Maseko Fresier C, Chirwa Maureen L, Muula Adamson S
School of Public Health and Family Medicine, College of Medicine, University of Malawi, Zomba, Malawi;
Prime Health Consulting and Services, Lilongwe, Malawi.
Glob Health Action. 2015 Jan 22;8:26282. doi: 10.3402/gha.v8.26282. eCollection 2015.
Cervical cancer remains the leading cause of cancer death among women in sub-Saharan Africa. In Malawi, very few women have undergone screening and the incidence of cervical cancer is on the increase as is the case in most developing countries. We aimed at exploring and documenting health system gaps responsible for the poor performance of the cervical cancer prevention program in Malawi.
The study was carried out in 14 randomly selected districts of the 29 districts of Malawi. All cervical cancer service providers in these districts were invited to participate. Two semi-structured questionnaires were used, one for the district cervical cancer coordinators and the other for the service providers. The themes of both questionnaires were based on World Health Organization (WHO) health system frameworks. A checklist was also developed to audit medical supplies and equipment in the cervical cancer screening facilities. The two questionnaires together with the medical supplies and equipment checklist were piloted in Chikwawa district before being used as data collection tools in the study. Quantitative data were analyzed using STATA and qualitative in NVIVO.
Forty-one service providers from 21 health facilities and 9 district coordinators participated in the study. Our findings show numerous health system challenges mainly in areas of health workforce and essential medical products and technologies. Seven out of the 21 health facilities provided both screening and treatment. RESULTS showed challenges in the management of the cervical cancer program at district level; inadequate service providers who are poorly supervised; lack of basic equipment and stock-outs of basic medical supplies in some health facilities; and inadequate funding of the program. In most of the health facilities, services providers were not aware of the policy which govern their work and that they did not have standards and guidelines for cervical cancer screening and treatment.
Numerous health system challenges are prevailing in the cervical cancer prevention program in Malawi. These challenges need to be addressed if the health system is to improve on the coverage of cervical cancer screening and treatment.
宫颈癌仍是撒哈拉以南非洲地区女性癌症死亡的主要原因。在马拉维，很少有女性接受过筛查，与大多数发展中国家一样，宫颈癌的发病率正在上升。我们旨在探索并记录导致马拉维宫颈癌预防项目成效不佳的卫生系统差距。
该研究在马拉维29个区中随机选取的14个区开展。邀请了这些区所有的宫颈癌服务提供者参与。使用了两份半结构化问卷，一份针对区级宫颈癌协调员，另一份针对服务提供者。两份问卷的主题均基于世界卫生组织（WHO）的卫生系统框架。还制定了一份清单，以审核宫颈癌筛查设施中的医疗用品和设备。在奇夸瓦区对这两份问卷以及医疗用品和设备清单进行了预试验，之后用作本研究的数据收集工具。定量数据使用STATA进行分析，定性数据使用NVIVO进行分析。
来自21个卫生设施的41名服务提供者和9名区级协调员参与了本研究。我们的研究结果显示出众多卫生系统挑战，主要集中在卫生人力以及基本医疗产品和技术领域。21个卫生设施中有7个同时提供筛查和治疗服务。结果显示在区级宫颈癌项目管理方面存在挑战；服务提供者不足且监督不力；一些卫生设施缺乏基本设备且基本医疗用品缺货；以及该项目资金不足。在大多数卫生设施中，服务提供者不了解指导其工作的政策，且他们没有宫颈癌筛查和治疗的标准及指南。
马拉维的宫颈癌预防项目中存在众多卫生系统挑战。如果要提高卫生系统在宫颈癌筛查和治疗方面的覆盖范围，就需要应对这些挑战。
