Healthcare system challenges to the provision of cervical cancer screening in Uganda

Abstract

Cervical cancer, despite being a preventable and curable disease, is the most commonly diagnosed female cancer in Uganda. Previous studies have sought to understand the challenges to the delivery and uptake of cervical cancer screening services in Uganda, but these studies were conducted in tertiary hospitals in cities and are not representative of the health facilities in which the majority of Ugandan women receive care. Therefore, the aims of my research were to understand the factors that contribute to the low provision of cervical cancer screening services in rural Northern Uganda, to establish the knowledge, attitudes, and practices of cervical cancer prevention among rural health workers in Northern Uganda, to understand the policy environment that contributes to low service provision, and to identify strategies that can be used to develop and deliver a robust and sustainable cervical cancer policy that can address the barriers to cervical cancer screening. The thesis is a series of published peer-reviewed articles that form Chapters Two to Five. The first article, which comprises Chapter Two, reported that most health workers were not screening women due to structural barriers, including a lack of training and equipment/consumables. The second paper reported that health workers had gaps in knowledge of the specific cervical cancer risk factors, signs and symptoms, and prevention methods. The third article was about the key informants’ belief that the absence of a cervical cancer policy in Uganda has affected the implementation of a cervical cancer prevention programme. The fourth paper reported that the policy context is lacking a policy to support cervical cancer screening, but importantly, lacks fundamental contextual requirements for a policy to be developed and successfully implemented. Therefore, the government of Uganda should develop a comprehensive cervical cancer policy that will address the healthcare system barriers to cervical cancer screening and provide for a cervical cancer screening programme to be run concurrently with a public health education programme to address myths about cervical cancer screening to improve screening utilisation and coverage. Improving coverage and utilisation of cervical cancer screening among age-eligible women will contribute towards the reduction of the cervical cancer burden in Uganda.