Abidjan, Côte d’Ivoire—While touring the Meagui Urban Health Center last fall, Dr. Jean Claude Kouassi Comoe took pride in the roomful of women listening carefully to a midwife describe the cervical cancer prevention and treatment services they would receive. Between 2009 and 2015, more than 36,000 women in Côte d’Ivoire received screening and treatment services that reduced their risk of developing cervical cancer.
Today, Meagui Urban Health Center is among the 91 health facilities that offer same-day cervical cancer screening and treatment services through the National Program for Cancer Treatment and Prevention (PNLCa) and Ministry of Health (MOH). With technical support from Jhpiego, in 2009, the MOH introduced the low-cost, safe and effective single visit approach, which includes visual inspection of the cervix with acetic acid (VIA), followed by an offer of same-day treatment for women who screen positive. Before then, women in Côte d’Ivoire could only receive cervical cancer screening through a Pap smear test in two teaching hospitals, both located in the same region.This limited screening provision often led to later cervical cancer diagnosis and a higher death rate.
Jhpiego’s work in Côte d’Ivoire generated the will and skills within the MOH and PNLCa to build a sustainable cervical cancer prevention program. The MOH and PNLCa have successfully taken ownership of the program and have increased the number of skilled providers and sites offering high-quality services.
Jhpiego’s cervical cancer prevention project, funded by the United States Centers for Disease Control and Prevention, brought the screen-and-treat approach to 20 sites in Côte d’Ivoire. A strategy to expand access included the integration of cervical cancer prevention services into routine care and treatment of women living with HIV. The government then expanded this work, with financial support from the United Nations Population Fund and the Global Fund to Fight AIDS, Tuberculosis and Malaria, increasing the number of sites to 91 that offer these lifesaving prevention and treatment services in 17 of the country’s 20 regions. The success of the Jhpiego-supported project, notably the integration of cervical cancer screening with HIV services, was shared regionally and globally through journal articles, presentations at international conferences and co-facilitation of regional workshops.
This partnership for cervical health began when Dr. Comoe, a physician and surgeon in the oncology unit at the Treichville University Hospital in Abidjan, attended a meeting convened by Jhpiego in 2009 to help the MOH expand access to cervical cancer prevention services in Côte d’Ivoire. He was in charge of multisectoral partnerships at the PNLCa, which coordinated the planning and implementation of cervical cancer screening interventions. Jhpiego’s technical assistance focused on the introduction of the single-visit approach, consisting of VIA to detect precancerous lesions on the cervix and the offer of same-day treatment with cryotherapy, a freezing technique. The approach also included the development of training tools and national policies, as well as the organization of training workshops and supervision visits to support the PNLCa.
“Because of this project, the PNLCa had better visibility nationwide and a larger impact on policies related to cervical cancer,” said Dr. Comoe.
In addition, he believes the introduction of VIA and cryotherapy has led to greater acceptability of cervical cancer prevention services by women because VIA screening offers results in about five minutes compared to the two weeks needed for processing of Pap smears. Jhpiego’s technical support, provided over five years, helped the government build an effective and sustainable program and promoted ownership by the PNLCa through:
- Developing resource documents including a training manual, data management tools, national guidelines and protocols;
- Training 32 epidemiological surveillance officers, 22 biomedical technicians, 17 national trainers, including Dr. Comoe, and 21 national supervisors;
- Establishing two reference centers for the treatment of more serious lesions with loop electrosurgical excision procedure; and
- Purchasing equipment for three simulation laboratories in the MOH’s training schools.
As a champion of cervical cancer prevention services and member of the PNLCa, Dr. Comoe also engaged the MOH in purchasing medical supplies and raised awareness about cervical cancer prevention through local and regional conferences and the national and international media.
Today, there are 560 health care providers offering cervical cancer prevention services, of which 210 were trained by Jhpiego between 2009 and 2015. These providers learned their skills from a national pool of trainers and supervisors, enabling the government to continue this program and ensure that Ivoirian women, wherever they live, receive quality cervical cancer screening and treatment services for years to come.