A proposal for cervical screening information systems in developing countries

Abstract

The effective and efficient delivery of cervical screening programs requires information for planning, management, delivery and evaluation. Specially designed systems are generally required to meet these needs. In many developing countries, lack of information systems constitutes an important barrier to development of comprehensive screening programs and the effective control of cervical cancer. Our report outlines a framework for creating such systems in developing countries and describes a conceptual model for a cervical screening information system. The proposed system is modular, recognizing that there will be considerable between-region heterogeneity in current status and priorities. The proposed system is centered on modules that would allow for the assembly and computerization of data on Pap tests, since these represent the main screening modality at the present time. Additional modules would process data and create and maintain a screening database (e.g., standardize, edit, link and update modules) and allow for the integration of other types of data, such as cervical histopathology results. An open systems development model is proposed, since it is most compatible with the goals of local stakeholder involvement and capacity-building. © 2002 Wiley-Liss, Inc. Key words: cervical screening; organized screening; information systemsThe effective and efficient delivery of cervical screening programs requires information for program planning, management, delivery and evaluation. In most settings, special information systems are required to meet these needs. Ideally, organized screening programs should have information systems that cover all aspects of screening and follow-up. However, in many situations, information systems that cover some program aspects already exist; for example, some programs are built around laboratory information systems. [1][2][3][4] In these settings, the program system must often be built to be compatible, as much as possible, with existing systems. Regardless, without an effective information system, it is not possible to run an organized cancer screening program, nor is it possible to evaluate whether it is operating as expected or achieving program objectives. Information systems are often considered stand-alone but must be integrated into existing health care information systems.Two important documents describe ideal information system goals and components. 5,6 However, few developing countries have been able to put such systems in place, despite recognizing the need for organized screening. Population registers are essential to the ideal system as envisaged by Miller 6 and others. 7 Successful cervical cancer screening programs (as measured by the rate of decline in cervical cancer incidence and mortality) supported by such systems have existed for some time in the Nordic countries, where population registers are integral to the countries' administrations. 8,9 More recently, impressive declines in cervical cancer mortality have been demonstrated in Australia (from a rate of 4.8 p...

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