Challenges in Cervical Cancer Control

Cervical cancer is highly preventable, yet it remains one of the leading causes of cancer death among women in low- and middle-income countries. The gap between what is scientifically possible and what is actually available is largest in settings with weak health systems, limited resources, and high levels of inequality.

These challenges affect every step of the prevention cascade: vaccination, screening, triage, treatment, and follow-up.

Barriers to vaccination, screening and treatmentHealth workforce crisisCompeting health prioritiesFragmented records and limited digitalization
PreviousNext

Barriers to vaccination, screening and treatment

Even though effective tools exist, women face multiple obstacles at each step:

  • Vaccination

    Limited vaccine supply, high cost, weak delivery platforms, and misinformation reduce HPV vaccine coverage, especially in rural and marginalized communities.

  • Screening and triage

    Distance to clinics, long waiting times, limited trained staff, stock-outs of tests, and stigma lead to low screening coverage and high loss to follow-up.

  • Treatment

    Limited access to ablative/excisional treatments for precancer, and insufficient capacity for surgery, radiotherapy, and chemotherapy for invasive cancer, especially outside major cities.

Global work force:
‘The world health report 2006: working together for health.’,
in WHO (ed.), (Geneva: WHO).

Health Workforce crisis

Cervical cancer control is further constrained by the broader health workforce crisis in sub-Saharan Africa. The region carries about 24% of the global disease burden but has only around 3% of the global health workforce and spends roughly 0.3% of global medical expenditure.

In sub-Saharan Africa, very low physician density and a severe shortage of specialists — including gynecologists, oncologists, pathologists, and radiologists — combine with limited radiotherapy and advanced cancer treatment capacity, leaving many countries with few or no radiotherapy machines. Overburdened staff and facilities make it difficult to add new services such as screening programs without disrupting existing care, making this workforce gap a fundamental barrier to scaling up cervical cancer prevention and treatment.

Competing health priorities

In many partner countries, health systems are already stretched by high burdens of infectious diseases:

  • HIV

    HIV prevalence remains high in eastern and southern Africa. HIV-positive women have an increased risk of persistent HPV infection, faster progression to precancer and cancer, and poorer treatment outcomes. This complicates screening and treatment, as these women require more frequent follow-up and coordinated care between cervical cancer and HIV services.

  • Tuberculosis

    Tuberculosis remains a leading cause of illness and death with nearly 9 Million new infections annually and a high mortality rate of over 1 Million. Most infections occur in resource-limited settings, and especially in populations where HIV is prevalent. TB programs require substantial staff time, laboratory capacity, and clinic space, with a strong focus on case detection, treatment adherence, and infection control. Health facilities often prioritize these acute infectious disease services within their daily workflows.

  • Malaria

    200 Million symptomatic malaria cases occur globally on an annual basis with the heaviest burden in sub-Saharan Africa where over 90% of all 600 000 malaria deaths occur, mostly among young children.  Seasonal surges in malaria cases increase patient loads and demand for diagnostics, medicines, and inpatient care. Clinics and hospitals must allocate significant resources to manage these peaks while maintaining routine services.

Fragmented records and limited digitalization

Many cervical cancer prevention programs still rely on paper-based registers and fragmented medical records. This leads to:

  • Lost or incomplete screening results and follow-up data.

  • Difficulty tracking women through the care pathway from screening to treatment.

  • Limited ability to monitor program performance, coverage, and outcomes at scale.

Click here to learn how ETiCCS is tackling these challenges

To address this, ETiCCS collabarates with partners to develop electronic data systems that link communities, health facilities, and laboratories, enabling real-time results, better coordination, and stronger monitoring and evaluation.

Learn more

What is the global burden of cervical cancer? See The Cervical Cancer Burden.

How does cervical cancer develop? Explore HPV, Precancer and Cancer.

What can be done to prevent it? Read about Cervical Cancer Prevention.