Lessons from the Field

Posted by On August 3, 2015
By Doyin Oluwole In my work at Pink Ribbon Red Ribbon, I spend significant time traveling domestically and internationally. Whether it’s to meet with the Governments and implementers in the countries that Pink Ribbon Red Ribbon supports, or share expertise and experiences at global health conferences, I always learn vital lessons that can guide us in the future. This year, I have been to Africa, Europe, the Middle East, and, domestically to several cities to speak about Pink Ribbon Red Ribbon and share our experiences. Each of these exposures has been a tremendous learning opportunity.  Here are a few of the lessons I’ve learned from listening to others and comparing our experiences with theirs:
  1. Leveraging existing platforms and partnerships for women’s cancer is efficient. In many of the countries in which we work, we support local implementers to add screening for cervical cancer at select HIV clinics. Now women who come to the clinic for HIV screening and treatment can also know their cervical-cancer status and receive treatment on the spot for smaller lesions before they can advance into invasive cancer. In countries where it’s difficult for women to go to multiple clinics because of family and work obligations, having access to multiple services at a single clinic is key to their continued good health and that of their families. Another effective combination is Pink Ribbon Red Ribbon’s partnership with the offices of African First Ladies. Working with First Ladies is a viable, results-oriented and sustainable platform for advocacy at the community, national, regional and global level. The First Lady of Ethiopia has successfully used her position to escalate cancer to become one of the top three health priorities in her country.
  2. Promoting the continuum of care through public-private partnerships is the smart model for global health. Most of the conferences I attend ask me to speak on public-private partnerships. These opportunities have made me realize that public-private partnerships are key to tackling cervical and breast cancer—and indeed, most global health issues. Every organization in a partnership brings value to the collaboration, whether they support prevention efforts or assist with palliative care at the tail end of the continuum. I’ve learned that no single organization can do it all. Both Governments and the private sector must play a key role—and Pink Ribbon Red Ribbon has been privileged to share some critical lessons for others to emulate.
  3. The single-visit approach to “See-and-Treat” is central to a successful program to prevent and control cervical cancer. I have learned the best way to ensure that women get the services they need is to use a single-visit approach. It removes the need for recalling women to the clinic, and reduces loss-to-follow-up. Models in developing countries that only screen and refer or recall report high rates of loss-to-follow-up. One visit to a clinic for both screening and treatment ensures that a woman gets the treatment she needs right there, when she is on site.  Pink Ribbon Red Ribbon promotes an approach that involves first screening for cervical cancer through visual inspection with acetic acid (VIA) and then removing pre-cancerous lesions with cryotherapy which means that most women can return to their community and domestic chores after just one visit.
  4. Be a catalyst for action. In many countries in which we work, we have been able to turn ideas into reality by being a catalyst for change. Our recent trip to Botswana confirmed this for me. In 2013, the Government of Botswana had every reason not to consider vaccination of adolescent girls against the human papillomavirus (HPV) until 2017. Following deeper discussions between Pink Ribbon Red Ribbon and the leadership of the Ministry of Health, and with the support of Merck, the Government of Botswana started a two-year demonstration program. This program, which covered 8,357 girls between the ages of 9 and 13, has been a catalyst for the country’s ownership and leadership of the nationwide roll-out of HPV vaccination earlier this year. While some would argue that international aid breeds dependency, I submit that, if appropriately planned and executed, aid can catalyze action by the recipient country.
  5. Enlist the help of champions to multiply your influence. When tackling a serious problem like cervical and breast cancer, it is critical to partner with champions. These agents of change can be at the community, national and international levels. One example that comes to mind is May, a nurse in Zambia, who started screening women in her local community for cervical cancer, and one day decided to practice what she was teaching others by going herself for screening and treatment. Now, she participates in outreaches beyond her immediate environment, and shares her own experience to encourage women to get screened. Other examples of champions are the First Ladies in Zambia, Tanzania, Ethiopia and Namibia, who advocate for women’s health at a national level; our Pink Ribbon Red Ribbon Ambassadors, who speak out at regional level; and advocates like President and Mrs. Bush, who accord women’s health the priority it deserves on an international stage.
  6. Actors outside the health sector are indispensable to health outcomes. Women in developing countries might not seek health care for simple reasons, such as a  lack of funds for transportation or childcare services. Because there is more to good health than just providing health services, it is important to employ resources and expertise across various sectors to remove some of these barriers to care. A one-hour single-visit conversation about Pink Ribbon Red Ribbon with the Head of Vodacom Foundation Tanzania led to a partnership that is now filling a major gap in our work. Vodacom Foundation has provided a grant to Pink Ribbon Red Ribbon partner T-MARC, in collaboration with Comprehensive Community-Based Rehabilitation in Tanzania (CCBRT), to assist low-income women with cervical cancer to reach the only cancer-treatment center in the country. Through this arrangement, Vodacom, an organization whose core business is not health, is contributing to improving the health and survival of women.
  7. Sustainability is key to strengthening health systems. I have learned that any work done on a project basis is at best a pilot program with a limited lifespan. Long-term success in a country comes from investing in the health system of that country. In our effort to combat cervical and breast cancer, we invest in strengthening human resources for health through  the training and equipping of various cadres of health workers; developing comprehensive and robust national cancer control plans; and improving health infrastructure to promote access to care providing life-saving diagnostics, vaccines and products; and embedding the services in existing national systems, and in the hands of local community-based organizations.  This approach ensures that the programs we catalyze in countries can be sustained well into the future.
Every day, whether I am on the road or in the office, I am learning valuable lessons to improve the work of Pink Ribbon Red Ribbon, and to ensure that the lives of women and girls are a priority in the countries in which we work. Dr. Doyin Oluwole is founding Executive Director of Pink Ribbon Red Ribbon.