Evaluation of cervical cancer screening programme in the Harare City Health Department, Zimbabwe.

ABSTRACT

PIP: An evaluation of the Harare City (Zimbabwe) Health Department's Cervical Cancer Screening Program revealed a lack of a comprehensive policy to guide program activities. The evaluation was based on interviews with 20 head office and district health executives and 18 family health clinic nurses as well as a review of annual reports and policy guidelines. All those interviewed agreed that cervical cancer is an important local and national health issue and health workers were well informed about the signs and symptoms of this disease. There was confusion, however, about who should be targeted for screening and how often and at what age Pap smears should be administered. Although the majority of health workers believed that all family planning clients, all women with gynecologic symptoms suggestive of cervical cancer, and all first-time Depo-Provera acceptors should be screened, a review of the records of five clinics indicated that only new Depo-Provera users were actually receiving Pap smear testing routinely. 16 of the 20 managers characterized the resources allocated for cervical cancer screening as inadequate. A review of annual reports revealed that the number of Pap smears declined from 758 in 1987 to 177 in 1993, then increased to 1329 in 1994 when Depo-Provera was reintroduced. At four of the clinics evaluated, more than 50% of Pap smears were classified as suboptimal. Four of the clinic nurses had never had a Pap smear. Overall, these observations suggest a need for development of comprehensive policies on cervical cancer screening, formal training of health workers on taking adequate smears, and allocation of adequate resources to the cervical cancer screening program.