Comprehensive Cervical Cancer Prevention and Control

This document offers programme guidance on the issue of cervical cancer to United Nations Population Fund (UNFPA) Country Offices and programme managers in Ministries of Health and partner agencies. Cervical cancer, caused by sexually-acquired infection with human papillomavirus (HPV), claims 270,000 lives worldwide each year. "Because of poor access to high quality screening and treatment services the majority of cervical cancer deaths (85%) occur in women living in low- and middle-income countries. The difference in cervical cancer incidence between developing countries and high-income countries is likely to become more pronounced when infection with common oncogenic HPV types is prevented by vaccinating a high proportion of adolescent girls."

Communication strategies suggested for service delivery include:

• Training of staff in counselling and screening, including delivery strategies on vaccination; the preparation of guidelines, manuals, and training materials; and methods to evaluate staff competencies;
• Strengthening existing health information systems and registries to ensure effective data collection.

According to the guidance, community participation is a key component of an effective delivery model and can be achieved through advocacy, communication, and community mobilisation to “empower individuals to make informed decisions on programme design and service utilisation. It is essential to engage community and professional groups to ensure community participation and acceptance.” The following are key recommendations when planning an advocacy and community mobilisation strategy:

• Advocacy and communication efforts should focus on:
  • High-level decision-makers and advisors in relevant government sectors, civil society organisations, academic institutions, professional associations, insurance companies, and social security agencies;
  • Managers in Ministry of Health, hospitals, clinics, and laboratories;
  • Health care providers, including physicians, nurses, midwives, and school health workers;
  • Community leaders and members;
  • Media representatives.
• Key stakeholders should develop an advocacy plan that includes identifying the main objectives of the plan, policies required for a comprehensive programme, and behavioural changes needed by policy-makers, health care providers, women, and community members.
• Communication messages that are carefully adapted to the situation and the audience in focus; they should include comprehensive strategies for prevention and control of cervical cancer (vaccination of young girls, screening and treatment of older women); messaging should include evidence-based technical information as well as political and emotional information and story telling. (Annex 2 in the document provides specific messages for specific audiences such as the general public, high-level decision makers, managers and health care providers, and clients).
• When appropriate, information that improves health education on human immunodeficiency virus (HIV) and the prevention of sexually transmitted infections (STIs) should be included.
• Messages should be disseminated using existing, effective channels of communication.
  • Strategic use of mass media through health, women’s, and youth magazines, radio, and television shows;
  • Internet and SMS (text messaging) technologies for providing accurate information and countering misinformation;
  • Messages should focus on areas where utilisation and prevention services are planned or currently available.
• Encourage high-visibility advocates or "champions" to speak publicly and publish articles about cervical cancer prevention and treatment.
  • Champions should be selected, trained, and monitored carefully.
• Collaborate with civil society organisations and others to focus on reaching marginalised or hard-to-reach groups such as minority language or ethnic groups and refugees.
  • Customised materials can be used for advocacy and communication through peer outreach.

The following agencies and organisations collaborated in December 2010 to draft the programme guidance:
programme managers from Ministries of Health and UNFPA Country Offices of seventeen countries; the GAVI Alliance; International Planned Parenthood Federation (IPPF); Jhpiego; Pan American Health Organization (PAHO); PATH; Union for International Cancer Control (UICC); and World Health Organization (WHO). Each of these organisations plays a role in developing and introducing new technologies and cervical cancer prevention programmes. The document is available in: English, Español, Français, Русский, and ا.لعربية