Challenges of Planning a Sustainable Comprehensive Cervical Cancer Prevention Program in Low-Resource Settings

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.