Partnership Report Cervical Cancer Preventive Services Implementation, Kedougou Region, Senegal 2010 - 2015
Kedougou / Sédhiou, Senegal
Peace Corps Senegal
University of Illinois at Chicago
Peace Care
This partnership is being funded with support from:
Peace Care
In-kind support through the US Peace Corps, the UIC Department of Family Medicine, and the UIC Center for
Global Health
Grant funding from the CDC GTHRN #1U48DP005010 and
The UIC Chancellor’s Global Health & Well-Being Seed Grant.
Acknowledgments
We would like to acknowledge the following organizations and individuals who have given significantly toward
the successful implementation of this project, in terms of hours of labor, financial support, and encouragement.
Kedougou Region Health Leaders and Staff. In particular:
Dr. Abib Ndiaye, Kedougou Region Medical Director
Elhadji Mamadou Dioukhane, MCD Kédougou
Dr. Evrard Kabou, Saraya District Medical Director
Hamidou Thiam, Supervseur Soins de Sante
Landing Sagna, Superviseur des soins de santé primaire: District de Kédougou
Primailes Region Kédougou
Fatou Traore, Lead Regional Midwife
Mariama Touré, Coordinatrice SR du D.S. Saraya
Marguerite Thiaré, Sage Femme de CSKdg
Ngoné Gueye, MSF CC Salemata
Oulimata Sane, Midwife, Sage Femme de Khossanto
Dr. Cheikh Senghor, Kedougou District Medical Director
Dr. Mamadouba Camara, Kedougou District Surgical Oncologist
Diouma Diallo, “Mdme. Diop”, Midwife
Sédhiou Region Health Leaders and Staff
Dr. Youssoupha Ndiaye, Sédhiou Regional Medical Director
Senegal National Level Collaborators, Advisors, Consultants, and Mentors
Dr. Anta Tal Dia, Director of the Institute of Health and Development (ISED), UCAD, Dakar
Dr. Mayassine Diongue, ISED
Dr. Kasse, Dakar
Peace Corps Senegal Admin and Volunteers. In particular:
Cheryl Faye, Peace Corps Senegal Country Director
Mamadou Diaw, Peace Corps Senegal Health APCD
Vanessa Dickey, Peace Corps Senegal Associate Director of Programming and Training
Katie Wallner / Aissatou Souare
Tess Komarek / Tiguida Tandian
Nicole Aspros / Niama Damba
Sarah Mollenkopf / Diabou Tounkara
Laurie Ohlstein / Binta Barry
Emily Johnson / Dienaba Dansokho
Aaron Persing / Sory Kandia Diakhaby
Peace Corps Volunteer Alumni
Peace Corps Washington
Office of Global Health and HIV
Peace Corps Masters International Program
The UIC Center for Global Health, The UIC Departments of Family Medicine and the School of Public Health,
& The UIC Institute for Health Policy and Research
The UIC Team
Andrew Dykens, MD, MPH
Karen Peters, DrPH
Tracy Irwin, MD, MPH
Memoona Hasnain, MD MHPE PhD
Trainees: Fri Awasum, Paul Rotert, Rina Dave', Tyrisha Clary, Sarah Johnson, Rithvik Balakrishnan,
Elly DeJesus
UIC Team Alumni:
Peace Care Board of Directors and Staff
Peace Care Advisory Panel
Partnership Summary 2010 – 2015
Community Focus and Project Impact
This partnership was initially formed between the health district of Saraya, Senegal; Peace Corps, Senegal;
and the University of Illinois at Chicago (UIC) to improve health care delivery within the local existing health
care system as well as provide training in global health and cultural competency for U.S. health care
trainees. Through a process emphasizing local prioritization, the primary focus of the project became cervical
cancer preventive services implementation. This process included the assessment of local health concerns,
the status of the health service delivery infrastructure, and the priorities of the local health care
leadership. Partnership efforts have been focused on the Kedougou Regional level. The Health Region of
Kedougou is located in the South-Eastern part of Senegal with an estimated population of 143,000 inhabitants
and comprises twenty-three health posts, three health centers, and the regional hospital. This project to date
has implemented regional-level cervical cancer prevention guidelines, a service accessible to an estimated
10,000 women in the target population, trained 63 health workers in visual inspection of the cervix with acetic
acid, and trained 1 health worker in cryotherapy as a treatment modality for pre-cancers. We have completed a
region-wide prevalence study with data indicating 2.27% prevalence of cervical dysplasia. Identified next steps
are formal policy development through a community participatory approach and the horizontal scaling of this
policy and health service to the neighboring region of Sédhiou.
Peace Corps Engagement
Since the partnership inception, a total of 7 generations of Peace Corps Senegal Volunteers have contributed
to this partnership. Among this group there have been 18 total Volunteers, of which 4 are Peace Corps
Masters International Students, who have worked extensively on this project. All Returned Peace Corps
Volunteers have contributed to this project after their return by way of translation, coordination, planning, or
other support including acting as ambassadors for the ongoing partnership.
Educational Impact
Since the partnership inception, a total of 12 Resident Physicians and 8 students in the UIC College of
Medicine, School of Public Health or Department of Communication has contributed to the project and learned
from the partnership approach and cultural aspects of the partnership.
