Policy Considerations to Promote Equitable Cervical Cancer Screening and Treatment in Peru

Andrea Thoumi; Sarah J Bond; Mary Elizabeth Dotson; Marlee Krieger; Patricia J Garcia; Nirmala Ramanujam

doi:10.5334/aogh.3442

Policy Considerations to Promote Equitable Cervical Cancer Screening and Treatment in Peru

Ann Glob Health. 2021 Nov 24;87(1):116. doi: 10.5334/aogh.3442. eCollection 2021.

Authors

Andrea Thoumi¹, Sarah J Bond², Mary Elizabeth Dotson³, Marlee Krieger⁴, Patricia J Garcia⁵, Nirmala Ramanujam⁶

Affiliations

¹ Health Equity, Duke-Margolis Center for Health Policy, 1201 Pennsylvania Ave NW, Washington, DC 20004, US.
² Duke University, 100 Fuqua Drive, Durham, NC 27708, US Margolis Summer Intern, Duke-Margolis Center for Health Policy, US.
³ Center for Global Women's Health Techologies, Duke University, Gross Hall, 140 Science Drive, Durham NC 27708, US.
⁴ Center for Global Women's Health Technologies, Duke University, Gross Hall, 140 Science Drive, Durham NC 27708, US.
⁵ School of Public Health, Cayetano Heredia University, Lima-Peru, Av. Honorio Delgado 430, Lima 31 SMP, PE.
⁶ Robert W. Carr, Jr., Distinguished Professor of Biomedical Engineering, Center for Global Women's Health Technologies, Duke University, Gross Hall, 140 Science Drive, Durham NC 27708, US.

Abstract

Background: Cervical cancer is one of the leading causes of death among Peruvian women. Women seeking screening or treatment services experience delays in receiving screening results provided at community clinics or district hospitals, and lack sufficient resources to pay out-of-pocket to travel to the capital city of Lima for specialized treatment. Continued disparities in health outcomes and systemic barriers to accessing services suggest there are gaps between policy measures and implementation.

Objectives: We aim to understand why national policies and clinical pathways that are aligned to global standards have been insufficient in improving cervical cancer screening and treatment in Peru, particularly among women who experience systemic exclusion from health services.

Methods: We conducted a policy analysis based on a literature review (2005-2020), in Spanish and English, on PubMed, Global Health, Scopus, EconLit, Lilacs, and Scielo using a value-based care framework.

Findings: The main barriers included unequal distribution of health infrastructure and health care workforce, and differences in access to health insurance. Additional barriers, including limited political will and support, limit efforts to prioritize the implementation of cervical cancer policies. We propose policy considersations in redesigning payment models, expanding healthcare workforce, generating costing and policy evidence, and reviewing policies for point-of-care technologies.

Conclusions and recommendations: The barriers identified in this literature review are applicable not only to cervical cancer care, but to primary health care in Peru. Systematic policy changes that address root causes of health inequities and are implemented at scale are needed to advance health reform efforts.

Publication types

Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.
Review

MeSH terms

Early Detection of Cancer
Female
Health Care Reform
Health Inequities
Humans
Peru / epidemiology
Policy
Uterine Cervical Neoplasms* / diagnosis
Uterine Cervical Neoplasms* / therapy

Grants and funding

Funding for this article was supported by USAID-DIV award to Duke University (PI: Ramanujam, Nirmala) #7200AA19FA00001 entitlted “Closing the Gap between Identification and Treatment of Cervical Abnormalities in Cajamarce, Peru through Integration of HPV Self-Sampling, Pocket Colposcopy, & Thermal Ablation,” as well as through Bass Connections at Duke University, which supports faculty-mentored multi-disciplinary projects for undergraduate and graduate students.