Efforts to increase uptake of cervical cancer screening in the absence of a national programme in Ghana: a qualitative study of stakeholders’ experience
Cervical cancer is the fourth most frequently diagnosed cancer in women globally. Ghana, West of Sub-Saharan Africa (SSA), is reported to have a high crude cervical cancer incidence of 18.3 per 100,000 women. Cervical cancer screening (CCS) uptake in Ghana has been reported to be between 0.8% and 12%. Ghana, like many developing countries worldwide, are yet to experience the benefits of organised screening. This study sought to understand the direct and indirect actions of key stakeholders in Ghana that contributed to the promotion of CCS in a country without a population-based screening programme. Primary qualitative data was obtained from 16 stakeholders using in-depth interviews via ZOOM virtual platform. Stakeholders were those involved in the delivery of CCS activities and were identified through purposive and snowball sampling. Transcripts were manually created from verbatim accounts of interviews. Data was managed in NVivo software and analysed using an inductive approach to qualitative data evaluation. Emerging themes were drawn out by thematic analysis. Key findings identified were intra-health facility-based factors that promoted CCS including cost control measures, screening methods, opportunistic CCS, promotion linked activities and innovative health practices. Additionally, sponsored mass CCS, staff training, policy advocacy and proactive health promotion and education were extra-health facility-based factors that stakeholders felt led to CCS uptake at the facility and community levels. Stakeholders played an active role in promoting CCS using health education through health promotional measures such as mass media advertisements, electronic fliers, creating social media content especially during the Cervical Cancer Awareness Month (CCAM) in January. CCS costs were often reduced during in January because of negotiations with non-governmental organisations and corporate bodies, ultimately resulting in sponsored mass cervical cancer screening which improved cervical cancer screening uptake. In the absence of a national cervical cancer screening programme, the study found out that it is the contributions of committed stakeholders that may be ensuring the continued existence of CCS services in Ghana. The goodwill that is shown by society during the CCAM in January should be harnessed to broaden the scope and reach of cervical screening activities beyond January.