Service Accessibility as a Determinant of Cervical Cancer Screening in Gwanda District, Zimbabwe

Abstract

Zimbabwe has one of the highest prevalence of cervical cancers in the world. The country has a low screening coverage despite the availability of cost-effective and evidence-based interventions for the prevention of the disease that include screening. This study therefore assessed service accessibility as a determinant of screening in Gwanda District, Zimbabwe. An explanatory sequential mixed-method design was employed firstly using a quantitative survey of 609 screening-eligible women selected through multi-stage random sampling. Subsequently, 36 women purposely selected from the quantitative phase were engaged in focus group discussions, and 25 health-care workers as key informants. About 74.4% of rural participants had never been screened compared to 62.1% of urban participants. Qualitative findings revealed that the district has two screening sites, both in urban locations. Rural based women access the service through outreach clinics which are inconsistent with no provision for treatment. Furthermore, treatment facilities are centralised to the provincial hospital at a fee. Financial constraints associated with travel expenses and treatment costs emerged as the key factor that hinders participation in screening. Improved access to services could greatly increase screening rates to match the high demand in the district. Decentralising screening to primary health facilities could ensure ready access of the service and enhance screening. Supplemental to that, outreach services to hard to reach areas need to be increased and sustained.