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I-TECH Team Contributes to New WHO Recommendations for Cervical Cancer Screening and Treatment

After two years of collaborative work, the World Health Organization (WHO) today launched a critical publication to aid health care workers in the march toward cervical cancer elimination: The WHO Guidelines for Screening and Treatment of Cervical Pre-Cancer Lesions for Cervical Cancer Prevention.

The guidelines contain evidence-based recommendations for cervical cancer screening and were created in the context of the WHO global strategy to accelerate the elimination of cervical cancer, as well as the need to provide screening and prevention services to all women around the globe.

Dr. Linda Eckert–University of Washington (UW) Professor of Obstetrics & Gynecology, Adjunct Professor of Global Health, and technical advisor to I-TECH’s cervical cancer programs in Namibia, Malawi, and Botswana–served as one of the lead consultants coordinating the WHO guidelines.

“It has been a true privilege to join with WHO colleagues to collect and synthesize data and work with cost effectiveness modelers and our 60-member multinational Guideline Development Group, who shared their immense experience and knowledge to create these evidence-based guidelines,” said Dr. Eckert. “It is so hopeful for women around the globe, and I feel inspired thinking about how many women can be spared the suffering of cervical cancer through implementation of these guidelines.”

Dr. Laura Muzingwani, the lead physician for I-TECH’s Cervical Cancer Prevention Program in Namibia, was also an active member of the Guideline Development Group. Her experience and expertise in cervical cancer screening and treatment in Namibia enabled her to offer valuable guidance in the crafting of these recommendations.

In addition to the UW, contributing partners in the project included McMaster University, the London School of Hygiene and Tropical Medicine, the Clinton Health Access Initiative, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the United States Agency for International Development (USAID), and Unitaid, among others.

I-TECH Helps to Improve Health Regulatory Systems and Training Programs in Cambodia

Pictured are mannequins used at two regional training centers for nurses, midwives, and dental nurses in Kampong Cham and Battambang, Cambodia. I-TECH has supported the procurement of new mannequins to replace those that are old or broken, as well as new teaching tools that will expand the centers’ ability to conduct simulation training. Photo credit: Ann Downer/I-TECH.

The International Training and Education Center for Health (I-TECH) is working on a project led by FHI360, and funded by the U.S. Agency for International Development (USAID), to empower health care managers and national and provincial stakeholders to improve service quality, safety, and utilization, as well as strengthen overall health systems in Cambodia.

The project’s four objectives include:

  1. Improving policies, guidelines and standards for streamlined quality assurance.
  2. Increasing the efficiency and effectiveness of service delivery.
  3. Strengthening regulatory framework, implementation, and enforcement.
  4. Supporting pre-service public health training.

Given I-TECH’s deep experience in health workforce development, supporting the environments that enable strong health systems, and working with stakeholders at all levels, the team was a natural fit for Objectives 3 and 4.

In service of this critical work, I-TECH is supporting implementation of regulations among private and public health workers, as well as helping to lay the foundation for a sustainable accreditation program for public and private health facilities. I-TECH’s team also works with national stakeholders to develop the capacity of pre-service training institutions to deliver high-quality programs aligned with current evidence and national health priorities.

“We are excited to work with our partners to strengthen these critical components of quality health services in Cambodia,” said Jeff Lane, Principal Investigator and Assistant Professor in the Department of Global Health.

“By leveraging I-TECH’s broad experience in health policy, regulation, and workforce development,” he continued, “we can help Cambodia build an accreditation program to recognize high-performing hospitals, strengthen health professional councils to regulate health practitioners, and build sustainable pre-service training institutions that deliver competency-based education to train Cambodia’s health care workers of tomorrow.”

Cervical Cancer Screening and Treatment Strategy Support in Malawi

Cervical cancer is the leading cause of cancer death among women in Malawi. In response, the Ministry of Health (MOH) in Malawi developed a five-year National Cervical Cancer Control Strategy for 2016-2020. The strategy outlines comprehensive interventions, including the integration of cervical cancer screening services into HIV care.

