Background Over 80% of new cervical cancer cases occur in women living in low- and middle-income countries. It is the second highest cause of female cancer deaths in Nigeria. School based vaccination programs are an effective strategy for delivering the HPV vaccine to adolescent girls. This study aims to understand the challenges to implementing school-based HPV vaccination programs, particularly in a remote rural setting where vaccine hesitancy is high. Methods A 22- item interviewer administered questionnaire was used to evaluate HPV knowledge and willingness to get the HPV vaccinate among 100 female secondary school students as part of an HPV vaccination pilot in a rural community in Kebbi State, Nigeria. Additionally, semi-structured interviews were used to assess community knowledge and attitudes on cervical cancer and HPV vaccination. Data collected were analyzed thematically to understand challenges and generate lessons for vaccine delivery in the study setting. Results Knowledge of HPV and cervical cancer among junior secondary school aged girls was fair with a mean score of 66.05%. For senior secondary school aged girls, the knowledge score ranged from 70 to 100% with a mean of 96.25% indicating good knowledge of HPV and cervical cancer. All participants (n = 100) received the first vaccine dose but due to COVID-19, 33 participants were not able to complete the vaccine dosage within the recommended 6-month schedule. Of the parents who provided consent, none could afford the vaccine out of pocket. Challenges to vaccine delivery included operational costs exacerbated by lack of adequate health workforce and infrastructure in the study setting. Conclusion An exploration of sociocultural perspectives and contextual realities is crucial to understanding the complexities of HPV vaccine introduction from the perspective of the target audience, and the local community. Strategies for introducing the HPV vaccine should address community concerns through effective communication, appropriate delivery, and targeted advocacy to make the vaccination program locally relevant. While school-based HPV immunization programs have been shown to be successful, adequate design, planning and monitoring is important. Additionally, considerations must be made to account for the high operational cost of vaccine delivery in rural, hard to reach areas where human resources and infrastructure are limited.

The WHO is leading a global call for the elimination of cervical cancer by the year 2030. Although the call in itself is ambitious, the adopted strategy is realistic. The WHO is optimistic that cervical cancer will be eliminated as a disease of public health concern if 90% of girls receive the HPV vaccine by 15 years of age, 70% of women are screened by HPV testing at 35 and 45 years, and 90% of identified cases are treated. The success of the global call will significantly depend on the capacity to operationalize, finance, and implement the strategy in low‐ and middle‐income countries (LMIC), where more than 80% of the disease burden resides. This capacity varies among and within countries. A SWOT (strength, weakness, opportunity, and threat) analysis of the WHO global strategy for elimination of cervical cancer, conducted through the lens of experience in planning and advocating for a comprehensive cervical cancer prevention program in Kebbi State, Nigeria, highlights the delicate balance between evidence of efficacy and science of implementation that program managers in LMIC have to consider while rolling out or scaling up cervical cancer prevention programs.

Amount raised: N17,307,000 Background and context: The power of games for social change is well documented. Football, the world's most popular game is a common passion shared by most Nigerians across all divides. It defies all barriers and unites people globally. Beyond the potential for cancer awareness creation using football games, it can also be used to raise funds for cancer course. Aim: The aim was to increase cancer awareness via community participation and involvement as well as raise funds for cancer patients. To encourage the population to engage in healthy lifestyles and physical activities in lowering the risks of cancer. Strategy/Tactics: We partnered with the League Management Company- Nigeria Professional Football League and the Nigerian Football Federation (NFF) for technical support to portray a tone of professionalism in our novelty football tournament. We worked a long side with expert active, retired, Nigerian and international professional footballers as well as artists to bring out in mass fans and the community at large toward achieving our goals. Radio and television jingles were made to ensure maximum reach out to the masses. Social media hype was done where some selected players called on to their fans to get involved. An awareness 5-km walk was organized where kits (T-shirts, face caps, wrist bands) were sold in addition to the tickets for the tournament. Footballers signed on various T-shirts which were auctioned during the tournament as well as arts and jewelry. Program process: Active and retired footballers were engaged as well as prominent local artist to bring out crowd in mass crowd that benefitted in this campaign. All transactions made were through the foundation's account for credibility. Costs and returns: Costs: media and logistics - N1,000,000, walk kits and jerseys - N1,500,000, food and refreshments - N1,300,000, security - N200,000, event planners - N300,000, kids corner - N500,000. Total N4,800,000 Returns: tickets and coupon sales - N1,057,000, walk kits sold - N 3,050,000, players registration - N200,000, teams registration - N4,000,000, stands sold - N250,000, auctioned art - 1,000,000, auctioned jerseys - N1,500,000, auctioned jewelry - 250,000, donations received - N10,800,000. Total N22,107,000 What was learned: A lot can be achieved collectively as a community in reducing the burden of costs in the treatment of cancer.

