Cervical Cancer Screening Policy

Objectives

Fiji’s cervical cancer prevention and control policy seeks to provide women with lifelong access to a comprehensive, integrated programme that reduces cervical cancer morbidity and mortality through human papillomavirus vaccination, early detection of pre-cancer, prompt treatment and referral for suspected cancer.[1][2][3]

• Provide human papillomavirus vaccination to Grade 8 girls before sexual activity begins, while maintaining screening for both vaccinated and unvaccinated women because vaccination does not protect against all oncogenic human papillomavirus types.[4][5][6]
• Screen asymptomatic women aged 30 to 49 years routinely, generally every three years after a negative result, and ensure women aged 26 to 69 years receive at least one screening test during their lifetime.[1][2][7]
• Achieve screening participation among 80% of women aged 30 to 49 years over a three-year period.[1][2]
• Prioritise screening for women and girls who have initiated sexual activity and test positive for human immunodeficiency virus, regardless of age, owing to their elevated risk of earlier cervical cancer.[8][7][9]
• Detect and treat cervical intraepithelial neoplasia and other precancerous lesions before progression to invasive cervical cancer.[4][10]
• Improve women’s and men’s knowledge of cervical cancer, prevention, vaccination, screening, treatment and routes to local services through accurate and culturally appropriate information, education and communication.[2][11][5]
• Ensure equitable access to high-quality prevention, screening, diagnosis and treatment, supported by a competent workforce, reliable equipment and consumables, outreach capacity and coordinated referral pathways.[2][12][3]

The programme combines visual inspection with acetic acid, cytology through Pap tests or liquid-based cytology, and potentially human papillomavirus DNA testing as screening methods.[4][13]Visual inspection with acetic acid and same-visit cryotherapy form a low-resource screen-and-treat approach for eligible precancerous lesions, while women with symptoms or a cervix suspicious for cancer should be referred directly for diagnostic assessment and management rather than screened.[1][13][14]Cryotherapy and large loop excision of the transformation zone are used according to lesion suitability and clinical eligibility.[10]

The policy also aims to strengthen information systems, quality assurance and service efficiency.[15][16]It identifies screening coverage, positivity, treatment completion, unsatisfactory cytology, same-visit treatment, cervical cancer incidence and mortality as central measures of programme performance and impact.[16][17][18]

Implementation

Implementation is based on a nationally coordinated cervical cancer prevention and control programme within the Ministry of Health and Medical Services, delivered through national, divisional and local teams, health facilities, schools, communities and participating non-governmental organisations.[2][19][16]National coordination is led by a National Coordinator and three Divisional Managers within a clinical governance framework, with multidisciplinary oversight from the Clinical Services Network.[2][19]

• Establish national and divisional programme teams and divisional work plans covering screening targets, workforce, training, equipment, commodities, monitoring and evaluation.[16]
• Deliver school-based vaccination alongside local screening, diagnosis, cryotherapy and referral services through health centres, nursing stations and divisional hospitals.[1][19][5]
• Refer women requiring colposcopy, biopsy, diagnosis, further treatment or follow-up to Divisional Hospitals, including women with suspicious symptoms, abnormal cervical appearance, lesions unsuitable for cryotherapy or specified abnormal cytology.[20][17]
• Use trained and assessed registered nurses, midwives and doctors to provide visual inspection with acetic acid, cytology, cryotherapy, counselling and follow-up services.[20]
• Apply a train-the-trainer model, refresher courses, divisional training, mentoring and certification to maintain provider competence in cytology, visual inspection with acetic acid and cryotherapy.[20][15][12]
• Conduct an initial quality-assurance visit within one month of training completion, followed by national mentoring and continuing divisional and local supervision.[15]
• Use facility audits to confirm accessibility, privacy, counselling and examination space, specimen transport, infection prevention, utilities, records, registers, equipment and cryotherapy readiness before opening new screening sites.[21]

Health promotion is implemented through the Cervical Cancer Prevention and Control Health Promotion Unit, divisional public health units, community workers, women’s and men’s groups, church groups, schools, government services and non-governmental organisations.[11][22]Outreach uses standardised brochures, posters, banners, flip charts, lesson plans, social media, mobile phones, ambassadors and print, radio and television campaigns.[10][11][22]Counselling should protect privacy and confidentiality, explain screening and treatment options, check understanding, support informed choice and respect a woman’s right to refuse screening or treatment.[8][23]

Data governance relies on the Fiji Cervical Cancer Screening Register, also referred to as the Fiji National Cervical Cancer Screening Data Registry, with standardised data collected from providers and non-governmental organisations for national aggregation and review.[2][19][6]Facilities retain original screening forms, send copies to the National Screening Unit for data entry, and send referral copies to Divisional Hospitals where applicable.[24]Monthly submissions and performance reports support local, divisional and national monitoring, with programme outcomes reviewed through Divisional Plus meetings, divisional forums and the Clinical Services Network.[16][3]

Quality assurance includes site assessments, observation of counselling, sampling, visual inspection with acetic acid and cryotherapy procedures, provider self-assessment, logbook and data-concordance checks, infection-control and equipment-maintenance reviews, and performance-improvement action plans.[15][25][23][26]Provider competency is rated as needs improvement, developing competence or competent, with assessor comments, signatures and dates recorded.[27][28][29]