In 2019, I-TECH supported the review and update of the National Cervical Cancer Guidelines and the accompanying monitoring and evaluation (M&E) framework in partnership with the Department of Reproductive Health and the Department of HIV/AIDS in Malawi. Training materials were developed in accordance with the updated guidelines and trainings rolled out across the country. As part of their support, the I-TECH team conducted a needs assessment to establish which sites in the Southwest Zone had received equipment for cervical cancer screening and treatment services. At that time, they found only 45 health facilities that offered these services to women. Just two years later (as of June 2021), there are at least 357 health facilities (46.1% of all HIV treatment sites in Malawi) currently providing cervical cancer screening services and 211 providing treatment services. Integration with HIV/AIDS programming has resulted in the screening of 79,171 HIV positive women (52.4% of all women screened), with 4,506 (6%) obtaining a screen positive test result and 1,584 (35% of those with a screen positive result) receiving treatment in 2020.

All women and girls (inclusive of HIV positive women) reached with cervical cancer prevention, screening, and treatment services in 2020 is illustrated in the following graph:

I-TECH also led the development of a cervical cancer Client Diagnosis and Treatment Register that is used in hospitals providing cervical cancer treatment in Malawi. This register helps to provide critical data for programmatic decision making, like confirmed cases, deaths, as well as data on cancer staging and the number of women receiving treatment.

To ensure that the strategy continues to endorse current evidence-based approaches and M&E frameworks, the team convenes regular cervical cancer partner meetings to review standard operating procedures and the M&E framework, revise monitoring tools, and conduct situational analyses. I-TECH is also part of the team providing technical guidance on development of the strategic plan for 2021-2025.

In addition to contributing to national strategy updates, I-TECH is working with MOH to ensure same-day treatment or follow-up for all pre-cancerous lesions found among women screened.

HIS Strategic Planning in Cameroon

National strategies, policies, and governance define the implementation environment for health information systems (HIS) and are recognized as a foundational building block for health system goals, including universal health coverage and control of HIV and other infectious diseases. I-TECH is supporting Cameroon’s Ministry of Health (MOH) to develop a national eHealth strategic plan by September 2019. A goal of the project will be to develop governance structures and processes, which can continue onward beyond the strategic planning process under MOH leadership, for on-going strategic direction, coordination, and oversight of investments in the national HIS.

Enhancing Quality of Healthcare Activity in Cambodia

The overall goal of the Enhancing Quality of Healthcare Activity (EQHA) program in Cambodia is to improve the quality of public and private health services in national and sub-national health systems by August 2023. The project, funded by the US Agency for International Development (USAID), is being implemented by Family Health International (FHI360) in collaboration with I-TECH and other partner organizations. I-TECH’s scope of work focuses on improvements to 1) the national health policy regulatory framework and 2) national pre-service health education and training institutions.

Continue reading “Enhancing Quality of Healthcare Activity in Cambodia”

Nursing Efficiency and Task-Sharing in Tanzania

I-TECH Tanzania led the development of the task-sharing policy guidelines for Health Sector Services approved in 2016 as well as the policy’s operational plan. While task-sharing is a widely known HIV service delivery efficiency strategy, still there is continues gaps between national strategies and actual implementation at the site-level [1,2].

Continue reading “Nursing Efficiency and Task-Sharing in Tanzania”

Formulating Guidelines and Operating Procedures in India

I-TECH India PL is part of various national ART and testing guideline groups of NACO in India, including Journey of ART Programme in India; HTS Guidelines; ART Guidelines for HIV-Infected Adults and Adolescents, May 2013; National Guidelines on Second-line and Alternative First-line ART For Adults and Adolescents, May 2013; Operational Guidelines for ART Centers, July 2012; HIV/TB Guidelines, 2015; and National ART Technical Guidelines, October 2018 (http://www.naco.gov.in/care-support-treatment).

