Zimbabwe Cervical Cancer Screening and Education Project – Executive Summary

A Cancer Prevention Initiative

Executive Summary

 Cervical cancer accounts for one-third of all cancer cases in Zimbabwe and is the leading cause of cancer death among Zimbabwean women. This high disease burden has been heavily influenced by the HIV epidemic. When woman arrive at rural hospitals with invasive, late-stage cervical cancer, little can be done for them. In practical terms, both treatment and palliation are unavailable, and these women usually die of their disease. In the absence of an HPV vaccine, cervical screening to detect and remove early, precancerous lesions is the most effective way to prevent the disease and the suffering it causes. Unfortunately, cervical screening is available to only a fraction of Zimbabwean women, particularly in rural areas.

Mr. Darrell Ward of Better Healthcare for Africa (BHA), Dr. Lowell Schnipper of the Beth Israel Deaconess Medical Center/Harvard Medical School and collaborators at St. Albert’s Mission Hospital, a rural mission hospital in Zimbabwe, are seeking funding to develop a hospital-based cervical-cancer screening and education program.

This “screen and treat” program uses a simple, inexpensive and proven method to detect precancerous lesions on the cervix, and a relatively simple and proven technology to remove those lesions and thereby prevent the development of invasive cervical cancer, for which few treatment options exist in rural Zimbabwe.

In brief, the program will establish a cervical screening clinic at the hospital that includes training in cervical cancer for staff and support a district-wide community cervical-cancer prevention campaign and weekly cervical-cancer screening at three of the hospital’s 11 outlying clinics. In brief, this project:

  • Has the potential to screen an estimated 100 women per month at St. Albert’s hospital;
  • Will offer education and rapid testing for the human immunodeficiency virus (HIV) to women of unknown HIV status;
  • Will meet national standards set by Zimbabwe’s MOHCW for this screen and treat program;
  • Includes program monitoring and evaluation at the hospital, patient and community levels.
  • Could serve as a model for cervical-cancer screening initiatives at other rural hospitals in Zimbabwe.

Of key importance, the program will create an infrastructure for the seamless introduction of an HPV-vaccination program and for the introduction of a more accurate and effective screening test when they become affordable.

On behalf of the principles and the hospital engaged in this initiative, BHA is requesting approximately $150,000 to initiate and support the three- year project.

As proposed, the project builds on local expertise and international “best practices,” and is designed to contain costs and facilitate sustainability. Working with physicians and staff at St. Albert’s, the Centenary District Medical Officer, and incorporating recommendations from Zimbabwe’s Ministry of Health and Child Welfare (MOHCW) and the UN Population Fund (UNFPA), this low-cost, low-technology program uses existing infrastructure, facilities and staff, and gives immediate results. Additionally, the program will introduce cancer awareness for women and men in the 29 wards of the Centenary district a rural area of Zimbabwe with a population of 120,000.

The current proposal requests funding to initiate this cervical-cancer prevention activity at St. Albert’s Mission Hospital. Assuming a successful launch at St. Albert’s, we plan to seek additional funding to adopt this initiative at a second location, Muvonde Mission Hospital (see Annex 3 below) in a second phase of the project.

St. Albert’s Mission Hospital

St. Albert’s Mission Hospital is located 120 miles north of Harare in Mashonaland Central Province. It is the only hospital in the Centenary district, and it operates under the director of the Parish of Chinhoyi Diocese. The International Medical Association (IMA) is a Catholic lay women’s missionary society headquartered in Rome that is committed to the health and welfare of the desitute poor. This organization has provided medical care and other services at St. Albert’s Hospital for 40 years and continues doing so today. Currently, IMA members at St. Albert’s include two physicians – one is hospital director, the other a family therapist – and other staff.

BHA personnel have worked with the hospital since 2000, including five visits to the hospital for a week or more at time to experience and understand the hospital’s programs, patient population, capabilities and challenges. BHA’s past assistance to St. Albert’s hospital form the basis for the collaboration that underlies this cervical-cancer prevention initiative. This assistance has included:

