On September 11, 2024, Being Africa hosted a Twitter Space under the “Her Reason for Being” series to discuss strategies for overcoming barriers to cervical cancer screening. The session was moderated by Ms. Valerie Aura, with panelists Ms. Elizabeth Makena and Ms. Martha Wanjiru sharing their expertise and insights.
Valerie opened the session by highlighting the preventability of cervical cancer and the ongoing challenges in screening and treatment access. She introduced the panelists, who provided crucial information on cervical cancer and the screening process.
Martha Wanjiru detailed the available cervical cancer screening methods, including Visual Inspection with Acetic Acid (VIA), HPV testing, and Pap smears. She noted that VIA and Pap smears are common, while HPV testing is less accessible due to logistical constraints. Martha clarified that screening should ideally start at age 21, with variations for HIV-positive individuals, and discussed treatments for pre-cancerous lesions. She also addressed misconceptions about the pain and discomfort associated with screenings.
Elizabeth Makena focused on the burden of cervical cancer in Kenya, emphasizing that it is a leading cause of cancer-related deaths despite being largely preventable. She described gaps in screening uptake and stressed the importance of early detection and preventive measures. Makena identified barriers, including individual, healthcare provider, and systemic issues, and called for improved education, better training for healthcare workers, and a more robust healthcare system to ensure consistent access to screening services.
Both panelists discussed barriers such as lack of knowledge, misconceptions, insufficient training, and resources. They also addressed systemic issues like supply shortages and the need for better policy enforcement and referral systems. Training Community Health Promoters (CHPs) is crucial for understanding cervical cancer and available resources. CHPs should accompany women to healthcare facilities to ensure timely care.
A well-coordinated community strategy is essential. CHPs identifying potential cases should accompany patients to hospitals for timely intervention. Referral processes must be efficient, with clear communication between facilities. For example, when a client is referred for a biopsy, the referring health worker should follow up to ensure the patient receives the necessary care and feedback.
At levels two and three, dispensaries and health centers should perform screenings and treat identified precancerous lesions. The “screen and treat” model should be followed, providing comprehensive care including treatment for precancerous lesions. This model requires trained personnel and established referral systems.
At levels four and five, specialized services including biopsies should have a clear process. Patients should be directed to specific clinics to avoid confusion and ensure timely care. Facilities must ensure prompt biopsy performance and effective communication of results to prevent treatment delays.
Makena highlighted the need to address cultural and social barriers, noting that training should include culturally accepted healthcare workers to overcome resistance due to gender and consent issues. Effective follow-up and reliable referral systems are essential to avoid delays or confusion for patients requiring treatment.
Martha stressed that women must seek treatment independently of their partner’s support, acknowledging that delays can lead to severe consequences. She noted that encouraging men’s involvement can be beneficial, citing successful instances where women brought their partners for support, leading to timely treatment and follow-up.

Makena added that training alone is insufficient; continuous on-the-ground follow-up is essential. She pointed out issues with the availability and distribution of thermal ablation machines and emphasized the need for better resource management. Martha also raised concerns about staffing adequacy and the need for proper assignment of trained personnel to manage cervical cancer screening and treatment effectively.
Ms. Patricia from the audience inquired about the relationship between cervical cancer and fibroids. Martha clarified that fibroids and HPV are unrelated, as HPV can cause 6 types of cancers like cervical, vulvar, penile, anal, oropharynx and vaginal cancer, but not fibroids. Makena added that fibroids are located within the uterus and are not detected during cervical cancer screenings. Fibroid treatment typically requires specialized care, including scans or MRI.
Makena discussed the impact of Community Health Promoters (CHPs) trained by the National Cancer Institute and the National Cancer Control Program. While CHPs have been trained, they often lack a medical background, making it challenging to educate others about cervical cancer effectively. She described a local initiative where CHPs receive one-day training, learn to simplify cancer education, and recruit clients for screening, leading to increased participation.
Makena emphasized the need for a tailored approach in training healthcare workers, addressing the full spectrum of cervical cancer services, including screening, treatment, education, and referrals. “We must close the gaps in service delivery,” she noted, advocating for integrated services where women receive comprehensive care during a single visit, including screening alongside other healthcare needs.
She highlighted the importance of effective client management and scheduling to reduce wait times and avoid burnout. “Serving 10 clients thoroughly is preferable to seeing 100 clients superficially,” she said. Additionally, she stressed the value of mentorship, encouraging experienced professionals to train successors and maintain service continuity during transitions.
Makena’s insights underscore the significance of improving healthcare systems to enhance service delivery and ensure quality care. “We must be intentional in our approach,” she concluded, calling for continued reinforcement of strategies to overcome staffing and operational challenges.
In conclusion, Martha and Makena emphasized the importance of a holistic approach to cancer screening and treatment. Martha highlighted the need for systematic tracking and comprehensive cancer education, including breast and colorectal cancer, using tools like MOH 412. Makena stressed integrating services and mentoring new healthcare workers to improve client management and reduce gaps. Both underscored the urgent need to provide dignified care and ensure timely and effective treatment. As we continue our advocacy, we must address these challenges and strive to improve awareness and service delivery for better cancer outcomes.