Process evaluation of quality of precancerous cervical lesion screening program in selected public health centers in Addis Ababa, Ethiopia.

Abstract

Cervical cancer is the second most prevalent disease among Ethiopian women of reproductive age and a serious gynecological malignancy affecting women regionally. About, 3235 deaths and 4648 new cases are reported nationwide each year. Precancerous cervical screening programs face many difficulties in settings with limited resources, despite their severity, such as a lack of medical supplies and equipment, poorly trained healthcare workers, a heavy workload for current staff, low professional compliance, and insufficient support from medical facilities. Furthermore, the quality of screening services is not well-supported by data in many places, which makes efforts to enhance these programs even more difficult. Improving service quality and customer satisfaction requires an understanding of the accessibility of critical screening tools and the skill of healthcare providers. Hence, this study aims to evaluate the process quality of the pre-cancerous cervical lesion screening program at selected public health centers in Gulele sub-city, Addis Ababa, Ethiopia. A case study design involving both quantitative and qualitative methods was conducted from April 09 to May 10, 2022. The study was conducted based on clinical guidelines and previously published evidence in peer-reviewed journals. A total of nine (n = 9) public health centers were involved in the study. A total of 223 study participants for service program evaluation. For the qualitative study, 12 key informants were interviewed at exit consecutively. Additionally, resource inventory and record review were conducted. Data were analyzed using SPSS for Windows version 25. Multi-variate logistic regression was used to check the association between the outcome and independent variables. Multivariate logistic regression was analyzed when the p-value was less than or equal to 0.25 in bivariate binary logistic regression, considering the statistical significance at p-value < 0.05. Qualitative data were analyzed manually by summarizing into a key thematic area. The evaluation findings were interpreted based on a predetermined judgment matrix with stakeholders during the evaluability assessment. From quality perspectives, study found that, pre-cancerous cervical lesion screening service concerning program resource availability was measured to be 80 %, which was good. In terms of satisfaction, the study found that 88 % of clients were satisfied with the precancerous cervical lesion screening service provided by health centers. Occupational status of a government employee (AOR: 0.04; 95 % CI: 0.003,0.63), educational status with no formal education (AOR: 0.04; 95 %CI: 0.006, 0.23), long-term use of contraceptives (AOR: 3.70; 95 %CI: 1.34, 10.21), and having multiple children up to three (AOR: 3.27; 95 %CI: 1.3, 9.44) were significantly associated factors with client satisfaction on screening services for precancerous cervical. However, while the overall program implementation scored 78.67 %, categorized as good, certain areas require improvement. Compliance with national guidelines among healthcare professionals were rated at 74 %, indicating a need for enhanced adherence to established standards. Qualitative findings revealed that trained providers often handle multiple responsibilities, leading to service quality challenges due to overburdening. Additionally, financial constraints hinder the availability of essential equipment and medications, posing significant barriers to effective service delivery. In conclusion, although the level of satisfaction with service provision was good and the overall quality of service was acceptable. However, the availability of necessary resources and compliance of health care providers to national guidelines need improvement. We recommend more efforts be exerted on improving providers' compliance and availing of necessary resources to enhance the status of pre-cancerous cervical cancer screening services.