Practice Cervical Cancer Screening and Treatment in FGAE Clinics

Background and context: In 2010, it was estimated that 20.9 million women were at risk for developing cervical cancer in Ethiopia and the estimated annual number of cervical cancer cases and deaths was 4648 and 3235, respectively. The Family Guidance Association of Ethiopia (FGAE), established in 1966 has been working with solid commitment to contribute to the national effort to improve the reproductive health of women, men and young people through providing quality and integrated sexual and reproductive health (SRH) services. Cervical cancer screening services using Papanicolaou test, FGAE began in 1990 and in 1994 the service was expanded to eight higher clinics. Aim: To integrate single visit approach with visual inspection with acetic acid (VIA) screening and cryotherapy to the existing SRH services. Strategy/Tactics: FGAE has provided an integrated quality SRH services through 42 service delivery points, 222 outreaches and 324 franchised clinics. Based on this, this strategy is developed to ensure that VIA and cryotherapy can be successfully integrated to the current SRH service package, such as demand generation, improve access to integrated quality SRH services, capacity building, strengthening partnership and quality assurance system and scaling up SRH/CCP service to private and public facilities. Program/Policy process: FGAE continued Papanicolaou test services, and promoted single visit approach, which combines visual inspection with acetic acid (VIA) screening and cryotherapy. In 2013, this approach was introduced to 5 higher FGAE clinics following the pilot study. Since 2015, all eight higher FGAE clinics and its GYN/OB specialty clinics have successfully integrated single visit approach to the exiting SRH services. Facility readiness was assessed and gaps were filled. Partnership with FMoH and other government institutions public and private health facilities and companies were established to scale up services and set up referral pathways. Data on service utilization were recorded using manual and electronic tools and national algorism for screening and treatment was applied. Regular mentoring and supervision was carried out to ensure quality and performance. Outcomes: Data for a period of 2010-2017 on cancer screening and treatment by FGAE were analyzed and shows that a total of 79,286 women were screened. The overwhelming majority of the screened women (96.2%) were age 25 and above. For women who chose VIA, 10.3% of them received positive result. 6164 were treated with cryotherapy while 12 women was referred as a suspected case of invasive cancer. The number of women screened has increased from 805 in 2010 to 79,286 in 2017. What was learned: The proportion of women tested positive for precancerous cervical lesion in FGAE clinics is high and comparable with national estimates of 12.3%. Integrating single visit approach into SRH services is feasible and effective in identifying and treating precancerous cervical lesions.