There is no doubt that primary prevention (lifestyle modification, especially sexual lifestyle modification in order not to acquire the Human Papillomavirus [HPV] infection, the virus that causes cervical cancer, and vaccination) is the strongest arsenal in the fight against cervical cancer. Unfortunately Ghana has no national HPV vaccination programme.
Even if we started immediately, it will take many years for the benefits to be seen. A large number of women who have never been vaccinated (nor screened) remain at risk. These women need to be screened and those with precancerous lesions of the cervix treated to prevent cervical cancer.
Another problem is that not many centres in Ghana have trained health workers and facilities (with equipment like cryotherapy units, thermal coagulators and electrosurgical units) to screen for cervical precancer and treat precancerous lesions of the cervix.
It is for this reason that it is laudable for sponsors like the Tema Lions Club, Pink on Wheels and others to take up the cost of training of over 160 health workers from over 80 institutions across Ghana (two health workers from each institution) at the Cervical Cancer Prevention and Training Centre in Catholic Hospital, Battor. This involves a lot of work, starting from February 3, 2020.
Selecting 8 health workers to come for the training every two weeks was even not easy. We considered the geographical location, the sponsor (some sponsors were restricted to specific regions) and the number of women the health workers expected to screen after the training.
So we asked them: How many women do you think you can screen in a year after the training? Then we made this clear: Remember cervical cancer screening is not covered by the National Health Insurance Scheme (NHIS) so women have to pay from their pockets to get screened.
While many of the health workers could have screened over 1,000 women in a year if women did not have to pay, many of them confined themselves to screening just between 50 and 200 women in a year (Group 4). Please see the groups at the end. Many women across the country cannot even afford GHS 15 (less than USD 3) to be screened with Visual Inspection with Acetic acid (VIA).
This is where I come back to the point I have made many times this month as Ghana observes January as cervical cancer awareness month: It is not enough to create awareness. We must involve the technocrats and policy makers to ensure that cervical cancer prevention services are available to the ordinary women. They deserve it!
Before we have a national screening programme covered by the NHIS though, we must ensure that health workers are trained across the country to screen and to treat precancerous lesions of the cervix. Institutions across the country must be equipped to screen and to offer treatment of precancerous lesions of the cervix. If we don’t get this right, we shall run into major problems. We still have time to do the right things.
Dr. Kofi Effah is a gynaecologist and head of the Cervical Cancer Prevention and Training Centre in Catholic Hospital, Battor in the North Tongu District of the Volta Region of Ghana.
