JMIR Publications

ABSTRACT

Background:

Carcinoma cervix is one of the leading causes of death among females worldwide. WHO has put forth the 90-70-90 global strategy for elimination of cervical cancer as a public health problem. It calls for 70% women to be screened at least once in their lifetime. This is as low as 1.9% for India and even lower for many other countries, making the target insurmountable especially in resource-constrained settings. COVID-19 pandemic made this further challenging.

Objective:

To identify bottlenecks, high leverage points and propose a technology driven national level program for improving screening of carcinoma cervix.

Methods:

Detailed process mapping was done to identify potential bottlenecks. Counterfactual approach to identify high leverage points for impact using “What if” scenarios was done. These findings were used to build program theory based logic models to propose a national level program for carcinoma cervix prevention.

Results:

Availability, accessibility, affordability, skewed distribution of infrastructure, cost implications and limited specialist manpower were identified as bottlenecks. COVID-19 pandemic put a strain on existing resources and worsened the situation. Existing network of primary healthcare workers, changes in health seeking behavior due to COVID-19 with increasing role of tele-health, conducive political milieu with initiatives like Digital India Mission and booming startup ecosystem were identified as high leverage points through counter-factual approach. Using these findings a national program was designed with program theory based logic modeling.

Conclusions:

The journey from <2% of women screened at least once in their lifetime all the way to 70% would need a drastic increase in funding and resource allocation which is unlikely considering the current conditions. COVID-19 has not only been an adversity but also opened new thinking & opportunities. Artificial Intelligence driven, cost-effective, easy to use and widely acceptable solutions like “Smart-Colpo” can be a game-changer to achieve the WHO targets.