Political determinants of cervical cancer control in Peru
Cervical cancer (CC) is the most common and second-most deadly cancer among Peruvian women, despite national authorities' sustained political and budgetary efforts to improve Human Papillomavirus (HPV) vaccination, screening for early detection of cervical cancer, and making treatment more accessible. Considering the importance of the health system in CC prevention and control, this article examines the role of the health system as a whole in the CC screening in Peru, a dimension that previous studies have not comprehensively covered. To this end, this article utilizes the WHO's building blocks framework as an analytical tool to examine the performance of the health system when providing services to prevent, detect, and treat CC. The research took place in the region of Madre de Dios, located southeast of the Peruvian Amazon. Madre de Dios reports the second-highest CC mortality rate in the country, and a lack of oncologic treatment (chemotherapy, radiotherapy, pediatrics, and surgical) and palliative care units. This qualitative study is grounded in in-depth interviews with key informants in Lima and Madre de Dios, as well as an analysis of report records provided by health authorities in Madre de Dios and Lima. The interviews were conducted between November 2022 and August 2023. They are policy experts with experience in designing national-level health policies, as well as health officials in Madre de Dios. Additionally, they have conducted interviews with representatives of civil society organisations in Madre de Dios. Additionally, we analyzed the anonymized records of Pap smear results collected in Madre de Dios for the years 2020, 2021, and 2022. Governance is crucial for organizing CC activities. Vertical national programs and policies are failing to accommodate local solutions and lack sensitivity to the unique characteristics of different contexts. CC policies in Peru are ambitious, and their implementation is challenged in Madre de Dios by the lack of trained human resources at the primary healthcare and hospital level, lack of laboratories, lack of financial resources for patient referrals, poor information system that do not allow patient follow-up, and lack of resources and political will to guarantee equipment maintenance. The analysis also highlights the significant shortcomings of organizing health system indicators around services provided, thereby ignoring indicators that assess the impact of health interventions on population health. The analysis demonstrated the utility of the WHO health system building blocks framework in analyzing the shortcomings of public policies aimed at preventing, detecting, and treating CC. It also provides a comprehensive view of the critical features of the health system that must be considered when designing and implementing interventions to address health conditions, such as CC.
