Health systems challenges in cervical cancer prevention program in Malawi

Abstract

BackgroundCervical cancer remains the leading cause of cancer death among women in sub-Saharan Africa. In Malawi, very few women have undergone screening and the incidence of cervical cancer is on the increase as is the case in most developing countries. We aimed at exploring and documenting health system gaps responsible for the poor performance of the cervical cancer prevention program in Malawi.DesignThe study was carried out in 14 randomly selected districts of the 29 districts of Malawi. All cervical cancer service providers in these districts were invited to participate. Two semi-structured questionnaires were used, one for the district cervical cancer coordinators and the other for the service providers. The themes of both questionnaires were based on World Health Organization (WHO) health system frameworks. A checklist was also developed to audit medical supplies and equipment in the cervical cancer screening facilities. The two questionnaires together with the medical supplies and equipment checklist were piloted in Chikwawa district before being used as data collection tools in the study. Quantitative data were analyzed using STATA and qualitative in NVIVO.ResultsForty-one service providers from 21 health facilities and 9 district coordinators participated in the study. Our findings show numerous health system challenges mainly in areas of health workforce and essential medical products and technologies. Seven out of the 21 health facilities provided both screening and treatment. Results showed challenges in the management of the cervical cancer program at district level; inadequate service providers who are poorly supervised; lack of basic equipment and stock-outs of basic medical supplies in some health facilities; and inadequate funding of the program. In most of the health facilities, services providers were not aware of the policy which govern their work and that they did not have standards and guidelines for cervical cancer screening and treatment.ConclusionNumerous health system challenges are prevailing in the cervical cancer prevention program in Malawi. These challenges need to be addressed if the health system is to improve on the coverage of cervical cancer screening and treatment.

Challenges in delivery and performance of a cervical cancer prevention program in the Kurdistan Region of the Iraq health system

“…As the number of health providers was inadequate to meet patients’ needs, it is necessary to train enough healthcare providers. This finding was consistent with that of Maseko et al . However, Townsend et al .…”

“…24 The present study found that primary healthcare centers in the Kurdistan Region of Iraq lacked sufficient equipment and supplies. This finding was similar to that of Maseko et al, 23 who reported unavailability of drugs and medical supplies; referral system; human resources;…”

“…As the number of health providers was inadequate to meet patients' needs, it is necessary to train enough healthcare providers. This finding was consistent with that of Maseko et al 23 However, Townsend et al 24 reported that healthcare providers in the US Affiliated Pacific Islands were generally well trained regarding cervical cancer and prevention strategies. 24 The present study found that primary healthcare centers in the Kurdistan Region of Iraq lacked sufficient equipment and supplies.…”

Use of thermo‐coagulation as an alternative treatment modality in a ‘screen‐and‐treat’ programme of cervical screening in rural Malawi

“…An early demonstration pilot found VIA positivity rates of 12.4%, but limited ability to provide same‐day treatment . There are acknowledged health system and cultural challenges to delivery of cervical screening in Malawi, most pertinently that only one‐third of facilities surveyed recently were able to provide treatment due to lack of cryotherapy equipment or gas . There are also reports of patient satisfaction and examples of successful integration with existing services …”

A review of patients with advanced cervical cancer presenting to palliative care services at Queen Elizabeth Central Hospital in Blantyre, Malawi

“…Opportunities for screening may be missed, 2 and delivery of screening services is beset by multiple challenges. 3 Invasive cancer of the cervix is categorised as a WHO stage IV AIDSdefining condition. This means that all women with this condition who test positive for HIV qualify automatically to start on highly active antiretroviral therapy (HAART), irrespective of CD4 count.…”