Scholarly Impact
Since 2010, this partnership model has been presented at more than 10 national or international scientific
meetings including the Network: Toward Unity for Health Conference, The Consortium of Universities of Global
Health, The Global Health Education Consortium Annual Conference, The American Public Health Association
Annual Conference, the International Federation of Gynecology and Obstetrics Conference, The American
Association of Family Physicians Global Health Conference, The Society of Teachers of Family Medicine
Conference. This project and partnership is the main focus of 2 published scientific journal articles. One other
scientific article has been submitted and three additional articles are in the writing phase. Coauthors on all
papers have included local researchers and Peace Corps Volunteers in addition to the researchers at US
academic institutions. The Senegal project is being funded by two research grants: CDC GTHRN
#1U48DP005010 and the UIC Chancellor’s Global Health & Well-Being Seed Grant.
PROJECT SUMMARY BY YEAR
2010-2011: The partnership began through 2009 initial discussions and a partnership formation site visit in May
of 2010. Community and health systems level assessments were conducted in 2010. A participatory approach
was used to design and conduct the assessment. Input was gathered through 23 focus groups in 6 convenience-
sampled communities representing the district, one health worker focus group at the district level, and seven
key-informant interviews with health leaders at the district and regional levels. Comments directed at women’s
health themes comprised 56 of the 341 (16%) suggested health priorities. These assessments were followed by
an evidence-based and participatory project development phase in preparation for the first stages of project
implementation occurring in early 2011. Many regional health priorities were identified, but it was noted that
there was no identified strategic plan to address cervical cancer prevention at the regional level. With significant
input from all partners, this topic was chosen, therefore, as the project priority. The partnership project was
defined as implementing cervical cancer prevention services in the Kedougou region of Southeastern Senegal
through service capacity building and regional health system policy implementation. World Health Organization
approved curricular materials were adapted through a collaborative process. Beginning in early 2011 teams
comprised of members from the UIC Department of Family Medicine and representative faculty from the UIC
School of Public Health as well as the OB/Gyne Department traveled to Senegal to begin project implementation.
Throughout the course of the assessment, project development, and project implementation phases locally
placed Peace Corps Volunteers played an instrumental role in community advocacy, information transference
and translation, project coordination, project logistics facilitation, data gathering, and visiting team cultural and
language orientation.
This partnership designed a strategic plan to implement a functional and sustainable cervical cancer
prevention service in this decentralized region using appropriate technology. A realist synthesis of the literature
informed the selection of this technical approach. The conclusions of the realist synthesis illustrated that Visual
Inspection of the Cervix with Acetic Acid (VIA) has a sensitivity of 80% (79-82%) which is better than that of
cytology (sensitivity of 61%, range of 52-70%) in low resource settings. The specificity of VIA is 92% (range, 91-
92%). With careful attention to quality assurance, VIA has proven to be safe and cost-effective. In order to
respond to the identified capacity challenges of the region in implementing this evidence-based solution, the
specified approach involved task sharing by educating midwives on the screening technique through the training-
of-trainers approach. In 2011, there were five trainers trained in the technique of visual inspection of the cervix
with acetic acid (VIA). These trainers, in turn, initially trained 14 additional personnel as a secondary training, to
advance workforce development and as a component of advancement toward Master Trainer status as defined
through the JHPIEGO Trainer Pathway. The District level medical director, as a strategy for scaling the project,
expressed a desire to illustrate this model as a successful means by which to initiate cervical cancer screening
throughout rural Senegal, where few efforts previously existed. It is through this motivation that discussions with
officials at the regional level subsequently occurred.
2012: The partnership expanded to the Kedougou Regional level, which is comprised of the Saraya,
Kedougou, and Salemata Districts. A priority was placed on building service capacity at the district and post
level. During this time, the local trainers continued to train additional health personnel in the technique of
visual inspection of the cervix with acetic acid to complete access to this service throughout the Saraya District
and advance the goal of covering the entire region. By the end of 2012, two trainers remained in the region,
three candidate trainers advanced their skills, and 39 total health workers had completed the VIA training. The
process for formal integration of this service into the Regional level health service policy began. A theoretical
training for cryotherapy implementation, as well, occurred and the region began preparations to implement this
service. A quality improvement process was initiated to guide further service implementation, programmatic
development, and policy creation. Health service implementation was guided by the themes specified by the
World Health Organization building blocks for health systems strengthening. Therefore, programmatic
development is centered around 1) clinical guidelines, 2) governance norms, 3) workforce development plan,
4) quality control, 5) health information systems, 6) resources management, 7) community-level information
and education and 8) strategic partnerships.
With resources and trained personnel in place, the determination of burden of disease within the region
was prioritized to help guide the advancement of the project and illustrate the relative burden. The goal to
provide self-sufficiency through the creation of Master Trainers and a local Management Team for future
scaling of the service implementation was, as well, stated.
2013: The partnership continued to advance at the Kedougou Regional level. Through this year of the
partnership, the local trainers trained additional health personnel in the technique of visual inspection of the
cervix with acetic acid to complete access to this service throughout the Saraya District and advance the goal
of covering the entire region. All personnel were encouraged to integrate routine screenings as a part of their
clinical practice. Refresher courses were completed by all trained personnel to assure continuation of adequate
skills. At the end of this year, 5 local trainers remained in the region, 55 total health workers had completed the
VIA training, and 1 local health worker was qualified to perform cryotherapy. The careful planning of a region-
wide prevalence study was concluded and initiated in late 2013. As well, in 2013, a quality improvement
process was continued to improve health service utilization and guide further service implementation and
policy development. Local Policy development as well as strategic planning discussions were ongoing to detail
guidelines and norms and provide insight into the next steps in expansion of the project.
