PHASE Worldwide has been working with the Nepal Network for Cancer Treatment and Research (NNCTR) on cervical cancer prevention in Nepal for 10 years. In 2002, NNCTR began introducing mass screening for cervical cancer in Nepal, in collaboration with the World Health Organisation (WHO) and the International Agency of Research on Cancer (IARC). To date over 20,000 women have been screened.
To increase the scale and impact of our work in cervical cancer prevention, PHASE Worldwide completed a two-year project, funded by the Tropical Health and Education Trust (THET) and the Department of International Development (DFID).
The aim of the project was to implement a programme of locally led, high quality screening camps using a single visit approach pathway. The project focused on capacity building of health workers providing colposcopy (a procedure used to look at the cervix in more detail if screening finds abnormal cells in your cervix) in urban areas of the Kathmandu Valley.
Women’s health in general is an especially under resourced area in Nepali healthcare, with limited access to specialists and preventive treatments, especially in rural areas.
Despite cervical cancer being the most common female cancer in women aged 15-44 in Nepal, and the leading cause of cancer deaths in Nepal, currently less than 2% of women aged 30 to 60 in Nepal are screened. This lack of screening is causing preventable deaths.
The first aim of the project was to implement a method of cervical cancer screening via a one visit pathway. The pathway model involved women attending a cervical screening camp, undergoing initial screening with a visual inspection with acetic acid (VIA). If screening showed positive, treatment with the thermocoagulator (a method of treating tissue with high-frequency electric currents to remove small growths) was given in one visit.
The second aim was to deliver a community education programme to increase engagement with the screening programme. With the stigma attached to women’s health generally in Nepal, particularly around menstruation and contraception, the education component was an important aspect of the project. Awareness raising focused around the importance of screening to prevent avoidable deaths and the ease of accessing a screening programme which only required one visit, even if treatment was required.
The project also focused on workforce training and development to enable a locally delivered self-sustained service which could be easily scaled to other areas.
The National Health Training Centre and the Nepal Network for Cancer Treatment and Research (NNCTR) worked with PHASE Worldwide to run a government accredited training course over six days in February 2015. The training enabled 18 doctors and nurses to become competent in cervical screening and treatment techniques.
Across the two camps in Kathmandu Valley 2,038 women were screened, 99 at high risk patients treated, and two diagnosed and treated for cervical cancer.
The project helped established four fully operational colposcopy clinics in hospitals in Nepal, with staff trained on how screen and treat using the thermocoagulator method.
This project has also led to an identification of a need to increase the scale and availability of screening programmes, particularly in rural areas. With the learnings from this project, PHASE is currently in the early stages of a pilot project to assess the effectiveness of cervical screening pathways in rural Nepal. A recent study found high-risk HPV to be present in 5.4 percent of women in rural areas.
PHASE Worldwide continue to look to support work to prevent cervical cancer in Nepal. A team of gynaecology specialists and researchers from the UK and Nepal have worked together to design a pilot research project to specifically assess needs in remote communities.
This research will consist of testing and implementing two pathways of cervical cancer screening and assess which one is most effective in terms of logistics and feasibility, as well as what is most cost effective and has the most potential for regional and national upscaling.
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