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.
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:
- Improving policies, guidelines and standards for streamlined quality assurance.
- Increasing the efficiency and effectiveness of service delivery.
- Strengthening regulatory framework, implementation, and enforcement.
- 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 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.
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.
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.
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].
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.
I-TECH will continue to support 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.