Cervical Cancer Screening Policy

Objectives

Fiji’s cervical cancer prevention and control policy establishes a comprehensive, life-course programme intended to reduce cervical cancer morbidity and mortality through human papillomavirus (HPV) vaccination, screening, early diagnosis, treatment of precancerous lesions, referral, health education and counselling.[1][2][3]It seeks universal access to high-quality, integrated services for women throughout their lives, while improving community awareness, defining clear pathways of care, and ensuring that services are effective, efficient and equitable.[4][5][2]

• Provide HPV vaccination for all Grade 8 girls as the principal primary-prevention measure, while continuing screening because vaccination does not protect against all oncogenic HPV types.[5][6][7]
• Provide routine screening every three years for asymptomatic women aged 30 to 49 years using visual inspection with acetic acid (VIA) or cytology, and ensure at least one lifetime screening test for eligible women aged 26 to 69 years.[5][2][8]
• Achieve screening of 80% of women aged 30 to 49 years over a three-year period.[5][2]
• Prioritise screening for sexually active women and girls who test positive for HIV, regardless of age, and provide one-off screening for women aged 50 to 69 years.[8][9]
• Detect and treat cervical pre-cancer promptly through VIA, cytology, HPV DNA testing where feasible, colposcopy, biopsy and appropriate treatment, including cryotherapy or large loop excision of the transformation zone.[6][10][11]
• Refer women with symptoms, suspicious cervical appearances, lesions unsuitable for cryotherapy, or specified abnormal cytology findings for diagnostic assessment and management.[12][13]
• Promote accurate, culturally appropriate information for women and men on prevention, screening, treatment, informed choice and where to access local services.[2][14][7][15]
• Strengthen a competent, sensitive and effective workforce, distribute commodities equitably, and maintain high-quality prevention, screening, diagnosis and treatment services across Fiji.[2][16][3]

Implementation

Implementation uses a nationally coordinated but divisional and locally delivered model, combining school-based immunisation, community promotion, facility-based and outreach screening, same-visit treatment where clinically appropriate, referral to divisional hospitals, workforce development, quality assurance and a national screening data system.[5][2][17][18]The Ministry of Health and Medical Services leads policy rollout, supported by the Family Health Unit, National and Divisional Cervical Cancer Prevention and Control Programme (CECAP) teams, the Clinical Services Network, public health and health-promotion services, laboratories, non-governmental organisations and community stakeholders.[1][2][18][14]

• Coordinate the programme through a National CECAP Coordinator and three Divisional CECAP Managers within a clinical governance framework, with national, divisional and local teams responsible for programme design, planning, delivery, monitoring and quality improvement.[2][17]
• Develop divisional work plans covering screening targets, workforce needs, training, equipment, commodities, outreach transport, monitoring and evaluation, and review progress through monthly and divisional governance meetings.[18][16][3]
• Deliver vaccination through the national immunisation schedule and school-based services for Grade 8 girls.[5]
• Provide screening through hospitals, health centres, nursing stations and participating non-governmental organisations, using VIA, Pap tests or liquid-based cytology according to local capacity and clinical need.[17][6][13]
• Use VIA with immediate cryotherapy for eligible precancerous lesions where feasible, while referring women with suspected cancer, non-visible transformation zones, unsuitable lesions or uncertain findings for cytology, colposcopy, biopsy or specialist treatment.[6][11][12]
• Deliver cryotherapy through trained and assessed doctors, nurses and midwives, and provide large loop excision procedures through gynaecologists and gynaecology registrars in the Central, Western and Northern Divisions.[11][13]
• Train providers through train-the-trainer, full-course and refresher models covering counselling, cervical sampling, cytology, VIA, cryotherapy and infection prevention; conduct post-training quality-assurance visits and ongoing divisional mentoring.[13][19][16]
• Engage women’s groups, community and village organisations, churches, religious leaders, community workers and other health professionals through local education, outreach, national media, mobile phones, social media and programme ambassadors.[17][14][20]
• Maintain the Fiji Cervical Cancer Screening Register, collect standardised provider data monthly, and use local, divisional and national reports to monitor participation, positivity, treatment, coverage, unsatisfactory cytology, follow-up and programme impact.[18][21][22]
• Apply quality-assurance tools including facility readiness assessments, register and form concordance checks, provider observations, competency ratings, site visits, laboratory turnaround monitoring and documented performance-improvement plans.[19][23][24][25]