  • Purchasing equipment requested by the hospital, such as an anesthesia machine and X-ray film processor;
  • Shipping donated medical supplies to the hospital;
  • Emailing PDFs of World Health Organization (WHO) and Alliance for Cervical Cancer Prevention (ACCP) documents to help guide the hospital in developing its cervical cancer prevention efforts;
  • Posting slideshows of the hospital and its outreach activities online to help in education and fundraising efforts (see the Annex for these links) to the online slideshows about the hospital).
  • Assisting American nurses and doctors interested in visiting St. Albert’s Mission Hospital schedule and prepare for their trip, which usually includes carrying in donated medical supplies. Since 2006, BHA has provided nonmonetary assistance to eight nurses and one physician in spending one to three months at St. Albert’s, working with the doctors at St. Albert’s to coordinate the visit. Most recently, BHA helped coordinate a six-week visit to St. Albert’s by three nurses who recently graduated from the Yale nursing program.
  • To help finalize this proposed cervical-cancer screening initiative, collaborators Dr. Schnipper and Mr. Ward visited St. Albert’s hospital in March 2013.
  • Following this 2013 visit, BHA and Dr. Schnipper provided $1,250 to install dedicated internet service for the entire hospital, allowing Dr. Schnipper and BHA to maintain regular and consistent email and Skype contact with the physicians at St. Albert’s to confer with the physicians at the hospital and monitor progress.

Zimbabwe Cervical Cancer Screening and Education Project in Brief

Research and the Alliance for Cervical Cancer Prevention have determined that visual inspection with acetic acid (VIA) is an efficient and cost-effective strategy for detecting and treating cervical cancer precursors in low-resource settings. For low-income countries, studies of visual screening confirm that these methods offer a low-cost, effective option until affordable HPV DNA testing technologies become more widely available and cost-effective and medically effective in resource-limited settings.

The Zimbabwe MOHCW has given a high priority to the prevention of cervical cancer by scaling up cervical screening services as part of the government’s National Health Strategy (2009-2013). With financial and technical support from the UNFPA and the World Health Organization, the MOHCW has initiated a national program for cervical cancer screening and management using visual inspection with acetic acid plus cervicography (VIAC). Cervicography is incorporated into the program to facilitate review of observed lesions. Those identified as precancerous are treated by expert gynaecologists to assure the highest level of performance of the screening procedure. The Zimbabwe government/UNFPA initiative, however, is being implemented only at the level of national and provincial hospitals. Resources are not available to extend the program to rural hospitals or clinics, where the need is acute.

The Cervical Cancer Screening and Awareness Project described in this proposal will support cervical-cancer screening using VIAC in the rural district served by St. Albert’s Mission Hospital.

  • The program will be supervised and implemented by obstetrician and gynecologist Dr. Neela Naha, FRCOG, at St. Albert’s, assisted by Matron Sr. Ronica Changata.
  • Women diagnosed with precancerous lesions – i.e., cervical intraepithelial neoplasia (CIN) 2 – by VIAC will be treated using cryosurgery to remove these early lesions, abrogating their progression to invasive cervical cancer. Women found to have invasive carcinoma will be referred to the Parirenyatwa Hospital in Harare.
  • The hospitals propose to screen all sexually active women aged 21 to 65 years, except those who are pregnant, who come to the hospitals’ outpatient or women’s health clinics. Pregnant women will be screened in the post-partum period.
  • St. Albert’s personnel who perform VIAC will receive standardized training in the technique by the MOHCW to ensure that the hospital conforms to the VIAC standards established by the MOHCW.
  • The St. Albert’s program will build capacity by providing basic cancer education of staff at the hospital and at 11 outlying clinics.
  • After establishing the VIAC clinic at St. Albert’s, a trained nurse will travel to three outlying clinics once a week to perform VIAC. Women with confirmed or suspected precancerous lesions or with cervical cancer will be referred to St. Albert’s hospital for follow-up.
  • Shortly after establishing the VIAC clinic, the hospital’s outreach program will begin a Cervical Cancer Community Awareness Initiative in the district’s 29 wards. The awareness program was designed by Dr. Naha and hospital staff who have more than 12 years’ experience in building community public-health awareness related to HIV/AIDS, TB and malaria. The initiative involves three hospital-organized groups: Volunteer Community Health Workers, Secondary Caregivers, and People Living with HIV. See Annex 2 for details of the cervical cancer prevention awareness program.
  • Metrics: This program will assess the following:
    • Number of women reached through educational outreach at the hospitals and surrounding villages;
    • Number of women screened, among those screened the number of women who are HIV positive;
    • Number of abnormal VIAC findings;
    • True and false positives for CIN;
    • Number of invasive cancers.
  • Since prevention is possible employing a vaccine that protects against HPV, we, with our collaborators in Zimbabwe, will investigate the possibility of providing HPV vaccinations through contacts in the pharmaceutical industry.
  • This effort by BHA and Dr Schnipper is also receiving guidance from Dr. Tsungai Chipato, Professor of Obstetrics and Gynaecology, at the University of Zimbabwe, who has experience with cervical cancer screening in Zimbabwe. We have held several conference calls with Dr. Chipato and have met with him personally during the 2013 planning visit to Zimbabwe.

