Health systems challenges in cervical cancer prevention program in Malawi.
Health systems challenges in cervical cancer prevention program in Malawi.
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DOI：
10.3402/gha.v8.26282
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发表时间：
2015
影响因子：
2.6
通讯作者：
Muula AS
中科院分区：
文献类型：
--
作者：
Maseko FC;Chirwa ML;Muula AS
宫颈癌仍然是撒哈拉以南非洲妇女癌症死亡的主要原因。在马拉维，很少有妇女接受筛查，而宫颈癌的发病率正在上升，大多数发展中国家的情况也是如此。我们的目的是探索和记录卫生系统的差距负责在马拉维宫颈癌预防计划的表现不佳。这项研究是在马拉维29个区中随机选择的14个区进行的。这些地区的所有子宫颈癌服务提供者都被邀请参加。两个半结构化的问卷调查，一个地区的宫颈癌协调员和其他的服务提供者。两份调查表的主题都是以世界卫生组织（世卫组织）卫生系统框架为基础的。还编制了一份核对表，以审计子宫颈癌检查设施的医疗用品和设备。这两份问卷连同医疗用品和设备清单在Chikwawa区进行了试点，然后作为研究中的数据收集工具。使用STATA和NVIVO定性分析定量数据。来自21个卫生设施的41个服务提供者和9个地区协调员参加了这项研究。我们的调查结果显示，卫生系统面临许多挑战，主要是在卫生人力和基本医疗产品和技术领域。21个卫生机构中有7个提供筛查和治疗。结果表明，在地区一级管理宫颈癌方案方面存在挑战;服务提供者不足，监督不力;一些卫生设施缺乏基本设备，基本医疗用品缺货;方案资金不足。在大多数保健设施中，服务提供者不了解指导其工作的政策，也没有宫颈癌筛查和治疗的标准和准则。马拉维的宫颈癌预防方案面临着许多卫生系统挑战。如果卫生系统要提高宫颈癌筛查和治疗的覆盖率，就必须应对这些挑战。
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.