2014: The region-wide Kedougou cervical dysplasia prevalence study was concluded in 2014. This study
sought to utilize VIA, a low cost cervical cancer screening tool, to establish prevalence of cervical dysplasia in
the Kedougou region in Senegal, a setting where this data was previously unavailable. The overall prevalence
(2.1%) was found to be lower than what was anticipated, yet we did find different rates in the three districts.
The highest prevalence (4.3%), found in the Saraya district, is likely due to a developing gold mining industry
that is largely isolated to that district. Such mining projects have been associated with increased STI rates due
to migratory workers and increased sex work.18 Higher STI rates are an established risk factor of cervical
dysplasia and cancer. The Saraya district also has one of the highest HIV prevalence rates, another emerging
risk factor for cervical cancer, in Senegal.17 Our findings highlight an area of need for cervical cancer
prevention and possibly STI reduction. Given the low number of positives, it is expected that the risk factor
data do not reveal any significant correlations. It was interesting that all the positive VIA cases were 30-39
years old. Our screening sample consists of very few screenings of women between the ages of 40 and 50.
While the greatest number of screenings were in the 30 to 35 group and fewer screenings in the 36 to 40
group, the trend still showed an increase number of positives with an increase in age. It is likely that with
greater numbers of screening in the 40 to 50 age group, we will identify higher prevalence in this region. Next
steps are to identify barriers to cervical cancer screenings, especially among older, higher risk women. The
goal is to increase service utilization, assure sustainability, assure health service quality; there were trends
toward fewer pregnancies and births and later sexual debut among the positives, but additional data would be
needed to confirm this. STI rates were high in this sample, with 43% of women reporting ever having had an
STI, while only 38% were aware of cervical cancer. This highlights STI prevention, detection and treatment as
another potential service need for women in this rural part of Senegal.
With full capacity in place and the illustration of clinical need for this service, it was noted that service
utilization remained low region-wide. In response to this concern, the partners submitted and successfully
received two grants to address certain questions with the hopes of improving the overall effectiveness of the
cervical cancer prevention program.
2015: In 2015, the partnership is initiating a five-year research project to continue to strengthen this community
health service. The project uses health service implementation and delivery science through a participatory
approach. This will bring together the practicality of capacity-building, the necessity of community participation,
and the need of building knowledge that will be applicable to further community health systems strengthening
in Senegal and beyond. The intervention will use community participation in health services quality
improvement and policy adaptation to implement policy that promotes access to cervical cancer prevention
services in Kedougou, Senegal and Sédhiou, Senegal. In this research, we will assess the horizontal and
vertical scaling of health policy and evaluate a partnership between the local communities and health system in
Kedougou, Senegal; Sédhiou, Senegal; Peace Corps Senegal; the Institute of Health and Development in
Dakar, Senegal; and the University of Illinois at Chicago. We will achieve the project aims through a
community-based participatory research (CBPR) partnership with community members, health workers and
leaders, Peace Corps volunteers, and academic personnel. CBPR partners will conduct a quality improvement
process for cervical cancer prevention services at intervention health posts while basic cervical cancer
screening capacity is grant supported at all posts. Both quantitative and qualitative data will be gathered to
assess 1) how community involvement will improve cervical cancer prevention service delivery approaches to
help local populations utilize this new clinical service, 2) how health service implementation can be scaled
horizontally into the Sedhiou region, 3) how health service quality improvement occurs at local levels and 4)
how this global health partnership functions. We will assess the impact of the horizontally-scaled community-
developed health services policy promoting access to cervical cancer on service community access and health
outcomes as well as the service process. We will ultimately recommend a Senegal national-level cervical
cancer prevention services policy approach for implementation in decentralized regions where this policy does
not currently exist by conducting an analysis of the existing Kedougou policy and its horizontal scale to the
region of Sédhiou, Senegal.
January 2015 Site Visit Jan 21, 2015 - Dakar Research Meeting at ISED
This productive meeting set the basis for a strong collaboration with the Institute of Health and Development
(ISED) and the Peace Corps over the course of this project. Each partner introduced her or himself and the
representative institution. We oriented all partners in attendance on the history of the project, the research
protocol and all data collection instruments in their current form, and set goals. All attendees expressed
dedication to the project. We will continue to develop the research protocol with the aim of submitting the
protocol for Institutional Review Board (IRB) approval by the end of February, 2015 to both the IRB at UIC and
the University of Cheikh Anta Diop (UCAD) in Dakar. All partners are enthusiastic to contribute to the
development of research dissemination and further grants development.
January 22, 2015 Meeting with Peace Corps Senegal at Headquarters
The meeting with Peace Corps Senegal was exceptional. The UIC / Peace Care team provided a brief
overview of the history of our collaboration. In addition, we were able to highlight the significant role of the
Peace Corps Volunteers (PCVs), the forward activities of the project, the funding of the research, and the study
of the partnership model. We discussed recent conference presentations and publications. We updated
headquarters on the selection of a PCMI student, Elly Dejesus, for the Senegal cervical cancer prevention
program. We also discussed the evolving relationship with Peace Corps Headquarters in Washington DC. We
expressed our sincere gratitude for the continuation of the partnership and our anticipation of continued
productive collaborative work.
January 24, 2015 – Sédhiou Regional Leadership Meeting at the Regional Medical Office
The UIC / Peace Care team met for the first time with the Sédhiou region medical direction. Dr. Youssoupha
Ndiaye described our history of collaboration and praised our working relationship. He summarized the
development of the project in Kedougou and explained the logic of advancing the project to this region.