For more information or to request a copy of the complete proposal, please contact Mr. Darrell Ward at dward@betterhealthcareforafrica.org or Dr. Lowell Schnipper at lschnipp@bidmc.harvard.edu

26 thoughts on “Zimbabwe Cervical Cancer Screening and Education Project – Executive Summary

  1. I am a student at Africa University doing an undergraduate Post Basic BSc Nursing. I am now in my final year and as a requirement for my program I have to embark on a research. My area of interest is cervical cancer. I would like to look into VIAC. I am kindly requesting for information on other researches that have been done on VIAC in Africa but especially in Zimbabwe. i will use this information for literature review.

    thank you

  2. Dear Ms. Mberikunashe – Thank you for your note requesting information about research on cervical cancer in Africa, particularly in Zimbabwe. Here are some resources you might find useful:

    You can search the medical literature and obtain abstracts of research papers at no cost (and some papers) using PubMed at: http://www.ncbi.nlm.nih.gov/pubmed/

    Other online resources:
    The International Agency for Research on Cancer (IARC)

    WHO: http://www.who.int/cancer/en/

    Cervical Cancer Action: http://cervicalcanceraction.org/home/home.php

    African Centre of Excellence for Women’s Cancer Control (Zambia): http://www.acewcc.org/what-we-do/cervical-cancer-prevention-program/

    Union for International Cancer Control: http://www.uicc.org/about-uicc

    Two more resources you might find interesting and useful:
    eHospice, the Africa edition: https://www.ehospice.com/africa/en-gb/home.aspx

    eCancer (I don’t know if this is open to students, but perhaps): http://ecancer.org/education/education.php

    Last, I know of two students who have now completed their research and graduated in Zimbabwe who worked in cervical cancer. If you would like to contact them, please send me an email at dward@betterhealthcareforafrica.org.

    Thank you, and I hope this information is helpful.

    Darrell E. Ward
    Better Healthcare for Africa

  3. Goodday

    My name is Prudence Mutemeri , l am a Registered General Nurse . l would like to find out if I could be part of the team in research in any projects that you do in your organisation .

    l would love to be part of the team and help to make a difference in the communities that you work with.

    please do send me requirements to be part of the team if they are any



  4. Im a student training as a Registered General nurse at Mpilo central Hospital doing my final year and im doing research on viac.Any information that you may have on viac will help me in conducting my researh as a pre requisite before I write my state final end of this year.Your assistance will be! greatly appreciated .
    Yours Faithfully
    Brown Pauline

  5. I am an state registered nurse in zimbabwe currently in private practise would like to in cancer screening programe,how do l go about it.

  6. I m a state registered nurse in zimbabwe currently in private practise.l would like to train in cancer screening viac,how do l go about it

  7. Dear Tendai – I’m sorry for the delay in replying to you. I am seeking the best answer to your question and will more soon. Thank you…Darrell

  8. How are you Dr Darrell. I need to know if you have started the treatment and screening.

  9. I am very grateful to know about this program .
    My request is to get tested cervical cancer by your hospital. Im aged 64 and l am sick on and off fo more than 12yrs. 2003 l was discovered patches of cancer by bulawayo hospital and was operated by they cut only areas affected.
    Please l need your help urgently if possible. I just think mayb the cancer has started again.

  10. Dear Tendai – I suggest that you visit one of the main hospitals who are doing the procedure and ask if you can be trained. Check at Pari in Harare or the hospital in Mpilo or Bulawayo UBH.

