By Dr. Adetoun Olateju, Country Program Manager at Pink Ribbon Red Ribbon . . .
The Government of Ethiopia has prioritized cancer control and is investing its resources in the prevention and management of cervical cancer. Pink Ribbon Red Ribbon’s partnership with them started in 2015. With our implementing partners, we have opened 36 health facilities providing cervical cancer screening and treatment of pre-cancerous lesions in Addis Ababa, Oromia and Southern Nations, Nationalities and Peoples’ Region with a goal to open another 59 sites in four regions by the end of 2017. Across the health facilities supported by Pink Ribbon Red Ribbon, almost 16,000 women have been screened for cervical cancer and over 80 percent of those requiring treatment have been treated.
Pink Ribbon Red Ribbon is advancing innovation to support countries to adopt and adapt new technologies that improve the quality of service delivery for cervical cancer prevention. The primary screening method adopted by the Government of Ethiopia is the visual inspection with acetic acid (VIA) test where health workers apply household vinegar to the cervix. They then determine the cervical status to be ‘negative’ or ‘positive’ for pre-cancerous lesions based on what they see. An accurate diagnosis hinges on the ability of the provider to visualize the cervix properly and differentiate between cervical lesions. Since health workers often perform visual inspection with a dim light and use their mobile phones to capture images, the process would benefit from improved technology.
The Mobile ODT® Enhanced Visual Assessment (EVA) device was created to improve diagnostic accuracy during visual
inspection, reduce the subjectivity of VIA testing and obtain a higher quality of cervical images. The EVA system comprises a mobile colposcope equipped with an ultra-bright light source and a magnification lens to enhance cervical visualization; and a smart phone which contains a software application that captures the client information, assists health workers to determine the
appropriate treatment pathways, and is useful for remote consultation and client follow-up. The supervising clinical personnel can review the images for diagnostic agreement, quality control and on-the-job capacitybuilding. The device is in use in 20 countries, including health facilities in Kenya, El Salvador, Rwanda and Haiti. Ethiopia is the first Pink Ribbon Red Ribbon partner-country to use the device.
With the approval of the Federal Ministry of Health and the Oromia Regional Health Bureau, Pink Ribbon Red Ribbon is testing the feasibility of using the device across eight selected health centers and hospitals in Woliso Zone of Oromia Region over the next four months.
In January, the supervising team was trained over two days in Woliso. The participants included seasoned gynecologists, Federal Ministry of Health and the Regional Health Bureau teams and the implementing partner organization, Doctors for Africa – CUAMM. We adopted a ‘training-of-trainers’ approach and the supervisors are currently training the 22 front-line health workers in Woliso.
By the end of February, we will be rolling out the use of the devices in eight Pink Ribbon Red Ribbon-supported health facilities in Woliso. Considering the scale of the expansion of cervical-cancer screening that is taking place in Ethiopia over the next two to three years, it is imperative that frontline health workers have the proper equipment and training to make precise diagnoses. One possible path towards improving diagnosis is the use of the EVA system.
With the support of the FMoH, the demonstration will assess the use of the devices as a tool for routine screening of women who are eligible for VIA, the improvement in the quality of clinical supervision, and the readiness and capability of the system for large-scale uptake. This will contribute to building a stronger service delivery system for cervical cancer screening in Ethiopia.