Building Capacity for Cervical Cancer Prevention in Senegal

Donate Now

2016 Rotary Global Grant Partners

Peace Care is partnering with the Kedougou and Sédhiou regions of Senegal to improve access to cervical cancer screening and treatment in the region. The goal is to train 115 health workers to help standardize this health service. By fulfilling our goal, we will provide access to 22,000 women to be screened for cervical cancer. The return on investment is one woman screened for every $2.73 or only $521.74 for every trained provider.

Summary

Problem

Context

Solution

Funding

Milestones

Impact

References

Issue

Women in the Kedougou and Sédhiou regions of Senegal do not have access to cervical cancer screening and treatment services which leads to unnecessary suffering and death.

Investment

By leveraging an existing program, Peace Care will train an additional 115 health workers which will help standardize the approach to cervical cancer screening and treatment in the region.

Impact

Up to 2000 women may be screened and if necessary referred for treatment of pre-cancer during the initial roll-out. Once established, 22,000 women will have access, with the potential for further expansion across Senegal.

Please meet us via this video:

Despite being both preventable and treatable, nearly 270,000 women die each year from cervical cancer. More than 85% of these deaths occur in low- and middle-income countries.  In Senegal, the cervical cancer incidence rate is nearly three times as high as in the United States.  This partnership between the health region of Kédougou, Senegal, Peace Corps Senegal, and Peace Care is focused on enhancing much-needed cervical cancer preventive services implementation.

Responding to community need and initiative: A formal partnership, with a leading voice from Regional Ministry of Health and Social Action offices in 3 regions of Senegal and including the above listed collaborating organizations, is committed to improving community access to quality cervical cancer screening services in Senegal. In 2010, a formal assessment was conducted and identified a strategic gap in the capacity at the Kedougou regional level in rural Senegal to address cervical cancer prevention. Using participatory approaches , the partnership has worked very closely with community health committees and health workers at the local level to develop all project plans.

Cervical cancer globally and in Senegal: Globally, there are over a half a million new cases of cervical cancer every year, with nearly 85% of these cases in developing nations. Senegal has a cervical cancer incidence rate of 41.4 (15th in the world and over five times greater than that of the U.S.). No comprehensive national cervical cancer initiative currently exists, leaving the large majority of rural Senegalese women without access to cervical cancer screening.

The partnership has developed a project to implement cervical cancer prevention services in this Southeastern Senegal rural region, with an emphasis on service capacity building and regional health system policy implementation. It was determined that Visual Inspection of the Cervix with Acetic Acid (VIA) was a safe and cost-effective approach for cervical cancer screening appropriate for this region. The partnership adapted WHO materials to create a training program that focused on a Training-of-Trainers (TOT) model. Going forward, the Regional Ministry of Health and Social Action of Tambacounda and Sedhiou have expressed a priority to scale this service to these regions.

Peace Care has a track record of success in project management and building partnerships to improve primary health services at the local level. Collaborators include the U.S. Peace Corps of Senegal, Rotary Chapters Almadies and Soleil in Dakar and the Chicago-Illinois Medical District, the University of Illinois at Chicago Center for Global Health, and the Institute of Health and Development in Dakar, Senegal.

Peace Care leverages the existing relationship that the Peace Corps volunteers have with local communities. By engaging the communities of Kedougou, Tambacounda, and Sédhiou, Peace Care is able to develop locally-adapted health policies that can have a sustainable impact. Specifically, Peace Care will:

  • Train and support master trainers and a management team in Tambacounda with the help of the existing local training team in Kedougou,

  • Train 110 health workers to provide capacity for cervical cancer screenings in Tambacounda and Sédhiou,

  • Ensure quality control of screenings through refresher courses and clinical evaluations

  • Train 5 health workers in cryotherapy as a treatment modality for precancers, and

  • Introduce a quality improvement process at the health service level that engages communities to form a person-centered health service.

Long-term sustainable impact: This project seeks to reinforce current local efforts to

  1. establish a permanent and centralized cervical cancer prevention center of training excellence (CCP-CTE) in rural Senegal to implement and reinforce human clinical and administrative capacity by strengthening regional knowledge, skills, and resources,
  2. strengthen the health infrastructure, regional clinical capacity and quality oversight for existing rural cervical cancer screening programs in Tambacounda and Kedougou, Senegal as well as build new capacity in Sedhiou, Senegal by training clinical and administrative personnel, and
  3. educate communities and empower women (women aged 30-59) to access and use the screening service (18,305 target-age women in Kedougou, 85,658 in Tambacounda, and 56,506 in Sédhiou) to reduce the incidence of cervical cancer.

Fund Drive Goal: $40,000

Allocation of funds:

Expense Total
Cryotherapy Equipment for Kedougou and Sedhiou $6,500
Training of Clinical Trainers & Management Team $2,500
Clinical Training for Cervical Cancer Screening and Cryotherapy Skills $12,000
Quality Control Refresher Course for Cervical Cancer Screening $5,000
Training in Quality Improvement in Kedougou and Sedhiou $3,000
Medical Records Development and Orientation $3,000
Community Information and Education Materials and Activities $3,500
Health Service Management $2,500
Project Management $2,000

