Article source: (2018). Improving data for decision-making: a toolkit for cervical cancer prevention and control programmes. World Health Organization. http://www.who.int/iris/handle/10665/279420. License: CC BY-NC-SA 3.0 IGO
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Introduction to the Toolkit
Cervical Cancer in Low and Middle-Income Countries
Cervical cancer in low- and middle-income countries (LMICs) accounted for approximately 85% of the 528 000 new cases diagnosed globally in 2012. In the same year, approximately 87% of the 266 000 deaths from cervical cancer worldwide occurred in LMICs [Globocan, 2012]. These statistics clearly illustrate the disproportionately heavy burden of cervical cancer faced by communities, families, and women in less developed regions. Women living in LMICs who are at highest risk are typically aged between 30 and 49 years. The tragedy of death or illness due to cervical cancer during what should be some of the most productive years in a women’s life is compounded by the knowledge that most cases are both preventable and treatable when identified early [WHO, 2014].
Key drivers of the disparate burden are the numerous challenges encountered in the development and implementation of effective and sustainable strategies for cervical cancer prevention and control. Lack of policies and programmes for cervical cancer; lack of timely and reliable data; lack of resources; and lack of coordination are all common barriers to comprehensive cervical cancer prevention and control in LMICs. In addition to the impact of these barriers on availability and accessibility of preventive services, women in LMICs frequently must contend with gender bias and cultural and societal norms which further restrict their ability to access services and make decisions about their health. Projections warn that without urgent attention, incidence of cervical cancer can be expected to rise by almost 25% in the next 10 years [Globocan, 2012].
Purpose of the Toolkit
Improving Data for Decision-Making
This toolkit aims to expand the support provided to LMICs in current global normative guidance through an aligned package of operational resources for improving the availability and use of high-quality data for decision-making in cervical cancer programmes. The standardized tools and guiding information provided are designed to be adapted to country and programmatic context in order to assist ministries of health and other stakeholders in generating the information necessary to better plan, implement, monitor, evaluate, and scale cervical cancer prevention and control programmes.
In 2013, the World Health Assembly identified cervical cancer as a priority intervention in its Global Action Plan for the Prevention and Control of NCDs 2013–2020. In order to support implementation and monitoring of the Global Action Plan, WHO Member States agreed upon the Global Monitoring Framework for Noncommunicable Diseases,1 which highlights the importance of prevention and control of cervical cancer through the inclusion of an indicator to monitor screening on a global level. In addition, cervical cancer also finds a place within several of the targets of the United Nations Sustainable Development Goals,2 specifically those related to the reduction of noncommunicable diseases worldwide (Goal 3) and the health of women and girls (Goal 5) [UN, 2016]. In alignment with such global initiatives, a secondary aim of this toolkit is to enable LMICs to more readily contribute to the global body of evidence surrounding noncommunicable diseases (NCDs), gender health equality, sexual and reproductive health, vaccination and other health areas where information on cervical cancer is highly relevant. Enhanced availability and quality of cervical cancer data from countries with the highest burden – and the most difficult challenges – provides global normative bodies, donor organizations, and international stakeholders with crucial opportunities for establishing and refining priorities, developing timely evidence-based guidance, and making critical funding decisions.
How to Use the Toolkit
Cervical cancer burden, prevention and control strategies and programme structure vary from country to country; therefore each section in the toolkit includes guiding information and suggestions on how to make adaptations while maintaining standardization over time and across countries. Careful adaptation will allow for appropriate planning and monitoring of national programmes, as well as high-quality global reporting. This toolkit is offered as a mechanism to strengthen data for decision making, and as such should not be considered required in part or as a whole.
This toolkit was developed primarily for ministries of health and their implementing partners, for the prevention, screening, and treatment programmes for cervical cancer. Key target audiences include programme managers, monitoring and evaluation staff, survey administrators, health administrators and economists. However, private-sector providers, civil society organizations, nongovernmental organizations, academic research groups, and other national and international stakeholders can all benefit from aligning and coordinating data practices. Cervical cancer prevention and control programmes consist of a combination of activities that include primary prevention through human papillomavirus (HPV) vaccination; secondary prevention through screening and the treatment of precancerous lesions; tertiary prevention through treatment of invasive cancer; and palliative care (Figure 0.1). While the primary focus of this toolkit is secondary prevention, primary and tertiary prevention are discussed as needed to promote coordination across the continuum.