Key operational indicators include screening participation over 36 months; positivity, treatment and same-visit treatment over 12 months; population coverage over an agreed period; a screening positivity target of 5% to 10%; and an unsatisfactory cytology target below 5%.[17][18]The programme also monitors annual full vaccination coverage among girls by age 13, adverse events following immunisation, laboratory turnaround time, referral completion and age-specific cervical cancer incidence and mortality.[16][24]Laboratory results are expected to return within four weeks, while annual reference levels are 20,000 Pap tests and 30,000 Thin Prep tests.[24]

Resources are to be secured through advocacy, facility audits, ordering of essential equipment and consumables, and confirmation of transport for outreach clinics.[2][3]Historical delivery received support from the Australian Government, the Australian Cancer Society and Australian aid, including donated human papillomavirus vaccines and support for a visual inspection with acetic acid and cryotherapy feasibility pilot.[1]No total budget, domestic allocation, costed implementation plan, funding gap or economic assumptions are specified in the supplied text.[30][12][3]

Monitoring & Evaluation

The policy establishes a national monitoring, evaluation and quality-assurance system for cervical cancer prevention, linking a screening register, standardised data collection, service indicators, routine reporting, clinical supervision and programme review across national, divisional and local levels.[2][16][3]

• Maintain the Fiji Cervical Cancer Screening Register or National Cervical Cancer Screening Data Registry, with screening, treatment, referral and follow-up data collected from local services and participating non-governmental organisations for national aggregation and analysis.[2][19][9][6][17]
• Submit standardised provider forms monthly and produce reports for local, divisional and national monitoring; retain original screening forms at health centres or nursing stations, send copies to the National Screening Unit for data entry, and send copies to Divisional Hospitals when referral occurs.[16][24]
• Monitor participation, population coverage, screening positivity, treatment, unsatisfactory cytology, same-visit treatment for eligible screen-positive women, treatment completion after colposcopy referral, and follow-up or treatment completion for suspected invasive cancer.[16][17][18]
• Measure participation over 36 months and positivity and treatment over 12 months; target 80% screening participation among women aged 30 to 49 years over three years, a 5-10% screening positivity rate, and an unsatisfactory cytology rate below 5%.[1][17][18]
• Track laboratory turnaround, with results targeted to return in under four weeks, alongside screening volumes by method, age group and Health Division; annual reference levels are 20,000 Pap tests and 30,000 Thin Prep tests.[24]
• Monitor human papillomavirus vaccination through annual coverage of girls fully vaccinated by age 13 and annual reporting of adverse events following immunisation.[16]
• Assess programme impact through age-specific cervical cancer incidence and mortality in the target population, while using disease burden measures to track longer-term progress.[16][1]
• Review outcomes through Divisional Plus monthly meetings, divisional meetings and the Clinical Services Network, using evidence-based feedback, recommendations and implementation reviews to improve accountability.[2][19][16]
• Strengthen information systems by exploring integration of screening, pathology and histology data with Fiji’s electronic medical record systems, use of the National Health Number as a unique identifier, and incorporation of records into the PATIS database.[16][3]
• Conduct site assessments and quality-assurance visits that review provider proficiency, procedure observation, infection prevention, equipment maintenance, documentation, logbook discordance, reporting, educational materials and agreed performance-improvement actions.[15]
• Assess provider competency in counselling, cervical sampling, visual inspection with acetic acid and cryotherapy through observation guides, three-level performance ratings, assessor comments, signatures and dated competency decisions.[25][23][27][28][26][29]
• Use clinical results to determine follow-up, treatment or referral, including direct diagnostic referral for women with symptoms or a cervix suspicious for cancer.[4][13][14]

The policy provides indicators, data forms, audit tools and reporting mechanisms, but some extracts do not specify a single comprehensive evaluation timetable or a fully named accountability framework beyond the responsibilities assigned to national teams, the National Screening Unit, Divisional Hospitals and the Clinical Services Network.[15][24]

Costing & Financing

The policy identifies resource needs and several historic sources of external support, but does not provide a total programme budget, unit costs, domestic allocations, quantified funding gap, cost-effectiveness analysis or wider economic assumptions.[1][2][19]

• Recognise historic external financing from the Australian Government and Australian Cancer Society for the formal cervical cancer screening programme introduced in 1993, donated human papillomavirus vaccines for a 2008 pilot, and Australian aid support for a visual inspection with acetic acid and cryotherapy feasibility pilot.[31][1]
• Advocate for sufficient staffing and resources, and ensure the availability of screening and treatment equipment, medical consumables and outreach transport across Divisions.[30][2][3]
• Plan equipment and commodity requirements through facility audits, including supplies for cytology, visual inspection with acetic acid and cryotherapy, while confirming transport access for outreach clinics.[3][21][25]
• Address infrastructure constraints, as Pap test infrastructure and human resources had reached capacity at approximately 20,000 tests annually, creating a need for more efficient or alternative screening approaches.[1]
• Consider liquid-based cytology and automated processing as potential means to reduce unsatisfactory samples and conserve laboratory resources.[13]
• Recognise that the current cost of human papillomavirus DNA testing is prohibitive for implementation as a screening programme.[13]

No financial value is assigned to the identified external support, equipment, consumables, transport, workforce development or quality-assurance activities, and the supplied sections do not quantify resource mobilisation requirements or a funding shortfall.[1][12][3]