During the ongoing International Conference on Public Health in Africa (CPHIA) in Kigali where delegates are discussing ways to improve health care on the African continent, the question of whether Africa is on the right path to ending cervical cancer is one of the sticking issues. A specific session was held to particularly evaluate the status, impacts, and future prospects of the World Health Organization (WHO) Cervical Cancer Elimination Initiative. It’s been two years since WHO launched the global strategy to eliminate cervical cancer, following a Call to Action in May 2018 from WHO Director-General, Dr Tedros. 194 countries then resolved to end preventable and curable cancer. The strategy’s targets by 2030 are to have 90 per cent of girls fully vaccinated with the HPV vaccine (vaccination preventing cancer-causing infections and pre-cancers) by the age of 15, have 70 per cent of all women screened using a high-performance test by the age of 35, and again at 45, and to have 90 per cent of all women identified with pre-cancer and cervical cancer treated. Rwanda’s experience According to Global Cancer Observatory data on Rwanda, cervical cancer comes second to breast cancer as the most prominent and accounts for over 13 per cent of total cancer mortality in Rwanda. In line with the set targets, Dr Francois Uwikindi, the manager of non-communicable diseases at Rwanda Biomedical Centre, shared that the country has established 93 per cent of HPV vaccination coverage across the country. In addition to availing screening and cancer treatment including surgery, chemotherapy, radiotherapy, and palliative care, the country has been intentional in promoting sex education, condom promotion/provision, and male circumcision, he added. He explained that the improvement was accomplished through integrated service delivery with active health programmes, demand generation during routine services and district-wide screening campaigns, the expansion of HPV testing into existing testing platforms from the Health Center to the District Hospital testing Laboratory, and the decentralisation of precancerous lesion treatment to the primary level with the involvement of nurses and midwives. In addition to training, mentoring, and supervision to improve health worker screening and treatment skills, and electronic patient tracking systems to follow up with women and ensure service delivery across the continuum of care. Data from the National Cancer Registry shows that awareness and diagnostic capacity have increased, from one lab with one pathologist in 2007 to five labs with 22 pathologists today. The cancer registration initiative also raised awareness among healthcare workers about the importance of proper documentation and reporting of cancer cases in the country. ‘Africa needs to accelerate’ When a mother dies from cervical cancer in Africa, the family sinks deeper into poverty. And for every 100 women who die, 14 to 30 children die, as a result, presented Dr Groesbeck Parham, senior clinical expert at the initiative. He made a case for low-level public awareness of cervical cancer in Africa, home to 19 of the 20 highest-burden countries. According to him, African countries still struggle with inaccurate, opportunistic, low coverage and lack of coordination of screening platforms, physician-centric precancerous lesions treatments, minimal HPV vaccination, limited surgical oncology, chemotherapy/radiation, and pathology. He emphasised the need to view cervical cancer as a ‘public health problem’. The panel of discussion concluded that “by adopting and implementing the Cervical Cancer Elimination Initiative, Africa is on the right path. But it is necessary to accelerate the movement.”
