Barriers to Cervical Cancer Screening in Rural Kenya: Perspectives from a Provider Survey

Abstract

Although cervical cancer is highly preventable through screening, it remains the number one cause of cancer-related death in Kenyan women due to lack of funding and infrastructure for prevention programs. In 2012, Family AIDS Care and Education Services in partnership with the Kenya Ministry of Health began offering free screening at eleven rural health facilities. We sought to explore why screening coverage remains low at some sites. We examined the barriers to screening through a survey of 106 healthcare staff. The most frequently cited barriers to service delivery included staffing shortages, lack of trained staff, insufficient space, and supply issues. The patient barriers commonly perceived by the staff included inadequate knowledge, wait time, discomfort with male providers, and fear of pain with the speculum exam. Despite multilateral efforts to implement cervical cancer screening, staff face significant challenges to service provision and increased education is needed for both providers and patients.

Barriers and Facilitators to Cervical Cancer Screening, Diagnosis, Follow-Up Care and Treatment: Perspectives of Human Immunodeficiency Virus-Positive Women and Health Care Practitioners in Tanzania

“…The providers cited a lack of confidence due to limited training in screening and treatment of precancerous lesions. These findings are not unique and have been found in surveys of health care providers in similar environments such as Kenya . In addition, limited space and equipment hampered attempts at screening.…”

Challenges to early detection of cervical cancer at primary healthcare level in Resource limited settings; a descriptive study.

“…They reported that the basic equipment for screening service, including examination table, light source and speculums, were available (94.3%, 81.6% and 97.7%, respectively). Contrary to these findings, inadequate infrastructures and insufficient basic equipment and supplies are repeatedly reported to be among the challenges to cervical cancer screening in resource limited settings (13,14).…”

“…Each was involved at different levels of cervical cancer services such as the actual VIA/VILI screening, patient education or filling entry forms (14). Considering the current critical shortage of healthcare professionals in the developing world, this approach in Kenya of training clinicians and non-clinicians in the provision of cervical cancer care services needs to be replicated in other low-resource countries in need of establishing organized and working cervical cancer prevention programs 14 . In Rwanda, community health workers have contributed significantly to decreased maternal morbidity and mortality through increased adherence to prenatal care follow up and increased health facility deliveries (15).…”

“…These findings are similar to other limited-resource countries where shortages of staff, specifically those trained in cervical cancer screening, are reported. The survey done in Kenya evaluating providers' perceptions on barriers to cervical cancer screening found that 62% reported inadequate staffing as the primary barrier to cervical cancer service delivery and 60% reported the limited number of trained staff as the primary barrier (14). Similarly, findings in Malawi showed lack of readily available staff to offer cervical cancer screening and prevention services (13).…”

Addressing socio-cultural barriers to family planning and co-designing services to improve utilization: evidence from northern Nigeria

“…In many of the facilities, only one provider was available to provide family planning and other services, a situation that often lead to providers being overworked under pressure and prone to exhaustion and stress. Manpower shortages in the right number and skill mix has been documented to be a major obstacle in provision of quality health services including family planning in Nigeria and several other similar settings in sub-saharan Africa [24,25].…”