Strategic Assessment of Cervical Cancer Prevention and Treatment Services in 3 Districts of India

Reproductive Health 2005 and BioMed Central
An Open Access Research article

Published 8 December 2005

Abstract (provisional)

Background
Despite being a preventable disease, annually cervical cancer claims the lives of almost half a million women worldwide each year. India bears one-fifth of the global burden of the disease, with approximately 130,000 new cases a year. In an effort to assess the need and potential for improving the quality of cervical cancer prevention and treatment services in Uttar Pradesh, a strategic assessment was conducted in three of the state's districts: Agra, Lucknow, and Saharanpur.

Methods
Using an adaptation of stage one of the World Health Organization's Strategic Approach to Improving Reproductive Health Policies and Programmes, an assessment of the quality of cervical cancer services was carried out by a multidisciplinary team of stakeholders. The assessment included a review of available literature, observations of services, collection of statistics and qualitative research (in-depth interviews and focus group discussions) to assess the perspectives of providers, policy influentials, community members and clients.

Results
Findings suggest tremendous need and potential for improvements in the quality of cervical cancer prevention and treatment services in all sectors. Despite the limited availability and poor organization of services, the capacity existed to improve quality, including access. There were gaps in provider knowledge and practices, potentially attributable to limited provider training and professional development opportunities. In the absence of a state policy on cervical cancer, screening of asymptomatic women was practically absent, except in the military sector. Laboratory based Pap testing was often erroneously used to help diagnose women with symptoms of reproductive tract infections. Access to appropriate treatment of precancer was limited and often inappropriately managed by hysterectomy in many urban centers. Cancer treatment facilities were well equipped but similarly inaccessible to women in need. Finally, policy influentials, community members and clients were mostly unaware about cervical cancer and its preventable nature, although with information, expressed a strong interest in having services available to women in their communities.

Conclusions
To address gaps in services and existing unmet need, state policies and integrated interventions have the potential to improve the quality of services and prevent cervical cancer in Uttar Pradesh.

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© 2005

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