An evaluation of the cervical screening programme in Johannesburg, South Africa

Introduction:
Cervical cancer continues to be a significant cause of morbidity and mortality in women, particularly in the developing world, due to the lack of effective population screening programmes.  The South African national cervical screening policy states that women aged 30 years or older will be screened three times in succession at ten year intervals, utilizing Pap smears.  The elements necessary for a successful cervical screening programme include: high coverage targeting the appropriate high risk age group, good quality smears, effective referral and treatment of women with abnormal smears, and a Health Information System that allows efficient planning and service organization.  Legislative and policy advances in South Africa have not necessarily been followed by successful implementation of services. 

Aims:
The study aims to assess the current status of the cervical screening programme in Johannesburg Metro District, including screening, referral and treatment and the health information systems.

Methodology:
Cervical screening data recorded in the District Health Information System and laboratory databases; and registers at Primary Health Care clinics and referral colposcopy services were evaluated in Jhb Metro District, South Africa for the period April 2007 – March 2008. 

Results:
Screening coverage was well below proposed targets.  Many clinics have unacceptably high smear inadequacy rates. High proportions of smears are done in women outside the target age group.  However, within the younger age group under 30 years, a high proportion of smears done are abnormal.  There are high rates of loss-to-follow-up.  Of women with high grade squamous intra-epithelial lesions (HGSIL), only around 40% attended referral appointments for colposcopy.  Long waiting times for appointments (up to 15 months) were noted to be a factor.

Conclusion:
The study provides evidence for health managers to evaluate the current service and inform recommendations to improve cervical screening coverage and effective referral and treatment in the district.