Original Article

Determinants of an integrated cervical cancer screening services in primary healthcare: sharing lessons from Kisumu, Kenya

Eyo Akpan, Nicholas Abinya, Everlyne Odhiambo, Ernest Ekpo
Journal of Public Health in Africa | Vol 14, No 4 | a160 | DOI: https://doi.org/10.4081/jphia.2023.1783 | © 2024 Eyo Akpan, Nicholas Abinya, Everlyne Odhiambo, Ernest Ekpo | This work is licensed under CC Attribution 4.0
Submitted: 05 April 2024 | Published: 30 April 2023

About the author(s)

Eyo Akpan, Grayscale International, Lagos, Nigeria
Nicholas Abinya, Hematology and Oncology Dept, Faculty of Medicine, College of Health Sciences, University of Nairobi, Kenya
Everlyne Odhiambo, Nursing Department, Migosi County Hospital, Kisumu, Kenya
Ernest Ekpo, Image Optimization and Perception Group, Discipline of Medical Imaging Science, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Lidcombe, Australia

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Abstract

Background: The successful integration of cervical cancer screening service (CCASS) into primary healthcare’s routine services depends on locality-specific and context-based service determinants.

Objective: This paper aims to identify the abovementioned determinants and discusses how health administrators can manage their influence on CCASS delivery at the primary healthcare level.

Methods: We conducted in-depth face-to-face interviews using a structured questionnaire with CCASS nurse providers and managers in four randomly selected primary health facilities. Information on the method(s) of screening utilised, the challenges faced, and the changes observed in CCASS provision were collected. Service managers were asked how they managed unplanned CCASS disruption, factors influencing CCASS replication, and aftercare support to cancer-affected women. Nurse providers were interviewed on the management of CCASS awareness and critical changes required to sustain CCASS service effectiveness. We used a constant interactive and inductive approach for data analysis.

Results: Nine thematic categories of CCASS determinants were identified: ‘cultural’, ‘socioeconomic’, ‘individual’, ‘health system’, ‘evidence-based operations’, ‘outcome-based resourcing’, ‘workflow improvement and standardisation’, ‘inclusive partner’s management’, ‘utilisation’. These determinants were grouped into three domains: ‘conceptual’, ‘outcomes’, and ‘growth’ domains, to correspond to clusters of determinants that are likely to influence the CCASS lifecycle in its formative, continuous delivery or productivity, and reproductive phases.

Conclusions: The findings show that sustaining an efficient integrated CCASS delivery at the PHC level requires phase-appropriate continuous adaptive improvements of service determinants within that locality.


Keywords

cervical cancer determinants; primary healthcare; screening; service delivery

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