  11. Dear Ms Veronica – I am sorry to learn of your difficulty. I am told that cervical cancer screening and prevention, or VIAC, is being done in all hospitals now. Pari in Harare and the hospital in Mpilo and Bulawayo UBH can help you if you are close to one of them. But if you would really prefer to go to St Albert’s, you are free to do so. They will offer you what services they can. After you visit the hospital to be checked, please write again if you can and tell us how it went. Best regards…Darrell

  12. Dear Bradley – I am doing well, thank you. I hope you are keeping well also. We have helped St Albert’s Mission Hospital start a cervical cancer screening and treatment program two years ago, and it is going well. (Also, just so people know, I am not a doctor; I write about cancer research for a university cancer program and have done so for many years.)
    Best regards…Darrell

  13. Hi
    I would like to enquire if you offer training in cancer screening
    Thank you

  14. Hie Darrell, can you please give me names of private centres who do VIAC in Harare.


  15. Hi Darrell

    I would like to commend you for the way you respond to questions posted on this platform. God bless you

  16. I am an environmental health student at Masvingo poly and am interested in taking part in eliminating the possibility of any new cervical cancer cases as I believe it can be achieved. I am currently designing an awareness campaign on this problem because I believe an educated nation is an empowered decision maker.

    I realized that a few women are aware of this type of cancer especially the signs and symptoms and how they might get early diagnosis. Therefor my request is for us to join venture in my program.

  17. Dear Darell.

    I wish to start a PhD on massive cervical cancer screening in Zimbabwe based on cytology and p16 Immunohistochemistry in HIV infected patients. Any chances of corporation with your organization.



  18. Hi Darrell would be very nice to get in touch with you. Thank you so much for your vision concerning HIV and cancer in zimbabwe. You had the passion since you first visited. Keep it up.Jeanette

  19. Hie Doctor Ward, i hope i find you well..
    i am a medical laboratory science student and i must say i’m pleased to hear you are keen to find out more about cervical cancer screening and treatment. I wish to be in touch and receive updates that i can in my email because i am interested in the research, screening and treatment of cervical cancer.

    i look forward to your response.

  20. How are you Dr Darrel.I’m a final student at women university.midwife by profession
    So I want to do a research on post natal mother’s who come for VIAC at year is lost delivery.The knowledge and attitude towards the cancer screening…

  21. Hi Mr. Darrell Ward
    I am a lecturer in Debre Markos University, department of midwifery, Ethiopia. I have got your cervical cancer project is so smart and I would implement this project in to my community. so would you forward your full proposal paper to me for the guiding me & reference for my work.


    Hello, Ms. Nyamadzawo, and thank you for writing. I believe you are a student at Midlands State University. Please let me note first that I am not a doctor. I am a science and medical writer who has many years of experience writing about cancer with The Ohio State University Comprehensive Cancer Center – James Cancer Hospital and Solove Research Institute. I have also worked for many years to assist St. Albert’s Mission Hospital in Mashonaland Central, and am a founding member of Better Healthcare for Africa (BHA), an NGO organized to help St. Albert’s and Karanda mission hospitals. Also, when needed, I seek help from doctors in Zimbabwe when replying to questions about cancer and VIAC screening.

    You are correct that more education about cervical cancer and the benefits of screening and early detection are needed. Cervical cancer is almost entirely preventable when it is detected early, and VIAC screening is designed for the early detection of cervical cancer. It can reveal abnormal — precancerous — cells on the cervix before they become cancerous. Eliminating these cells usually prevents the disease. The screening exam also detects what may be cervical cancer itself, along with noncancerous conditions of the cervix that require treatment.

    You can learn more about cancer by taking the free, online course Introduction to the Science of Cancer. Enroll for the course at https://go.osu.edu/cancercourse.

    To see the course material without enrolling, and to learn more about how to prevent cancer, visit https://learn.canvas.net/courses/1565.

    • On the left side, click on Modules.
    • Go to Module 4, Prevention of Cancer.
    • At the top of the page, click on Lecture Materials.
    • Scroll down to see all the videos and related downloadable print material about cancer prevention.
    • I recommend video 4.6 Screening and Vaccination and 4.8 Cancer Prevention in Zimbabwe and Under-Resourced Countries.

    Thanks for your interest in cervical cancer and its prevention!

  23. Hello and thank you for your question. I am not certain where Pap testing is available in Harare, but I suggest that you check with Avenues Clinic, located on the corner of Baines Avenue and Mazowe Street. If they do not do Pap testing, they should be able to direct you to a clinic where it is available. Here is their web site:
    Please write again and let us know whether you were able to obtain your test and where.
    Best regards…Darrell

  24. Hello and thank you for writing. There will be a cost for someone who is treated for cancer. What the cost will be depends on the kind of treatment needed and the extent of the treatment. If you would like to learn more about the different methods of treatment, please watch this video, Cancer Treatment – an Overview.
    Best regards…Darrell

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