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Implementing cervical screening in South Africa: Lessons learnt

Jennifer Moodley, MBChB MMed1, M Kawonga2, J Bradley3, M Hoffman1, V Daries1, and E Robertson2. (1) School of Public Health and Family Medicine, Women's Health Research Unit, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa, 27 21 406 6504, jmoodley@cormack.uct.ac.za, (2) School of Public Health, Women's Health Project, University of the Witwatersrand, P.O. Box 1038, Johannesburg, South Africa, (3) EngenderHealth, 440 Ninth Avenue, New York, NY 10001

Introducion: Cervical cancer is a preventable disease, yet in South Africa 1 in 29 women will develop cervical cancer in their lifetime. Recently a policy was introduced stating that women over 30 should have 3 free Pap smears, 10 years apart, in their lifetime. This policy presents a challenge to managers tasked with translating policy into action. It was in this context that the Cervical Health Implementation Project was initiated with the aim of developing, testing and evaluating health system interventions for improving screening services.

Methods: The project was conducted between 2001 and 2003 in 3 districts in South Africa. Baseline surveys were conducted to: assess knowledge, attitude and practice of potential clients and health providers and, describe the provision of cervical screening services. Based on the findings of these surveys a series of interventions was developed and implemented. Post intervention surveys were then conducted. Data on coverage, smear adequacy and client management were also collected.

Results: Staff knowledge, attitudes and practices improved and this led to improved services. However there were still numerous missed opportunities for screening among clinic attendees. Efforts to improve referral and feedback, health information and cytology reporting systems proved challenging and are barriers for optimal client management. Two guides: a guide for program managers and a guide for trainers were developed, based on lessons learnt from this project. The implications of the findings for cervical screening programs in developing countries will be discussed.

Learning Objectives: At the end of this session, participants will be

Keywords: Cervical Cancer, Screening

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Population, Family Planning, and Reproductive Health Roundtables

The 132nd Annual Meeting (November 6-10, 2004) of APHA