Monitoring & Evaluation

The programme establishes a national monitoring, evaluation and quality-assurance system centred on the Fiji National Cervical Cancer Screening Register, standardised data collection, routine performance review, supervisory visits and competency assessment. Data are intended to support monitoring at local, divisional and national levels, with outcomes reviewed through governance meetings and clinical oversight structures.[2][17][18]

• Maintain a national screening register that captures demographic information, screening dates and methods, results, rescreening, cryotherapy, follow-up, referrals and referral reasons.[2][21]
• Collect identified screening and treatment data from health facilities and non-governmental providers, submit standardised data monthly, and prepare regular reports for local, divisional and national review.[17][18]
• Develop data definitions, programme indicators, reporting forms and a framework that extends the visual inspection with acetic acid register to include cytology, client recall and programme reporting.[16][3]
• Monitor human papillomavirus vaccination coverage among girls by age 13 and the annual rate of adverse events following immunisation.[18]
• Measure screening participation among women aged 30 to 49 years, screening positivity, treatment after positive visual inspection with acetic acid or cytology, screening coverage among women aged 26 to 69 years, unsatisfactory cytology and same-visit treatment of eligible screen-positive women.[18][21][22]
• Apply a screening participation target of 80% of women aged 30 to 49 years receiving their first screen within the preceding 36 months by 2017.[21][22]
• Use reference targets of 5% to 10% for screening positivity and less than 5% for unsatisfactory cytology; the source notes that the period for measuring lifetime coverage and handling of repeat tests require agreement.[22]
• Assess treatment completion after referral, same-visit cryotherapy for eligible lesions, and treatment or appropriate follow-up for suspected invasive cancer.[21][22]
• Assess impact using age-specific cervical cancer incidence and mortality in the target population.[18]
• Monitor laboratory processing time against a benchmark of less than four weeks, alongside annual reporting targets of 20,000 Papanicolaou tests and 30,000 ThinPrep tests.[23]
• Review annual work plans, screening targets and implementation against agreed indicators through Divisional Plus monthly meetings, divisional meetings and the Clinical Services Network.[2][18]
• Conduct quality-assurance visits that examine site readiness, infection control, equipment maintenance, provider proficiency, data management, registers, documentation, discordant records, observed procedures and corrective action plans.[19][26]
• Assess counselling, cervical sampling, visual inspection with acetic acid and cryotherapy competency using structured observation tools, assessor comments, signatures, dates and ratings of needs improvement, developing competence or competent.[24][27][25][28][29][30]
• Require National CECAP to review performance standards and indicators during quality-assurance visits, while Divisional CECAP teams undertake continuing divisional and local quality assurance.[19]
• Explore integration of screening, pathology and histology data with electronic medical records, including use of the National Health Number as a unique register identifier and incorporation of screening records into the PATIS database.[18][3]

Costing & Financing

Financing information is limited. The policy identifies historic external support for screening, pilot activities and vaccination, while recognising workforce, equipment, consumables, data systems and outreach transport as operational resource requirements. It does not provide a costed implementation plan, budget allocations, annual funding requirements, funding gaps, financing mechanisms or economic assumptions.[5][3]

• Record Australian Government and Australian Cancer Society funding for the formal cervical screening programme introduced in 1993.[5]
• Record Australian aid support for the visual inspection with acetic acid and cryotherapy feasibility pilot.[5]
• Record donated vaccines used for the 2008 human papillomavirus vaccination pilot.[5]
• Recognise that the current cost of human papillomavirus DNA testing is prohibitive for implementing it as a screening programme in Fiji.[10]
• Use automated liquid-based cytology processing as a means of saving laboratory resources.[10]
• Plan for resource advocacy, equitable distribution of equipment and consumables, facility assessments, equipment ordering and transport for outreach clinics.[2][3]
• Maintain minimum equipment and consumables for screening and cryotherapy services, although the available material attaches no prices or funding source to these requirements.[26][24]