Evaluation of the National Cervical Cancer Screening Programme of Bangladesh and the formulation of quality assurance guidelines

Abstract

Background/Methodology: External quality assurance for the National Cervical Cancer Screening Programme of Bangladesh was done in June 2008 by the United Nations Population Fund (UNFPA). The programme, initiated in 2004, has set up screening facilities in 44 districts of Bangladesh. Women aged over 29 years are screened using visual inspection after acetic acid application (VIA) by trained paramedics. Independent consultants not involved in strategic planning or implementation of the programme were engaged to review the ongoing activities. They visited different service delivery set-ups, collected data using a structured proforma, interviewed the service providers, and held discussions with the programme managers. This paper summarises the observations and recommendations of the experts performing the quality control process. Results/Conclusions: The consultants observed that the programme was based on largely opportunistic screening with good central co-ordination and some elements of organised screening. The coverage of the target population at the end of 4 years was very low. The compliance to colposcopy was good, though nearly half of the patients with high-grade precancers did not receive treatment. Cryotherapy was infrequently used and a 'see and treat' policy was rarely followed. No strategy for internal monitoring and quality control was built into the programme. The reviewers enumerated the quality assurance standards at various levels of service delivery based on which the performance assessment can be done periodically. This is the first evaluation report of a VIA-based national cervical screening programme. ©FSRH.