Cervical cancer screening: barriers to access and potential solutions for Nigeria

Abstract

In developed countries, giant strides have been made in reducing mortality due to cervical cancer. The success recorded has been largely attributed to effective screening programmes. In contrast, the burden and mortality due to this disease is rising in developing countries. Access to screening services remains a major challenge for the majority of the population at risk. This paper reviews the current demand-side barriers to cervical cancer screening in Nigeria and identifies potential solutions. Using academic databases and grey literature, a review was carried out to identify current screening modalities, barriers to access, and potential solutions. The current innovative method for control is early detection and treatment using "See and Treat" which involves visual inspection of the cervix with acetic acid (VIA) and cryotherapy. Lack of awareness, cost, and availability were identified as major barriers to access. Potential solutions feasible in the Nigerian context were categorized as financial and non-financial. The potential financial interventions include voucher schemes, conditional cash transfers, health equity, community loan funds, and prepayment mechanisms. Potential non-financial interventions that would be useful include raising awareness via health education and counseling, community participation, community based interventions, and pre-payment mechanisms.

A comparative analysis of cervical cancer prevention between Nigeria and Nordic countries that have experienced a decline in cervical cancer incidence

“…We also found that the implementation of screening in Nigeria is opportunistic with evidence suggesting that opportunities are not fully maximised by caregivers. 20 , 28 , 29 When reviewing the evidence, we found that organised screening was recommended over opportunistic screening because it was the deemed to be a more successful means of achieving full coverage. It is also touted to be cheaper and more cost-effective in the long run.…”

“… 54 Therefore, we do not discount the alleviating effect of subsidy; rather, we suggest that, in addition to offering screening free of charge or offering subsidies for screening alone, consideration should be given to a more complex package that may include health education interventions, individualised communication, treatment subsidies in the event of a positive screening outcome 32 and other means of incentivisation such as payment vouchers or prepayment schemes. 20 …”

“…It is also believed to be a more low-cost and low-technology method, especially when considering implemention in rural settings. 40 The evidence suggests that reducing or removing fees alone is insufficient to improve women's participation in cervical cancer screening initiatives in Nigeria, yet there are claims that the biggest barrier to healthcare access in Nigeria is finance, 20 hence we cannot simply disregard the usefulness of interventions that provide screening free of charge or at a subsidised rate. Prioritised programmes in Nigeria, like those for Malaria and HIV that are heavily subsidised by the government and donors, have achieved appreciable levels of success owing to this support.…”

“…54 Therefore, we do not discount the alleviating effect of subsidy; rather, we suggest that, in addition to offering screening free of charge or offering subsidies for screening alone, consideration should be given to a more complex package that may include health education interventions, individualised communication, treatment subsidies in the event of a positive screening outcome 32 and other means of incentivisation such as payment vouchers or prepayment schemes. 20 The invitational system used in the four Nordic countries, to invite all women targeted, requires cancer screening registries with information databases. This may not currently be feasible in the Nigerian setting, owing to lack of cancer registries, but there are existing structures that can be leveraged, such as the biannual Maternal, Newborn, Child Health Week, which is used to reach large numbers of the women in this defined target group.…”

“…18,19 In another study, screening gaps were attributed to demand-side barriers like cost and the nonavailability of local screening services. 20 These, and similar studies, [16][17][18][19]21,22 provide a basis for proposing solutions and charting a course forward towards progress.…”