Andrew Dykens introduced the research project, clarifying the intervention of community engagement in health
services quality improvement. He also described the planned activities and timeline for regional capacity
building. It was discussed that it is likely that the prevalence for dysplasia and cervical cancer is higher in the
Sédhiou region relative to some other districts. Sédhiou recently had the opportunity for some capacity
development in cervical cancer screening on a very small scale and during those screenings several positives
and two suspicions for cervical cancer were found. They are anxious to scale up the capacity throughout the
region as it is evident that cervical cancer is a priority. Questions were raised about the approach and
limitations of the financing. Both Dr. Ndiaye and Andrew Dykens reassured the group that cryotherapy will be
immediately available at the regional level for the treatment of precancers. We also discussed that we will
collectively identify funding, if necessary, to assure the treatment of women identified as having frank cervical
cancer. It was reiterated that policy considerations are an aspect of this research and our intention over time is
to assure sound and responsive cervical cancer prevention policy at the regional and national levels that is
people centered. We also discussed other priority needs of this region. The priority of Sickle Cell is an
identified issue of significant need. Currently, there is minimal capacity to deal with this issue. Emergency
services are also severely lacking. Additionally, it is noted that strokes are a leading mortality indicator and
further information to understand the primary etiology is needed. Diabetes is prevalent in the region, but there
are no activities to date in this area.
Next steps were discussed. The UIC / Peace Care team will work alongside our Senegalese co-investigators,
namely Dr. Youssoupha Ndiaye and Myassine Diongue to finalize the protocol and instruments and,
subsequently, submitted these documents to the IRB’s at UIC and Cheikh Anta Diop University in Dakar for
approval. We will plan to begin mobilization of personnel in the region in April with specific planning and
preparatory activities. In the mean time, the local leadership will specify their capacity needs and recommend a
timeline. The UIC / Peace Care teams will adapt our proposed timeline when and where possible. Currently,
our anticipated initiation of capacity building activities, namely the training of trainers and initiation of
cryotherapy training will occur in August of 2015. Concerning other priority areas for the Sédhiou Region, the
UIC / Peace Care team will begin aligning the Sédhiou Region with institutions and programs of parallel
interest.
January 25, 2014 – Kedougou Regional Leadership Meeting at the Regional Hospital
Our meeting with the leadership in the Kedougou region was thoughtful and energizing. We spent time
reflecting on the project to date and identified several barriers to achieving our goals. It was reassuring to note
that the proposed solutions by the Regional Direction are parallel to the perceived steps forward iterated in the
protocol, and as specified by our local partners and Senegalese research colleagues. The meeting identified
concrete next steps in reporting the progress to date and preparing for the initiation of the research as phase
two.
January 26, 2015 – Kedougou Partnership, Project Reporting, and Research Orientation Meeting
An exceptionally formative meeting, we discussed the theory and values of the partnership including the
partnership evaluation component. There were several questions about the type of partnership corresponding
to the role of research vs health systems development vs policy and the manner these all overlap. There were
questions about the nature and purpose of the relationship with ISED, the role they play and the importance of
their involvement. The response to these questions generally revolved around the importance of research at
decentralized levels in local communities, especially the needed pursuit of implementation and delivery
science. It was also stated that the development of knowledge around policy development at local levels is
important not only for raising awareness of the context of decentralized regions but sharing the lessons learned
with similarly situated populations within and exterior to Senegal. The necessity of integrating the research and
cervical cancer prevention service into the general health services consideration was expressed and agreed.
We discussed the approach to the research and received several suggestions and comments. A summary of
comments are noted here with a brief overview of the response.
Currently there are health committees present at all health system levels within the region, with various
functionality. – Therefore, concerning intervention sites, we will work with the existing health
committees. At control sites we will inform the existing committees but will not include them in the
COPE training.
The Regional Direction will prepare a summary report to send to the National Ministry to inform them of
the project. It was emphasized that we must well-inform the leadership within the National Ministry. –
The UIC / Peace Care team expressed the necessity that all correspondence to National level Ministry
officials occur through the expected chain. The UIC / Peace Care team prefers to remain as
collaborators and support the continued direct communication within the existing health system.
The question was raised about the responsibility of treating women who screen positive or with
suspicion for cervical cancer. – The UIC / Peace Care team reiterated the importance of the regional
medical system to provide full assurance that women who screen positive would be adequately treated
in a timely fashion. The UIC / Peace Care team refrains from offering formal support for this necessity.
In the future it will be absolutely necessary to assure sustainability of the program that the regional
health system take full responsibility for this issue. The UIC / Peace Care team stated that we are
available to help informally (through fundraising or solicitation of funds) in this area if funds are not
readily available to deal with a specific case. The UIC / Peace Care team expressed the importance of
offering a cryotherapy treatment session for all women who have been screened positive up to this
date.
The suggestion was made to create a research committee at the regional level and the involvement of
multiple personnel at the district level to oversee and carry out the functions of the research project. –
The grant makes available adequate funds for research oversight at these levels. We will respect the
decision by regional leadership on the specification of these funds. The expectations for continued
funding of the project were reiterated and will remain consistent. Thus, as long as all research
requirements are met, there is flexibility in the project management.
Subsequently, we discussed the COPE quality improvement process. There were comments at district
leadership levels, notably from Saraya and Kedougou leadership, in support of the implementation and
continuation of this model of quality improvement. The quarterly completion of activities was expressed
and agreed.
The tone of the meeting was highly collaborative. There were multiple research methodological suggestions
that were valuable, appreciated, and well-noted. There was agreement on next steps and the enthusiasm for
the collaboration and project.
