Exploring barriers to the delivery of cervical cancer screening and early treatment services in Malawi: some views from service providers

Abstract

BackgroundCervical cancer is the most common reproductive health cancer in Malawi. In most cases, women report to health facilities when the disease is in its advanced stage. In this study, we investigate service providers’ perceptions about barriers for women to access cervical cancer screening and early treatment services in Malawi.MethodsWe conducted in-depth interviews with 13 district coordinators and 40 service providers of cervical cancer screening and early treatment services in 13 districts in Malawi. The study was conducted in 2012. The district coordinators helped the research team identify the health facilities which were providing cervical cancer screening and early treatment services.ResultsAlmost all informants reported that cervical cancer was a major public health problem in their districts and that prevention efforts for this disease were being implemented. They were aware of the test and treat approach using visual inspection with acetic acid (VIA). They, however, said that the delivery of cervical cancer screening and early treatment services was compromised because of factors such as gross shortage of staff, lack of equipment and supplies, the lack of supportive supervision, and the use of male service providers. Informants added that the lack of awareness about the disease among community members, long distances to health facilities, the lack of involvement of husbands, and prevailing misperceptions about the disease (eg, that it is caused by the exposure to the VIA process) affect the uptake of these services.ConclusionWhile progress has been made in the provision of cervical cancer screening and early treatment services in Malawi, a number of factors affect service delivery and uptake. There is a need to continue creating awareness among community members including husbands and also addressing identified barriers such as shortage of staff and supplies in order to improve uptake of services.

Use of thermo‐coagulation as an alternative treatment modality in a ‘screen‐and‐treat’ programme of cervical screening in rural Malawi

“…19 There are acknowledged health system and cultural challenges to delivery of cervical screening in Malawi, 25,26 most pertinently that only one-third of facilities surveyed recently were able to provide treatment due to lack of cryotherapy equipment or gas. 27 There are also reports of patient satisfaction 28 and examples of successful integration with existing services. 23 The potential for overtreatment in screen-and-treat programmes with VIA is recognised.…”

Knowledge and Practices of Cervical Cancer among Married Men in Rural Phalombe?

“…Majority tend to seek health care when they have a problem. Munthali AC [25], suggests that effective prevention of cervical cancer largely depends on the screening coverage which is not consistent with these findings. Therefore as much as the Malawi government has included cancer in its essential health package, the prevention aspect needs to be expounded.…”

“…These findings are consistent with other findings from Mwaka [18] where participants said cervical cancer can be treated if diagnosed early [26] also found that participants believed that the medical personnel will treat them in case they are found with cervical cancer. These findings depict that health care in Malawi is more focused on the curative aspect than preventive 48 just as in many developing countries [25].…”

“…Often times married men are decision makers at the household level and mostly determine the kind of health care that their wives can access. Munthali, et al [25] reported that some women after cervical cancer screening refuse treatment to first consult their husbands. More than half of the participants mentioned that men as heads of families are responsible for making the decisions at home and this includes deciding whether the spouse should access cervical cancer screening.…”

Challenges in delivery and performance of a cervical cancer prevention program in the Kurdistan Region of the Iraq health system

“…21 Some of the women in the Ugandan study felt that transportation and distance hindered them from receiving services as they lived far from the hospital. 21 Munthali et al 22 also reported distance as a major barrier to accessing cervical cancer screening and early treatment in Malawi.…”