Expanding Cervical Cancer Screening and Treatment in Tanzania: Stakeholders’ Perceptions of Structural Influences on Scale-Up

Abstract

Tanzania has the highest burden of cervical cancer in East Africa. This study aims to identify perceived barriers and facilitators that influence scale-up of regional and populationlevel cervical cancer screening and treatment programs in Tanzania. Convenience sampling was used to select participants for this qualitative study among 35 key informants. Twenty-eight stakeholders from public-sector health facilities, academia, government, and nongovernmental organizations completed in-depth interviews, and a seven-member municipal health management team participated in a focus group discussion. The investigation identified themes related to the infrastructure of health services for cervical cancer prevention, service delivery, political will, and sociocultural influences on screening and treatment. Decentralizing service delivery, improving access to screening and treatment, increasing the number of trained health workers, and garnering political will were perceived as key facilitators for enhancing and initiating screening and treatment services. In conclusion, participants perceived that system-level structural factors should be addressed to expand regional and population-level service delivery of screening and treatment. The Oncologist 2015; 20:621-626 Implications for Practice: Tanzanian women have a high burden of cervical cancer. Understanding the perceived structural factors that may influence screening coverage for cervical cancer and availability of treatment may be beneficial for program scale-up.This study showed that multiple factors contribute to the challenge of cervical cancer screening and treatment in Tanzania. In addition, it highlighted systematic developments aimed at expanding services. This study is important because the themes that emerged from the results may help inform programs that plan to improve screening and treatment in Tanzania and potentially in other areas with high burdens of cervical cancer.

Assessment of the scale‐up of cervical cancer screening in Abidjan stratified by HIV status

“…The reasons for postponing cryotherapy among women eligible for the see‐and‐treat approach were mainly related to logistic constraints such as an irregular gas supply, low maintenance of cryotherapy devices, and shortage of trained healthcare workers. Similar barriers have been reported in Tanzania and Burkina Faso, highlighting the need for sufficient and sustained financial support dedicated to this screening activity in participating facilities . To overcome some of these challenges, the introduction of thermocoagulation as an alternative to cryotherapy might mitigate the issue of gas supply and device maintenance, as previously demonstrated in Malawi .…”

Setting up a community-based cervical screening service in a low-income country: a pilot study from north-western Tanzania

“…In sub-Saharan Africa, decentralisation is a key facilitator for initiating regional programmes for cervical screening (McCree et al 2015 ). In our data, however, the high occupational profile of attending women suggested that socioeconomic selection factors are frustrating, at least in part, our efforts to target the rural population.…”

Factors influencing the uptake of cervical cancer screening services in Tanzania: A health system perspective from national and district levels

“…These initiatives aim at achieving one of the goals of the National Cancer Control Strategy—2013–2022 of reducing the burden (morbidity, disability and premature mortality) related to non‐communicable diseases in Tanzania by 20% by 2020 (United Republic of Tanzania Ministry of Health & Social Welfare, ). The initiatives also intend to achieve the goal of non‐communicable diseases (NCD) strategic plan to control and prevent cancer for 2016–2020, which is 50% increase in proportion of patients detected with early‐stage cancer (McCree et al, ; Moshi et al, ; United Republic of Tanzania, Ministry of Health, Community Development, Gender Elderly & Children, ). In addition, the MoHCDGEC established the Reproductive Health‐Cancer Unit to deal with cervical cancer (Moshi et al, ).…”