Cervical Cancer Prevention and Control Policy

Objectives

South Africa’s Cervical Cancer Prevention and Control Policy seeks to improve women’s health and wellbeing by reducing cervical cancer morbidity and mortality through an integrated continuum spanning primary prevention, screening, diagnosis, treatment, follow-up and palliative care.[1][2][3]It positions cervical cancer control as a national priority linked to sexual and reproductive health, universal health coverage, Sustainable Development Goal 3, National Health Insurance, primary healthcare re-engineering, and responses to HIV and non-communicable diseases.[4][5][6]

• Reduce oncogenic human papillomavirus infection, detect and treat cervical pre-cancer, and ensure timely treatment and palliative care for invasive cervical cancer.[7][1]
• Reduce invasive cervical cancer incidence from 31.7 to 20 per 100,000 women and the age-standardised mortality rate from 18 to 15 per 100,000 women by 2022.[1]
• Reduce oncogenic human papillomavirus infection incidence among HIV-negative women from 25% to 20% and among HIV-positive women from 60% to 55% by 2022.[1]
• Prevent infection through human papillomavirus vaccination for pre-pubertal girls, safer sexual health practices, voluntary medical male circumcision, lifestyle measures, tobacco prevention and cessation, and appropriate HIV management.[8][6][9]
• Provide organised screening and treatment for cervical abnormalities, prioritising women aged 30 to 50 years and applying intensified lifelong screening to women living with HIV and other immunosuppressed groups.[10][11]
• Promote equity, access, quality, safety, acceptability, efficiency, sustainability, accountability and integrated service planning, particularly for women facing HIV-related risk, poverty, geographical barriers and unequal access to care.[5][12][6]
• Improve quality of life for women with invasive or terminal cervical cancer through stage-appropriate treatment, rehabilitation, symptom control, palliative care and social support.[13][1][14]

Implementation

The policy uses a primary healthcare-based, multisectoral delivery model across community, primary healthcare, district, regional, tertiary and quaternary levels.[15][1][6]It combines school-based immunisation, structured population-based screening, linked diagnostic and treatment pathways, specialist cancer care and community support, while adapting technologies and service packages to local resources and referral capacity.[8][16][17][18]

• Deliver two human papillomavirus vaccine doses six months apart to girls generally aged nine to 12 years, primarily through the Integrated School Health Programme and collaboration among the Departments of Health, Basic Education and Social Development.[6][9]
• Provide free public-sector screening for eligible women, with three screening tests at ten-year intervals from age 30 for women at general risk, and more frequent screening for women living with HIV.[7][10][11]
• Use cytology, liquid-based cytology, visual inspection with acetic acid and progressively expanded human papillomavirus DNA testing according to laboratory capacity, trained staff, specialist access and local resource availability.[17][9][10]
• Organise screening around population coverage, quality-assured testing, prompt communication of results, reliable laboratories, referral pathways, follow-up and treatment of abnormal findings rather than opportunistic testing alone.[16][17]
• Strengthen visual inspection with acetic acid services in lower-resource settings through provider training, supervision and quality assurance, with same-day screen-and-treat services where appropriate.[17][10][19]
• Link all positive screening methods to treatment for pre-cancerous lesions, including cryotherapy, thermal coagulation and excisional procedures such as large loop excision of the transformation zone, with colposcopy and biopsy where feasible.[18][20][19][2]
• Refer women with confirmed invasive disease for staging and stage-appropriate surgery, radiotherapy, chemotherapy, chemoradiation, adjuvant treatment or palliative care, with advanced therapeutic services concentrated at tertiary facilities.[18][13][21]
• Develop multidisciplinary care involving surgeons, medical and radiation oncologists, pathologists, psychologists, social workers, families, communities, hospices and home carers.[18][13]
• Engage community healthcare workers, civil society organisations, academic institutions, research bodies and other government sectors to build awareness, create demand, recruit clients, reduce stigma and address wider barriers such as poverty, gender inequality and long travel distances.[14][22][3]
• Strengthen the National Cancer Registry, laboratory capacity, workforce skills, supplies, equipment, patient transport, strategic information systems and referral-feedback linkages as core implementation enablers.[1][6]
• Monitor vaccination coverage, human papillomavirus infection, screening coverage, laboratory service availability, treatment of high-grade lesions, cancer incidence, five-year survival and hospice care, with facilities treating cervical cancer required to report progress through the monitoring framework.[14][22]
• Recognise that the supplied material does not provide a quantified budget, financing allocation, funding source, resource-mobilisation plan or funding-gap estimate, although it identifies workforce, laboratory, infrastructure, technology and transport requirements.[1][6][21]

