Table 4 Health system factors

Service delivery

∙ Lack of user-friendly services

∙ Opportunistic screening instead of proactive screening

∙ Inadequate privacy or confidentiality

Health workforce

∙ Insufficient or lack of staff (gynecologists, trained nurses or midwives, pathologists, laboratory staff)

∙ Inadequate staff capabilities

∙ High turnover of staff

Monitoring and evaluation

∙ Inadequate paper patient files and reporting

∙ Lack of a reminder system for defaulting patients

Access to medicines / supplies

∙ Unavailability of hrHPV tests;

∙ Supplies for cryotherapy or thermal ablation only via commercial suppliers

∙ Insufficient sterilization of equipment

∙ Lack of maintenance and repair

∙ Limited number of distributors

Financing

∙ Vertical approach toward community-based programs

∙ Focus on financing curative care

Governance

∙ Lack of / insufficient implementation of guidelines

∙ Lack of a functional national screening program