The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #66554

Ilana G. Dzuba, MHS¹, Martha Jacob, MD, FRCOG, MPH¹, Siri Bliesner, MPH², Maria Lorencikova, MD³, and Silvana Luciani, MHSc⁴. (1) EngenderHealth, 440 9th Avenue, New York, NY 10001, 212.561.8000, idzuba@engenderhealth.org, (2) Formerly University of Michigan, Population Fellow, 16403 NE 111th St, Redmond, WA 98052, (3) Bolivia, EngenderHealth, Calle Fernando Guachalla No. 342, Edificio Victor, La Paz, Bolivia, (4) Pan American Health Organization, 525 23rd Street, NW, Washington, DC 20037

Background: Cervical cancer is a principal cause of death among women in less-developed countries where 80% of all cervical cancer deaths occur. Cervical cancer incidence and mortality rates have not appreciably decreased in Bolivia despite the availability of cervical cancer prevention services since 1984. Objectives: Assess the organization and availability of cervical cancer screening and treatment services in four regions of Bolivia and identify appropriate intervention strategies. Create ownership and develop linkages among in-country stakeholders by forming a multidisciplinary team to conduct the fieldwork and preliminary analysis. Methods: We adapted the first stage of the WHO Strategic Approach, which consisted of a literature review on cervical cancer in Bolivia; qualitative research using semi-structured interviews with 583 clients, community members, providers, and regional authorities; observations in 56 health care facilities; and a technical input workshop with approximately 50 key decision makers and local actors to identify evidence-based priorities and recommendations for future action. Results: Despite recent progressive actions to reduce the impact of cervical cancer Bolivia’s cervical cancer prevention program lacks the appropriate strategies to implement and achieve the established goals for screening coverage and follow-up of women with detected abnormalities. Recommendations: Recommendations include policy, programmatic and research options, such as strategies to improve coordination within the health system and to implement norms for cervical cancer screening and treatment, suggestions to strengthen existing services, pilot projects of information systems and mechanisms for client follow-up, techniques to improve interpersonal communication, and studies on effectiveness of alternative screening and treatment methods.

Learning Objectives:

• Recognize the importance and utility of participatory methods to research and program development.
• Describe approaches to assess cervical cancer prevention services.
• Understand the current situation of cervical cancer prevention and treatment services in Bolivia.
• Identify three ways that cervical cancer prevention activities can be improved.

Keywords: Cervical Cancer, Participatory Research

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.