Monitoring & Evaluation

The policy establishes monitoring and evaluation as a strategic enabler for reducing cervical cancer morbidity and mortality, using reliable information to track implementation, service coverage, quality, outcomes and accountability across prevention, screening, diagnosis, treatment, follow-up and palliative care.[1][14][3]

• Develop a detailed monitoring framework jointly with provinces and districts, covering programme inputs, activities, expected outputs, and input, process and output indicators.[14]
• Align monitoring and evaluation with the national Health Information System Strategy and strengthen personnel, resources, technology and information management.[14]
• Strengthen the South African National Cancer Registry as a principal source of cancer statistics, baseline evidence and outcome tracking. The Registry receives pathology-based data from public and private laboratories and reports incidence by age, sex and population group.[12][23][1]
• Interpret Registry data cautiously where information gaps and limited current data affect representativeness.[12]
• Monitor human papillomavirus vaccination coverage and oncogenic human papillomavirus infection incidence, including the policy’s 2022 targets to reduce infection incidence from 25% to 20% among HIV-negative women and from 60% to 55% among HIV-positive women.[1]
• Track cervical cancer incidence, mortality and survival, including 2022 targets to reduce invasive incidence from 31.7 to 20 per 100,000 women and age-standardised mortality from 18 to 15 per 100,000 women.[1]
• Monitor access to laboratory-based cytology, screening coverage among eligible women, treatment of high-grade squamous intraepithelial lesions or cervical intraepithelial neoplasia grades 2 to 3, five-year survival, and hospice care received by women with terminal cervical cancer.[14][22]
• Measure screening performance through Pap-test adequacy, coverage and referral capacity, and quality-assure population targeting, test performance, laboratory reliability, treatment, referral, follow-up and communication.[16][10]
• Maintain quality assurance, provider training and supervision for visual inspection with acetic acid, liquid-based cytology and human papillomavirus testing to improve reliability and limit overtreatment.[17][10]
• Use result-based follow-up schedules, including annual screening for women living with HIV after a positive result and three-yearly screening for low-risk women after abnormalities until a negative result is obtained.[10][11]
• Ensure follow-up after lesion treatment, with repeat screening after three years or after one year for women living with HIV, and follow women treated for invasive cancer according to clinical guidelines.[2][21]
• Require facilities treating cervical cancer, irrespective of patients’ HIV status, to monitor and report improvements using indicators defined in the monitoring framework.[21][14]
• Maintain referral and feedback linkages, clinical monitoring of symptoms and treatment complications, and post-treatment follow-up for a minimum of three to five years.[13][1][6]

Costing & Financing

No quantified budget, costed implementation plan, financing allocation, funding source, funding gap, resource-mobilisation plan or economic assumptions are specified in the supplied extracts.[12][1][14][3]

• Provide eligible women with free public-sector cervical cancer screening as a national priority.[9]
• Recognise that staffing, facilities, direct treatment, detection and follow-up of pre-invasive lesions place substantial demands on primary and district services, while radiotherapy is expensive and concentrated mainly in tertiary and quaternary hospitals.[12]
• Address patient-borne costs associated with long-distance travel, accommodation and living expenses for treatment and follow-up, particularly where geographical inequities limit local access.[12]
• Prioritise earlier diagnosis and treatment because late-stage cervical cancer is more difficult and more expensive to treat effectively.[23]
• Allocate resources for skilled and supervised personnel, laboratory capacity, facilities, supplies, equipment, referral systems, patient transport, palliative-care facilities and home-care support, although their costs are not quantified.[18][13][1]
• Use screening technologies according to local resource availability, laboratory capacity and specialist access. Cytology-based programmes face financial, workforce, infrastructure, laboratory, logistics and technology barriers.[16][10]
• Recognise that screening expenditure rises with broader age eligibility, more scheduled tests and shorter screening intervals.[16]
• Use visual inspection with acetic acid where appropriate in constrained settings because it requires fewer commodities, no laboratory support and limited infrastructure, while managing its lower specificity and risk of false-positive results.[16][17]
• Consider the cost, logistical and technological barriers to commercial human papillomavirus testing; existing GeneXpert machines could reduce initial capital expenditure, although no quantified savings are provided.[17]
• Recognise human papillomavirus vaccination as the most cost-effective cervical cancer prevention strategy and apply efficiency and cost-effectiveness as guiding principles.[6]
• Use liquid-based cytology and human papillomavirus DNA testing progressively where resources permit, as these approaches may reduce repeat testing or lifetime screening requirements through longer intervals following a negative test.[9][24]
• Note that temporary disability grants may reduce financial threats for low-income women affected by cervical cancer.[18]