Health system factors affecting Cervical Cancer services delivery at primary, secondary, and tertiary levels in Addis Ababa, Ethiopia

Abstract

Background: For Ethiopian women, cervical cancer ranks as the second most common cause of death from cancer. The study aimed to examine the existing national strategies that support the implementation of the National Cancer Control Plan (NCCP) and raise the quality of services for cervical cancer provided in Ethiopia. It also targeted to assess the factors within the health system that influence the quality and accessibility of diagnosis and treatment services in Addis Ababa's public and private hospitals. Moreover, it dealt with the factors influencing the uptake, utilization, accessibility, and caliber of prevention and screening for cervical cancer at public health centers in Addis Ababa. Methods: The study employed a mixed-methods methodology, which included document reviews, exit interviews, focus group discussions, key informant interviews, and surveys. The discussions in focus groups and exit interviews looked at variables impacting the uptake and utilization of screening, key informant interviews investigated the challenges faced in implementing the NCCP. Using surveys, health facility services were determined. The target achievement for the human papillomavirus vaccination, screening, and treatment as well as the links between the NCCP and other national policies was established from secondary data. While the qualitative data were examined thematically, STATA version 17 and SPSS version 26 were used for the descriptive data analyses with p < 0.05 applied for statistical significance. Results: Although the NCCP implementation had high-level policy support, it faced several challenges. These issues included a lack of charismatic women leaders involved in prevention campaigns, inadequate funding, low population empowerment, limited access to diagnostics, shortage of radiotherapy and chemotherapy centers, scarcity of specialty care, insufficient in-service training, long waiting times, poor electronic health records, and weak referral systems. Lack of partner support, dread of the procedure, embarrassment, the provider's gender, poor public awareness campaigns, and childcare obligations were the primary barriers to screening uptake. Women aged 40 years and older were more likely to use screening than women under 30 years (AOR=13.85; 95% CI: 1.40, 136.74). The national screening coverage was 8.4%, with a preference for female providers among women screened after attending antiretroviral therapy clinics (AOR=7.07; 95% CI: 1.53, 32.75), and those screened due to abnormal vaginal bleeding (AOR=6.87; 95% CI: 1.02, 46.44) than women referred from family planning clinics. Women’s perceptions about safety of screening were negatively associated with women aged 30-39 and those with primary or higher education. Conclusion: The study revealed multiple challenges in the health system that made the NCCP's implementation ineffective. We recommended that decision-makers intensify coordinated efforts with all stakeholders, prioritize the identified challenges, and mobilize more resources to meet the WHO’s 90-70-90 cervical cancer targets by 2030, and ensure that the incidence of cervical cancer in Ethiopia is less than 4 per 100,000 women.