The team also assisted NACO in designing standard operating procedures for implementing newer program initiatives such as Treat All, Pre-ART mop-up, co-located ART and OST (Oral Substitution Therapy) Centres, ART through targeted intervention programs, and multi-month dispensation of ART.

Health Policy System Strengthening in South Africa

I-TECH supported the National Department of Health (NDoH) in the process of strengthening the policy management and implementation systems with a focus on reaching the 95-95-95 targets and provided ongoing technical assistance as the NDoH beta tested the policy information management system (PIMS) developed in COP 2017.

I-TECH supported the revision and finalization of a Policy Manual and coordinated with the NDoH Policy Project Steering Committee to promote engagement from NDoH staff.

Aaron Katz

Aaron Katz is a principal lecturer emeritus of Health Services, Global Health (adjunct), and Law (adjunct) at the University of Washington School of Public Health where he teaches several graduate level courses in health policy. He also has an adjunct appointment at the University of Queensland (Australia) School of Public Health. Aaron has held numerous academic leadership positions, including his current role as faculty coordinator of the Health Systems and Policy Concentration of the Health Services Master of Public Health (MPH) program and was founding director of the Leadership, Policy, and Management track of the Global Health MPH program. He was director of the UW Health Policy Analysis Program from 1988 until 2003 and editor-in-chief of the School’s biannual journal, Northwest Public Health, from 1999 to 2008.

Aaron received the American Public Health Association’s Award for Excellence in November 2006 and the Outstanding Teaching Award from the UW School of Public Health in 2004. At the 2011 “State of Reform” Washington Health Policy Conference, Aaron received the Health Reform Leadership Award.

Aaron has developed a deep understanding of the U.S. health care system and its strengths and weaknesses during a career that has spanned 40 years and four “bouts” with health care reform. He has worked in health policy and planning in Washington state since 1978, serving as a health planner, policy and planning consultant, lobbyist, and political adviser. Aaron has directed numerous policy analysis and policy development projects for legislative bodies, state and local public agencies, and private sector clients, including work on health system reform, public health reform, managed care, rural access, HIV/AIDS, workers compensation, long term care, medical economics, and services for people with low incomes. Since 1999, Aaron has collaborated on policy development and advocacy projects with colleagues in various countries in southern Asia, sub-Saharan Africa, Latin America, and Japan.

Aaron has served as a peer reviewer of articles for the International Journal for Equity in Health, Health Affairs, Journal of Health Care for the Poor and Underserved, Global Health Action, and the American Journal of Public Health. He has served on numerous community boards, including the Washington State Budget and Policy Center, Northwest Health Law Advocates, Washington Physicians for Social Responsibility, and Health Alliance International.

Aaron received a bachelor of science degree from the University of Wisconsin – Madison in 1974 and a certificate [master] of public health degree from the University of Toronto in 1975.

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Jeff Lane

Jeff Lane, JD, MPH, is an Assistant Professor with the University of Washington Department of Global Health and is an affiliated faculty member with University of Washington’s (UW) International Training and Education Center for Health (I-TECH). From 2010-2015, Jeff worked on the PEPFAR Policy Monitoring Project that built capacity of PEPFAR partner countries to develop and monitor health law and policy reforms critical to HIV/AIDS program scale-up and sustainability. Jeff co-led the South Africa health policy systems strengthening project, which worked with the National Department of Health of South Africa to strengthen its health policy management processes and information systems.

During his career, Jeff has worked to strengthen health policy and regulatory environments in Cambodia, Dominican Republic, Ghana, Haiti, Kenya, Malawi, Nigeria, South Africa, Tanzania, Uganda, the United States, and Zambia. Jeff’s research interests focus on how policy development and implementation impacts public health around the world and specifically on access to essential medicines and health services. Jeff teaches a graduate level course every spring titled Policy Development and Advocacy for Global Health (GH523). Jeff received his Juris Doctorate and Masters of Public Health from UW.

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