Cervical cancer screening decentralized policy adaptation: an African rural-context-specific systematic literature review

ABSTRACT

Background: Worldwide, nearly 570,000 women are diagnosed with cervical cancer each year, with 85% of new cases in low- and middle-income countries. The African continent is home to 35 of 40 countries with the highest cervical cancer mortality rates. In 2014, a partnership involving a rural region of Senegal, West Africa, was facing cervical cancer screening service sustainability barriers and began adapting regional-level policy to address implementation challenges.

Objective: This manuscript reports the findings of a systematic literature review describing the implementation of decentralized cervical cancer prevention services in Africa, relevant in context to the Senegal partnership. We report barriers and policy-relevant recommendations through Levesque’s Patient-Centered Access to Healthcare Framework and discuss the impact of this information on the partnership’s approach to shaping Senegal’s regional cervical cancer screening policy.

Methods: The systematic review search strategy comprised two complementary sub-searches. We conducted an initial search identifying 4272 articles, then applied inclusion criteria, and ultimately 19 studies were included. Data abstraction focused on implementation barriers categorized with the Levesque framework and by policy relevance.

Results: Our findings identified specific demand-side (clients and community) and supply-side (health service-level) barriers to implementation of cervical cancer screening services. We identify the most commonly reported demand- and supply-side barriers and summarize salient policy recommendations discussed within the reviewed literature.

Conclusions: Overall, there is a paucity of published literature regarding barriers to and best practices in implementation of cervical cancer screening services in rural Africa. Many articles in this literature review did describe findings with notable policy implications. The Senegal partnership has consulted this literature when faced with various similar barriers and has developed two principal initiatives to address contextual challenges. Other initiatives implementing cervical cancer visual screening services in decentralized areas may find this contextual reporting of a literature review helpful as a construct for identifying evidence for the purpose of guiding ongoing health service policy adaptation.

KEYWORDS:

• Implementation
• partnership
• global health
• visual inspection of the cervix with acetic acid
• gynecologic cancer

Responsible Editor Jennifer Stewart Williams, Umeå University, Sweden

Responsible Editor Jennifer Stewart Williams, Umeå University, Sweden

Acknowledgments

The authors would like to acknowledge and thank the following individuals and institutions:

Mariama Touré Diarra, Dr. Abib Ndiaye, Dr. Abdoul Aziz Kassé, Dr. Manuel Pina, Dr. Cheikh Senghor, Dr. Evrard Kabou, Landing Sagna, Mamadou Diaw, Chris Hedrick, Vanessa Dickey, Maureen Cunningham, Cheryl Faye, Adji Thiaw, Pape Camara, Imane Sene, Dr. John Hickner, Dr. Stevan Weine, Dr. Rithvik Balakrishnan, Tina Schuh, Dr. Paul Rotert, Dr. Tracy Irwin, Dr. Marielle Goyette, Chris Coox, Nicole Aspros, Sarah Mollenkopf, Aaron Persing, Tess Komarek, Elle De Jesus, Laurie Ohlstein, Emily Johnson, Arielle Kempinsky, Lesa Young, Carmen Dibaya, Maria Castrillon, Zola Collins, Ethan Quinn, Gracey McGrory, Aaron Macoubray, Sherry Vazhayil, Ashley Prettyman, Hans-Martin Ishida, Brendan Gray, Elizabeth Costello, Emma Murphy, Ellen Hendrix, Cason Kirby, and Catherine Lind, and the University of Illinois at Chicago Department of Family Medicine and the Center for Global Health. We are grateful for funding through the Centers for Disease Control and Prevention and the UIC Department of Family Medicine that enabled the partnership to respond to identified barriers through the development of a quality improvement program.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethics and consent

This paper does not require ethical clearance or consent as it is based entirely on material from secondary published sources and the authors’ own insights and experience.

Paper context

In 2014, a partnership involving a rural region of Senegal was facing cervical cancer screening service sustainability barriers and began adapting regional-level policy to address implementation challenges. This literature review empowered the partnership to develop a strategic plan to address major structural challenges including workforce retention and client uptake, among others. This article reports the literature review as well as a narrative describing the evolution of the service implementation and policy adaptation since 2014.

Additional information

Funding

This work was supported and funded by the UIC Department of Family Medicine and the US Centers for Disease Control and Prevention, Prevention Research Centers Program [Cooperative agreement: #3U48DP005010-02S2]. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Notes on contributors

M. D. Clark

All authors contributed to the conception and design of the study (RR, MC, FT, EMD, YN, KEP, ELD, MH, JAD) or to the acquisition, analysis, and interpretation of data (ZRC, HT, ND, TK, AML, PEL, KEW, MC, CEP), and drafted the manuscript (RR, MC, JAD) or revised it critically for content (ZRC, FT, EMD, HT, YN, ELD, ND, KEP, TK, AML, PEL, KEW, MC, MH, CEP). All authors read and approved the final manuscript.