January 27, 2015 COPE Meeting
The first quarterly Client Oriented Provider Efficient (COPE) quality improvement meeting as a part of this
study has occurred at the District level in Saraya. The meeting was opened by Dr Kabou and then Mariama
Toure led the entirety of the meeting. The meeting focused on the theory of COPE including the rights of
clients and the needs of health providers. Subsequently, the group broke into two groups: one group for client
questionnaires, one group for self-evaluation. The plan was for the two groups to complete their activities on
the following morning.
January 27, 28, & 29, 2015 COPE TOT and Research Coordinator training
We spent three days together with the candidate COPE trainers, also identified as District Research
Coordinators. During this time, these leaders learned the COPE process and discussed a strategic plan to
implement this at the district level and the specified intervention and control sites. The research plan was
discussed in depth, including the manner that these individuals would oversee the data collection. The district
research coordinator personnel will be further supported by the Peace Corps Volunteers in the region for all
research activities. All data collection instruments were revised and the plan for a research guide was
elaborated, to be completed in the very near future for distribution prior to the initiation of the research.
January 30, 2015 Intervention and Control Site Research and COPE Orientation
Representatives for the health posts and community health committees from all specified intervention and
control sites were invited to Kedougou for a half-day research orientation meeting. The objectives of the
research were discussed and the plan for the implementation of the research was detailed. In order to carry out
the proposed research, the COPE quality improvement process will need to be initiated at each site. Therefore,
a brief introduction of COPE was provided and a preliminary plan for the COPE training at each site was
discussed. These representatives will be invited to attend the Partnership Research meeting at the Regional
level every six months as detailed in the protocol and research guide.
February 2, 2015 Meeting with Peace Corps Senegal at Headquarters
The UIC / Peace Care team was proud to report a highly successful site visit to the Peace Corps office in
Dakar. The team expressed sincere gratitude to the highly organized, efficient, and effective volunteers onsite
for their significant support. The team discussed the accomplishments of the trip including evidence of regional
ownership of the project and the ideal of developing sustainability. The outcomes of the research plan were
clarified and next steps were discussed. The UIC team will initiate the research upon approval by the UIC and
Cheikh Anta Diop University’s research ethics board (likely in March) and will begin preparations for a late
August site visit to continue the research. The Peace Corps office will assist with coordinating some document
translation and the printing of research guides for local application. Both the Peace Corps office and UIC
expressed gratitude for the partnership.
Additional meetings were held with Mr. Matt McLaughlin, the Director of the Malaria Bootcamp initiative for
bednet distribution and the ProaCT malaria prevention program, Mr. Diouf, the Director of Human Resources
at the Minister of Health’s Office, Dr. Issakha Diallo, a past Director of the Institute of Health and Development
in Dakar, and a visit to the Bargney Men’s and Women’s Basketball Club.
Discussion
This project is advancing well and has illustrated that a participatory approach is effective in
implementing cervical cancer preventive services through a community, university, Peace Corps partnership.
In assuring a sustainable end result, the project has been shaped by strong attention to the local context.
The Partnership – This project is illustrating the efficiency of engaging academic resources and the US
Peace Corps in addressing health service capacity needs at a decentralized community health
system level in order to provide access to a quality primary health care service to the local population.
The partnership emphasizes an understanding of local context through a longitudinal approach,
continuous engagement, and flexibility in the approach. There is ongoing refinement of the strategic
plan that responds to identified barriers and the expressed priorities of all partners.
Task Sharing – We have effectively utilized task shifting by utilizing midwives as the primary screening
practitioners. The Master Trainer team for teaching visual inspection of the cervix with acetic acid
(VIA) are all midwives. Nurses have, as well, been taught the clinical skill of VIA. The approach of
using practitioners who are disbursed more widely throughout the region than physicians is proving
valuable and will likely result in greater service utilization by the population.
Appropriate Technology – The selection of VIA as a screening methodology and cryotherapy as a
treatment modality for cervical precancerous is useful for several reasons. This can effectively be
performed as a single visit screen and treat. In addition, minimal infrastructure is needed to support
this highly affordable and easily attainable technology.
Training of Trainers – The primary training team in place in the Kedougou Region have been provided
additional training in advanced clinical training skills and are all highly effective educators for this
focused issue. The fact that a training team remains in place will allow the service to continue to self-
maintain with natural attrition of health workers. This capacity in place will also facilitate the horizontal
scaling of capacity to the neighboring region of Sedhiou. Therefore, this approach emphasizes clinical
skills, clinical training skills, and service management capacity.
Health Service Policy – Health service programmatic and policy development will continue to be a
central focus of the project. This includes considerations such as the following: a) Planning,
Monitoring and Evaluation, b) Resources and Capacity including Financing, Workforce Capacity, and
Resources Management, c) Community and Health Service Activities including Clinical Service
Guidelines and Health Information Systems, d) Networks and Partnerships, 3) Management,
Accountability, and Leadership, and e) Communication and Outreach. Attention to these details and
the development of formal service policy integrates the service into the local context with more
specificity and is likely to more greatly assure sustainability. We will continue to strengthen the
programmatic plan and health service policy through an approach that utilizes the COPE quality
improvement process and the Civil Society Community Systems Strengthening Framework.
PARTNERSHIP MODEL INTRODUCTION
This project utilizes the Global Community Health Partnership (GCHP) model and holds as its principle goal to
Foster health equity by improving community access to quality primary health care services. Through this goal
we strive to positively impact global health disparities by specifically addressing the global burden of disease,
the global shortage of health care workers, the deficiency of primary health care in low-income countries, and
the deficiency of global health research. Access to quality primary health care in areas where this partnership
is focused is difficult to obtain, primarily due to the geographically dispersed area and the limited number of
trained personnel. In training additional health care workers and improving the skills and knowledge base of
existing health care workers, individuals in remote villages will have increased access to quality medical care.