Collaborating Organizations        

  • Peace Care, Chicago-based 501(c)(3) nonprofit organization
  • Rotary Clubs:
    • Host Sponsor: Clubs Soleil and Almadies (Dakar, Senegal
    • International Sponsor: Chicago-Illinois Medical District 
    • Seeking additional Rotary chapter partners
  • Association PREVENIR (Dakar, Senegal)
  • U.S. Peace Corps Senegal 
  • Senegal Ministry of Health and Social Action, Kedougou, Tambacounda, and Sedhiou, Senegal
  • Institute of Health and Development, Dakar, Senegal Cheikh Anta Diop University
  • National Cancer Institute, Dakar, Senegal Cheikh Anta Diop University
  • University of Illinois at Chicago Center for Global Health, IL, USA

Milestones: The involved partners will work collaboratively to develop the strategic plan for the implementation of the training program and ensure that it aligns with the regional capacities. Twice a year, these partners will meet to evaluate progress, assess the training curriculum, and gauge quality control of the program. We will establish the CCP-CTE within the first three months and build the administrative capacity on an ongoing basis. We will adapt World Health Organization endorsed materials into a standardized training curriculum specific for rural Senegal, and invite the Clinical Trainers for training in the first year. After completion of the training, the Clinical Trainers will return to their respective regions to train and provide refresher trainings for healthcare providers every six months. We will acquire all equipment and supplies and produce all materials locally.

This project will have measurable and significant impact in three areas:

  • Health Service Capacity – This project will help maintain a local­ Training Team of technical experts. Each year, these technical trainers will build additional capacity. Master Trainers may also train other trainers, so that the capacity grows exponentially.
  • Health Service Access – This project will strengthen a local health service, providing a new clinical service to many patients at the community level. The total number of patients projected to access this service over the course of one year will be 2000 patients and by 5 years, the service will reach 22,000 new patients.
  • Community Health Status – Patients accessing the service will receive a direct benefit (improved outcome) through prevention, referral, or treatment for cervical cancer. Over time, therefore the impact on the health status of the community will be significant.

Measureable results:  

  1. Number/type of trained individuals
  2. Number of benefiting health facilities,
  3. Number of health education campaigns,
  4. Number/percent of women screened/re-screened/referred/treated ,
  5. Number/percent of women recommending service,
  6. Knowledge of cervical cancer,
  7. Cervical dysplasia incidence rates,
  8. Established regional health policy.

Year Health Services Capacity*Trainers/ Trained Providers Health Service Access**Patient Visits:
1 5 / 35 2,000
2 5 / 115 8,000
3 5 / 115 12,000
4 5 / 115 16,000
5 5 / 115 22,000
Cumulative Total: Trainers: 5 Total Trained Providers: 115 Patient Visits: 22,000

* Cumulative totals: Based on maintaining 5 trainers for this project and all workforce training in the first two years

** Cumulative totals: Based on estimates of improving service utilization over time.

 Over the course of 5 years, a $40,000 investment (with additional funding) will result in:

$521.74 per Trained Provider OR $2.73 per Woman Screened

Potential longer term outcomes

This project will contribute to recommendations at the Senegal national level for a cervical cancer prevention services policy approach for implementation in decentralized regions where this policy does not currently exist by conducting an analysis of the existing Kedougou policy and its horizontal scale to the region of Sédhiou, Senegal.

We enjoy communicating with donors and will keep updating you on the project’s progress. Please join us and help save lives by pledging now!

  1. Cervical cancer statistics | World Cancer Research Fund International [Internet]. 2015 [cited 3/2/2015]. Available from: http://www.wcrf.org/int/cancer-facts-figures/data-specific-cancers/cervical-cancer-statistics
  2. Forouzanfar MH, Foreman KJ, Delossantos AM, Lozano R, Lopez AD, Murray CJL et al. Breast and cervical cancer in 187 countries between 1980 and 2010: a systematic analysis. Lancet. 2011;378(9801):1461-84.
  3. Shah M, Dykens J, Huang A, Galvin S, Sorensen J, Lopez R et al. A LMIC community, Peace Corps, university CBPR partnership: Primary health care quality improvement in Guaymate, Dominican Republic as the framework for US global health education. The Lancet Global Health Abstract in press. 2014;
  4. Dykens J, Diaye Y, Peters K, Irwin T, Brown C, Moriarty L et al. Piloting a LMIC community, Peace Corps, university partnership model: A case study of cervical cancer preventive services implementation in Kedougou, Senegal through a Global Community Health Collaborative. Consortium of Universities for Global Health Conference.; ; Washington, DC: 2013.
  5. Panzer J, Dykens J, Wright K, Evensen A, Jones S, Sanner L et al. Implementing the Advanced Life Savings in Obstetrics (ALSO) course in Ethiopia in partnership with a local community utilizing the Peace Care model. Consortium of Universities for Global Health Conference,; 2013; Washington, DC: 2013.
  6. Sankaranarayanan R, Rajkumar R, Esmy PO, Fayette JM, Shanthakumary S, Frappart L et al. Effectiveness, safety and acceptability of ‘see and treat’ with cryotherapy by nurses in a cervical screening study in India. Br J Cancer. 2007;96(5):738-43.
  7. WHO | Task shifting: global recommendations and guidelines. World Health Organization; 2008.
  8. Lehmann U, Van Damme W, Barten F, Sanders D. Task shifting: the answer to the human resources crisis in Africa? Human resources for health. 2009;7:49.
  9. Dykens A, Hedrick C, Ndiaye Y, Linn A. Peace corps partnered health services implementation research in global health: opportunity for impact. Global advances in health and medicine : improving healthcare outcomes worldwide. 2014;3(5):8-15.