Existence of national cervical cancer prevention policy
The existence of formal governmental declarations, laws, and statutes related to cervical cancer prevention. Policy also can refer to operational regulations, guidelines, norms, and standards. Although not essential criteria for this indicator, ideally a cervical cancer prevention policy should address:
- Women (sociocultural and gender influences, community outreach, education, medical profile);
- Services (program structure and management, HPV vaccine coverage, quality, referrals, health information systems, qualified providers); and
- Technology (efficacy, safety, procedures and supplies, costs, acceptability, laboratories) (ACCP, 2004).
Verification of the cervical cancer prevention policy, implementation plan, guideline or strategy
Directive, resolution; guideline or strategy; meeting minutes providing evidence of dialogue among national and subnational governments on new guidelines; key informant interviews.
This indicator measures the extent of policymakers’ support for cervical cancer prevention. It is meant to capture earlier stages of support for the policy continuum. In many cases it takes time to strengthen the policy environment and in the meantime, policies drafted reflect a measure of support for prevention strategies.
With global focus on the Millennium Development Goals (MDGs) and specifically reducing maternal deaths (MDG 5), the world has witnessed a steady decrease in maternal deaths. Unfortunately, the same progress cannot be seen in combating deaths from cervical cancer along with breast cancer, which together take more women’s lives than maternal causes and may soon approach maternal causes as a critical driver of mortality in women of reproductive age in developing countries (IHME, 2011). Previous research indicates that lack of progress in cervical cancer can be traced in part to weak or nonexistent screening programs in many countries. But national strategies can work as witnessed in the UK, for example, where a national screening program begun in 1988 reversed an alarming trend in women younger than 35 developing cervical cancer. In order for a national screening program to be developed – and subsequently funded and implemented – it is crucial to have an official policy or strategy in place outlining the national cervical cancer prevention priorities and guidelines, which includes an HPV vaccination program, where relevant.
Evaluators may face difficulty finding a “cervical cancer prevention policy” since some countries may not have an explicit policy related to cervical cancer but rather encompass it within a broader reproductive health policy. Whereas the existence of a policy on cervical cancer prevention signals political concern over the topic, it may be relatively meaningless if not translated into concrete actions. Further work is needed to ensure the necessary human and financial resources are available to plan, implement, and monitor such a program. Thus, a related indicator involves the existence of structures to (1) provide effective cervical cancer screening and treatment services and (2) undertake initiatives aimed at preventing precancerous cervical lesions in the future.
It is important to note that when a national policy is adopted at the subnational level, some adaptation of the policy for the local context is expected, and even necessary to ensure that the spirit of the law translates into various settings.
policy, health system strengthening (HSS), sexually transmitted infection (STI), cervical cancer
Alliance for Cervical Cancer Prevention (ACCP). Planning and Implementing Cervical Cancer Prevention and Control Programs: A Manual for Managers. Seattle: ACCP; 2004. http://www.who.int/reproductivehealth/publications/cancers/a92126/en/
Institute for Health Metrics and Evaluation (IHME). The Challenge Ahead: Progress and setbacks in breast and cervical cancer. Seattle, WA: IHME, 2011. http://www.healthdata.org/policy-report/challenge-ahead-progress-and-setbacks-breast-and-cervical-cancer