GCHC Model Description
The partnership approach links 1) LMIC community members and local health care providers to 2) U.S. and
LMIC university faculty through the assistance of the 3) Peace Corps. The approach incorporates CBPR,
empowering the community to set priorities and guide the implementation of the research. The Peace Corps
facilitates the partnership by offering community expertise, cultural guidance, onsite project coordination, and
community advocacy. The universities offer professional technical and public health training resources and
evaluation support. Partnership project planning meetings occur longitudinally through distance communication
and document sharing. Community Advisory Board (CAB) meetings, focus groups, data collection, policy
discussions, and technical trainings occur primarily during biannual university site visits. The participatory
partnership and CAB meetings guide the health service adaptation, implementation, quality improvement, and
the evaluation. The outcome of a partnership is a sustainable health service, trained health care providers,
service guidelines directed at a locally-prioritized health issue, and health service implementation research
using mixed methods to evaluate the process and impact of the health service. The expansion of a community-
Peace Corps-academic approach will continue to foster the development of global health partnerships that 1)
consistently use participatory approaches to address the need of sustainable health systems in low resource
communities and 2) focus on primary health care services implementation research.
GCH Partnership Structure and Function
There are six phases of a GCH partnership. The Partnership, Assessment, and Development phases
culminate in the adaptation of a curriculum aimed at developing evidence-based primary health care capacity
for a community priority. During the Intervention, the academic institution leads curriculum implementation
through the training-of-trainers, ensuring long-term local ownership of the service enhancement initiative. In
addition, health service policy is enacted through a participatory process involving local health leaders. In the
Evaluation phase, a continuous quality improvement process is enacted through iterative self-assessments.
Service- and population-level data are gathered to measure the impact of the partnership. Through the
Dissemination phase findings and recommendations are distributed to partners and the academic community
through presentations, publications, and a research repository.
The GCH partnership approach emphasizes policy and programmatic development that is responsive to the
needs at the local level, and rejects centralized models or external policy development that may fall short of
addressing community needs. Although the model develops partnerships that are academic institution-advised
and Peace Corps-facilitated, they are intended to remain community-led; this enables researchers to assess
evidence-based translations of technologies or interventions that build capacity, and to study the
implementation of these technologies within the complicated realities of local health systems at the community
level. The GCH partnership model utilizes the established framework of training trainers, continuous quality
improvement, evidence-based global health translational research, and a participatory approach
IRB Approval
While this Community Based Participatory Research Project carries minimal risk it upholds the highest ethical
standards of human research. In regards to this, all key personnel with access to research data and with a role
in terms of project evaluation completed the required ethics and IRB course on research with human subjects.
Figure 1: Global Community Health Partnership Model
GCH Partnership Objective: Foster health equity by improving community access to quality primary health
care services.
Figure 2: Community-Peace Corps-Academic Partnership as an Enhanced Approach
Global Health Disparities
Low and middle income countries are disproportionately affected by the global disease burden, and experience
a double burden of disease, with a significant prevalence of both infectious diseases and non-communicable
diseases. Because of this poor state of health, local communities in LMICs experience slowed development
and economic growth, and individuals experience greater morbidity and mortality. Many low technological,
inexpensive, and low-resource-appropriate solutions have strong evidence of effectiveness for impacting the
most common health issues. In order for implemented solutions to have sustainable effect, strong local
primary health care systems are needed. There exists a significant shortage of health care workers in low
income countries, especially at the local levels. Therefore, expanding workforce capacity can have a
significant impact on local health systems. This local workforce capacity expansion can be sustainably
accomplished through effective global health partnerships. Furthermore, focusing on decentralized (local)
health systems greatly benefits workforce capacity policy development and improves retention and attrition
rates.1 Among the multiple tiers of policy making, including national, regional, district, city, and institutional
levels, there are marked differences between theory and practice in health systems operation.2 Therefore, in
order to inform global health partnerships, research devoted to the implementation of locally-focused health
services and policy is needed. 3
Implementation Research
Siddiqi et al. (2009) illustrated that health services development at the national level is dependent on
responsible governance.4 Brinkerhoff established that poor governance contributes to ineffective health
systems.5 Decentralization of health policy has many potential benefits, including a more rational and unified
health service that caters to local preferences, reduction of inequalities between rural and urban areas, and
improved intersectoral coordination, particularly in local government and rural development activities.6
However, relatively little is understood about the manner in which partnerships assist health systems at
decentralized levels in LMICs to develop and implement health policy and service delivery programs. In these
settings, capacity development arises from centrally initiated policy, often with barriers to implementation at the
local level.
Significance
This study focuses on understanding the role of partnerships within local health system policy development in
the context of being aligned with national-level health system priorities and with national-level health system
awareness, yet independent of a centralized catalyst or directive. This research builds knowledge on the role
partnerships play on health service policy development needed to inform the design, implementation, and
evaluation of local health service policy in low resource settings such that it is sustainable, effective, efficient,
and scalable. The development of this scholarly work will encompass this focus (as suggested by Hyder et al.)
as it is further developed and will, thus, as well, focus on understanding the ways in which academic centers,
communities, and development agencies collaborate and the benefits and disadvantages of partnerships on
each of these partners. This research builds knowledge that can be used to inform the development,
implementation, and evaluation of global health partnership programs with the goal of creating a synergism
among (1) dis-empowered yet highly-motivated communities; (2) trusted development agencies rich in field
experience and infrastructure but limited by technical expertise; and (3) academic institutions, resource-rich but
limited in local experience.