Background and context: Breast cancer is the most common cancer among Nigerian women, mostly aged 35 years and older. The survival rate of breast cancer patient in northern Nigeria is 40% and below as compared with that of developed countries at 95% and above. The rising incidence of breast cancer in northern Nigeria is complicated, mainly due to cultural beliefs for incision by traditional rulers, poverty, illiteracy and fear of high cost of treatment. Aim: Breast cancer is the most common cancer among Nigerian women, mostly aged 35 years and older. The survival rate of breast cancer patient in northern Nigeria is 40% and below as compared with that of developed countries at 95% and above. The rising incidence of breast cancer in northern Nigeria is complicated, mainly due to cultural beliefs for incision by traditional rulers, poverty, illiteracy and fear of high cost of treatment. Strategy/Tactics: We made contact with two tertiary health facilities in Kebbi state to determine the baseline prevalence of stage 3 and 4 breast cancer in the hospitals. Organized cancer sensitization workshops for religious bodies to incorporate breast cancer awareness into sermons and also capacity building for nurses and traditional healers. Engaged the media through delivery of radio and television jingles on dangers of refusing medical care and also telling the stories of cancer survivors to enable the populace to be strong and brave to take charge of their health and quality of life. Program/Policy process: The entire communities were carried along. Tertiary health facilities provided support in giving access to relevant data. Permission from local government chairmen were sorted to interact with members of the communities. The general public were engaged through media. Outcomes: There was 30% increase in percentage of male participation especially spouses in encouraging women to seek appropriate help for breast cancer. Traditional healers and religious leaders had a positive impact in sensitizing women on need to attend hospitals for any breast changes early so as to reduce the incidence of late detected cases. They also alleviated avenues of stigmatization among the populace. Survivors were able to tell their stories via various media channels. What was learned: Majority of the target population lack access to basic health care. They patronize unorthodox medicine rather than clinical medicine. Cancer education and advocacy made a huge difference in health care perspective of this population. There is great need for continued cancer education and awareness to improve patients' survival and quality of life.

Background and context: Advancement in science and technology has been appropriately applied in the prevention of cervical cancer that it is not unreasonable to conclude that cervical cancer is potentially an eradicable disease. While there is significant reduction in both incidence and mortality from cervical cancer in developed countries that have instituted organized cervical cancer prevention programs, the incidence and mortality from cervical cancer in developing countries are either static or on the rise. This has been reported to be largely due to lack of organized cervical cancer screening program in developing countries despite the availability of effective screening methods appropriate for low resource settings. The challenges of planning a sustainable comprehensive cervical cancer control program in low resource settings are hereby highlighted based on experience from execution of Global Scholar's seed grant of American Cancer Society. Aim: To document innovative approach to overcoming challenges of planning a comprehensive cervical cancer care and control in low resource settings. Strategy/Tactics: The strategy recommended by Alliance for Cervical Cancer Prevention in Planning and Implementing Cervical Cancer Control Program: A guide for manager was adopted in planning of a comprehensive cervical cancer prevention program for Kebbi state. Program/Policy process: Learning from HIV program implementation, the program adopted policy of integration into existing health structure rather than creating a vertical program. Conscious effort was being made at every stage not to create impression of a special intervention program deserving extra pay for the healthcare professionals nor incentives other than good health for the clients. Outcomes: A local guideline was developed based on a trade-off consideration of evidence of efficacy, cost-effectiveness and sustainability within the context of prevailing local challenges. What was learned: Literature on cervical cancer prevention seems to be skewed in favor of search for appropriate screening method for low resource settings rather than programmability of cervical cancer prevention and control strategies. No individual component of cervical cancer prevention will impact on the burden of cervical cancer independent of the other components. For a cervical cancer program to be impactful, all the components; awareness creation, acceptable screening method, treatment and follow-up of screen positive women, call and recall of clients, treatment of invasive lesions must not only all be available (albeit at different levels of sophistications) but must also be linked. Rapidly evolving science ironically could pose a significant challenge to sustainable execution of a comprehensive cervical cancer prevention program in low resource settings if there is no guideline to guide interfacing of program with evolving science.