Providing portable cylinders (5-10 kg) to ensure adherence to SVA during outreaches. • Capacity building of service providers in cryotherapy and continuous supportive supervision • Quality counseling prior to the VIA to ensure clients understood the importance of immediate treatment • Well planned logistics during outreaches to ensure a wider coverage and cryotherapy treatment. • Training of community health workers and mobilizers to ensure right information dissemination. • Use of media and collaboration with political and religious leaders helped local partners to raise awareness of cervical cancer. Program/Policy process: Used SVA at all screening sites to address the loss of clients needing cryotherapy and avert the progress to cancer disease stage. Outcomes: The game changer was the implementation of the single visit approach. Results recorded were; year 3- (59%), year 4- (94%), year 5- (92%) and year 6- (97%). What was learned: It is imperative to implement SVA with high degree of planning, organizing and coordination from the beginning of a project • Ensure resources and capacities to implement VIA and cryotherapy are in place by conducting a facility assessment • Ensure continuous training and mentorship to enhance providers competences. • Portable gas cylinders are very essential and convenient to ensure adherence to the practice of SVA. Conclusion: The single visit approach used strengthened the cervical cancer screening program, made treatment more accessible to a wider number of marginalized women. Thousands (514,681) were screened and 14,083 treated to avert progress to cancer stage in future, and this contributed to reduce cervical cancer related morbidity and mortality.