Health systems strengthening will impact population-level health outcomes. In order to effectively impact local
health systems in LMICs, the translation of evidence-based solutions from similar contexts into systems of
identified need and priority is needed. As well, due to the shortage of healthcare workforce, globally, capacity
building and development of human resources is needed. The GCHP model could address these challenges
through leveraging already existing, extensive infrastructure. The Peace Corps currently has over 9000
volunteers and operates in 76 countries while there is significant movement among US universities to develop
global health partnerships. By partnering communities, the Peace Corps, and US universities, the GCHP
partnership model could have significant impact.
APPENDIX 1
Community Health Assessment
The baseline health assessment of the Saraya district in Senegal was conducted in November 2010 by Chris
Brown, PCV, and the field ethics trained local advisory board. Using the interview tools, community member
focus groups and key informants, including health care workers, were interviewed with the goal of obtaining
information regarding community assets for health care, primary health problems within the community, the
state of health care utilization, and the state of patient satisfaction.
Focus Groups
Saraya-4 focus groups
Barabiri-4 focus groups
Bembou-3 focus groups
Mandokholing-4 focus groups
Bambadji-4 focus groups
Moussala-4 focus groups
Community Health Workers -Saraya-1 focus group
Key Informant Interviews
Nurses-3
Doctors-1
Midwives-1
Laboratory Technician-1
Issue Selection
Through the baseline health assessment, several health issues were identified by the community as primary
health concerns, notably sexually transmitted infection (STI) prevention and diarrhea.
An additional issue, Cervical Cancer Screening, was initially identified by the Chief Medical Officer at the
district level as a health service need by this community. It was noted that, at that time, no cervical cancer
screening program was in place. While lacking from the community level assessment data, it was noted to be
a significant public health issue from the analysis of the collected epidemiological data.
Health Care Delivery Assessment
After the community health assessment and issue identification, the Peace Corps Volunteer and the Local
Advisory Board performed a focused assessment of the local health care delivery system directed at the
selected issues, and, along with local health care workers and the guidance of Peace Care, identified the
assets and needs of the local community in this regard. This work was accomplished along with the local board
of health to foster sustainability and local autonomy.
APPENDIX 2
Cervical Cancer
The World Health Organization Report on Cervical Cancer in Senegal reports,
"Senegal has a population of 3.20 million women ages 15 years and older who are at risk of developing
cervical cancer. Current estimates indicate that every year 1197 women are diagnosed with cervical
cancer and 795 die from the disease. Cervical cancer ranks as the most frequent cancer among
women in Senegal, and the most frequent cancer among women between 15 and 44 years of age.
About 12.6% of women in the general population are estimated to harbor cervical HPV infection at a
given time and 43.6% of invasive cervical cancers are attributed to HPVs 16 or 18.”
Realist Synthesis
A realist synthesis of the literature was performed to guide the team in the development of the curriculum for
the issue of cervical cancer.
Abstract
Realist Synthesis: Cervical Cancer Screening in Low Resource Settings
Background: The effective implementation of interventions in low-resource settings requires attention to
specific factors. This realist synthesis approach reviewed literature to identify these elements. The focus was
on identifying the most effective cervical cancer screening interventions for low-resource settings, where it is
estimated that about 85 percent of cervical cancer deaths occur.
Methods: Publications pertaining to cervical cancer screening methods in low-resource settings from 1990 to
2010 were retrieved using Pubmed, Cochrane, Cervical Cancer Library, and the Alliance for Cervical Cancer
Prevention. Studies were included if: (1) performed in low or middle-income countries, (2) focused on
screening methods, and (3) included assessments relevant to the implementation of cervical screening
programs to low-resource settings. Twenty-seven publications were reviewed and the information categorized
into the different elements.
Results: The key findings showed a wide range of sensitivity and specificity among tests. VIA had a lower
sensitivity and higher specificity, but compared to cytology, it had lower specificity leading to a significant
number of false positives. However with VIA, patients can be treated immediately and it is a cost-effective test.
In a significant number of the studies the screening was performed by non-physicians. Many of the
interventions recommended performing a community-based formative research prior to developing the
intervention.
Conclusions: This realist synthesis showed that despite its limitations, VIA is currently a safe and feasible
screening test for low-resource settings. It also showed that this method can allow developers to identify
elements that could be incorporated into new interventions.
APPENDIX 3
Project Development / Adaptation
Based on the assessment phase findings high quality curricula and training materials were adapted for
implementation. These curricula are based on materials developed or approved by the World Health
Organization, as listed below.
Curriculum Development - Cervical Cancer Screening
Alliance for Cervical Cancer Prevention (ACCP): Planning and Implementing Cervical Cancer Prevention and
Control Programs: A Manual for Managers. Seattle: ACCP; 2004.
English: http://screening.iarc.fr/doc/ACCP_screen.pdf
French: http://screening.iarc.fr/doc/MfM_French_final.pdf
Sankaranarayanan R, Wesley R (2003) A Practical Manual on Visual Screening for Cervical Neoplasia, IARC
Technical Publication No. 41. Lyon: IARC Press.
English: http://screening.iarc.fr/viavili.php
French: http://screening.iarc.fr/viavili.php?lang=2
World Health Organization (2006) Comprehensive cervical cancer control: A guide to Essential Practice.
