Monitoring and Evaluation

Monitoring and evaluation of a prevention program’s operations and impact help determine whether the program is meeting its objectives effectively and efficiently. Results of program monitoring and evaluation can be used to help ensure appropriate delivery of services, assess coverage, and correct problems in program operations. Positive evaluation results also can be used to mobilize continued financial and political support for the program.

Client records are key to effective program monitoring. Records should allow programs to follow individual women over time, and they should include the clients’ screening results, diagnostic referrals, and treatment outcomes. For example, a basic health card system could include a woman’s identifying information, date of each screening test, the results, and any diagnostic or treatment details. Ideally, information from client records should be linked to regional or national databases to allow aggregation of key health data.

Program and Policy Implications

The demand for programs to combat cervical cancer is strong. All over the developing world, women’s health providers regularly see women with advanced, incurable cervical cancer. While many countries have expended their scarce resources on providing surgical and radiotherapy services to a very small proportion of these women, there is little they can do for most cancer patients but provide palliative care. At a minimum, programs must plan to achieve the goals listed below to reduce cervical cancer incidence and mortality:

• increase awareness of cervical cancer and preventive health-seeking behavior among women in their thirties and forties;
• screen all women aged 35 to 50 at least once before expanding services to other age groups or decreasing the interval between screening;
• treat women with high-grade lesions, refer those with invasive disease where possible, and provide palliative care for women with advanced cancer;
• collect service delivery statistics that will facilitate ongoing monitoring and evaluation of program activities and outputs.
  

At the same time, of course, support for general STI control efforts will contribute to preventing a portion of cervical cancer cases in the long term. Key activities for achieving these minimum program goals in many low-resource settings include:

• coordinating cervical cancer prevention services with health programs that offer related services and/or reach women in their thirties and forties;
• identifying and addressing bottlenecks to effective service delivery (for example, inadequate cytology services or inadequate information systems) before initiating a new program;
• removing regulatory barriers to broadening access to services, such as regulations that do not allow nurses, midwives, or other paramedical workers to provide screening services;
• ensuring that providers at all levels are trained in all aspects of cervical cancer prevention, including counseling skills;
• using innovative, culturally appropriate, field-tested strategies to reach underserved older women; and 
• supporting targeted research on new screening and treatment approaches that may increase access to services and cut program costs.

Through creative service delivery strategies and well-trained, dedicated staff, cervical cancer prevention programs can address the challenges of providing appropriate screening and treatment and ultimately have a lasting effect on women’s health.