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International Journal for Quality in Health Care Advance Access originally published online on January 26, 2006
International Journal for Quality in Health Care 2006 18(2):81-86; doi:10.1093/intqhc/mzi100
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International Journal for Quality in Health Care vol. 18 no. 2 © The Author 2006. Published by Oxford University Press on behalf of International Society for Quality in Health Care; all rights reserved

Quality in Practice

Improving cervical cancer prevention in a developing country

Irene Agurto1, Jorge Sandoval2, Maribel De La Rosa3 and Maria Elena Guardado3

1 Pan American Health Organization, Washington, DC, USA, 2 Ministry of Health, El Salvador, San Salvador, 3 Organizacion Panamericana de la Salud, El Salvador, San Salvador

Objective: to enhance the delivery of services, using continuous quality improvement, and an outreach strategy.

Design and setting: pre and post measurements in a Primary Health Care system in El Salvador. Outcome indicators: women screened for the first time in their lifetime, unsatisfactory samples, turnaround time, and follow-up.

Intervention: involvement of policy, service provision and community levels in 4 plan-do-study-act cycles, facilitating linkages between work processes and a quality control group.

Results: 3,408 women screened for the first time in their lifetime in 1 year in regular services; unsatisfactory samples reduced by 1/2; turnaround time reduced by almost 1/3; follow-up increased from 24% (22/90) to 100% (196/196) .146 of the 151 women cytologically defined as low and high-grade squamous intraepithelial lesions (L-HSIL) were confirmed on histology as cervical intraepithelial neoplasia (CIN), while 5 showed benign changes. Of the 43 women classified as having high-grade squamous intraepithelial lesion on cytology, 36 were diagnosed with CIN2 lesions, 7 with CIN3 and 2 were confirmed with invasive carcinoma.

Conclusion: improvements in delivery of screening can be made with few additional resources in the absence of an organized system. We promoted linkages between detection and diagnosis through enhancement of teamwork and functional coordination, which improved follow-up rates. We restored links between screening and reading processes through minor adjustments, which improved the turnaround time of samples. Trained outreach workers created new links between community and health services, identifying women who had never been screened before in their lives and facilitating their access to regular clinic services.

Keywords: quality of Health Care, cervical cancer, practice guidelines, screening, developing countries

Address reprint requests to Irene Agurto, Pan American Health Organization, 525, 23rd St. N.W. Washington, D.C. 20037, USA. E-mail: iagurto{at}yahoo.es

Accepted for publication December 19, 2005.


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