Health facility assessments of cervical cancer prevention, screening, and treatment services in Gulu, Uganda

BackgroundCervical cancer is ranked globally in the top 3 cancers for women younger than 45 years, with the average age of death at 59 years of age. The highest burden of disease is in low- and low-to-middle income countries (LLMICs), responsible for 90% of the 311,000 cervical cancer deaths in 2018. This growing health disparity is due to the lack of quality screening and treatment programs, low human papillomavirus (HPV) vaccination rates, and high human immunodeficiency virus (HIV) co-infection rates. To address these gaps in care, we need to develop a clear understanding of the resources and capability of LLMICs health care facilities to provide prevention, screening, and treatment for cervical cancer. ObjectivesThis project aimed to (1) develop a health facility assessment (HFA) to assess available cervical cancer prevention, screening, and treatment resources and (2) implement the HFA to determine the cervical cancer resources available in Gulu, Uganda. MethodsWe adapted the World Health Organizations Harmonized Health Facility Assessment for our own HFA and grading scale, deploying it in October 2021 to analyze 21 health centers in Gulu. ResultsGrading of Health Center IIIs (n=16) concluded that 37% had "excellent" or "good" resources available, and 63% of facilities had "poor" or "fair" resources available. Grading of Health Center IVs and above (n=5) concluded that 60% of facilities had "excellent" or "good" resources, and 40% had "fair" resources available. DiscussionThe analysis of health facilities in Gulu demonstrated subpar resources available for cervical cancer prevention, screening, and treatment. Focused efforts are needed to expand health centers resources and capability to address rising cervical cancer rates and related health disparities in LLMICs. The development process for the study HFA can be applied to global cervical cancer programming to determine gaps in resources and indicate areas to target improved health equity.