English: http://screening.iarc.fr/doc/cervicalcancergep.pdf
French: http://screening.iarc.fr/doc/text_fr.pdf
Digital learning series. A training course in visual inspection with 5% acetic acid (VIA). IARC, 2005.
English: http://screening.iarc.fr/digitallearningserie.php
French: http://screening.iarc.fr/digitallearningserie.php?lang=2
A Training Course in Visual Inspection using 4% Acetic Acid (VIA) - theory and practice. IARC
English: http://screening.iarc.fr/movieVIA.php
French: http://screening.iarc.fr/movieVIA.php?lang=2
Sankaranarayanan R, Wesley. Quick Clinical Reference Chart for Visual Inspection with Acetic Acid
(VIA). IARC
English: http://screening.iarc.fr/doc/schartvia.pdf
French: http://screening.iarc.fr/doc/schartviafr.pdf
Sellors J, Camacho Carr K, Bingham A, Winkler J. Course in Visual Methods for Cervical Cancer Screening:
Visual Inspection With Acetic Acid and Lugol’s Iodine. Seattle, WA: PATH; 2004.
APPENDIX 4
Cervical Cancer Preventive Services
Screening: Visual Inspection with Acetic Acid
Treatment of Precancers: Cryotherapy
Kedougou Region Service Guidelines 2010-2015
These guidelines are adapted from the World Health Organization Guidelines for implementation of cervical
cancer screening programs and in consideration of the available resources in the health system and the
region.
Target Population: Women aged 30 – 50 years of age
Workforce Objective
All midwives region-wide should have the skills to perform cervical cancer screening using visual
inspection with acetic acid (VIA)
All ICPs should be aware of cervical cancer prevention services and facilitate cervical cancer
prevention in their health zone
Cryotherapy services should be offered at district hospitals by midwives with supervision by doctors
who have been trained within the local health system
Certification and Health Services Expansion
Initial Provider Certification in VIA requires the following:
o Successful completion of a provider training certified by the health system. Must achieve a
score of 70% on a photo exam testing interpretation of visual inspection with acetic acid, as well
as an adequate observed standardized clinical exam.
Initial Qualified Trainer Certification in VIA requires the following:
o Successful completion of a training of trainer course certified by the health system. This entails
a score of 80% on both a written exam and photo exam testing interpretation of visual
inspection with acetic acid, a successful observed standardized clinical exam, and
demonstrated competence when observed performing a training session.
Initial Cryotherapy Provider Certification requires the following:
o Successful completion of a training certified by the health system. This training should include a
didactic component and a practical component. We recommend a score of 80% on a photo
exam test that evaluates skill in both VIA and appropriate management of lesions. This health
care worker should demonstrate competence in the procedure and have observed performance
of cryotherapy on at least 10 patients.
Maintenance of Certification
o Refresher Course: There will be a one day required refresher course one year after initial
certification. One must achieve a score of 70% on a photo test to maintain certification to
provide clinical services and a score of 80% on a photo test to maintain certification as a trainer.
o Clinical Practice: Clinicians are expected to perform 50 cervical cancer screenings with VIA
during the first year after certification to retain certification. A report of individual performance
will be gathered from the submitted quarterly reports.
Information and Education
A communication plan should be developed and implemented in the local language to bring awareness
about cervical cancer and how it can be prevented.
Cervical cancer screening should be incorporated into usual clinical services offered at health posts
and district hospitals.
Mass screening and mobilization campaigns can be considered.
Village aunts should be resources of information concerning cervical cancer prevention and services
offered in their area.
Clinical Services:
Costs
o Screening: There is no charge for VIA cervical cancer screening
o Cryotherapy Treatment: To be determined by district hospitals where equipment is
maintained
Location
o Screening
Health Posts: if staffed by trained midwife
District Hospitals
o Treatment of Precancerous Lesions
District Hospitals: If have equipment and staff trained to perform cryotherapy
Cervical Cancer Screening Centers
Clinical Management
o Negative Results – Follow up in 2 years until the age of 50 years old.
o Positive Results – All positive results should be confirmed by a certified VIA trainer or health
professional that performs cryotherapy. Referral and management options for confirmed VIA
positives include:
Refer to District Hospital for management.
VIA is repeated to confirm the lesion
Cryotherapy to be performed if lesion meets inclusion criteria
o Same day “see and treat” is recommended
It is not recommended to confirm VIA positive results with a pap smear as this
confers no significant advantage over visual inspection with acetic acid in terms
of sensitivity and specificity.
If available diagnostic colposcopy with biopsy and endocervical curettage could
be performed.
Refer to surgical oncologist, gynecologist or cervical cancer screening center
If cryotherapy cannot be performed at the district
If the lesion is too large
If a loop electrosurgical excision procedure (LEEP) or cold knife cone is
necessary to remove precancerous lesion
o Suspicion of Cancer –
Refer to district hospital to confirm diagnosis
Refer to closest surgical oncologist, gynecologist or cervical cancer screening center
Attempt to obtain a biopsy for confirmation of diagnosis in the district or region
Refer to DANTEC, Dakar
Counseling and palliative care can provide comfort to patient and families if patient is
unable to be referred for treatment
Documentation:
VIA Screening Register: Keep account of all women screened, their results and disposition
Patient Carried Note: A small card for the woman to keep that will document that she was screened
and disposition (when needs future screening or if referred for treatment)
Referral Form: information about the patient and findings including a drawing that depicts the size and
location of the lesion for the verifying/treating clinician
Quarterly Reports: Each health post will keep account of women screened and treated. Information
from all quarterly reports will be combined to produce a district level quarterly report.
APPENDIX 5
KEDOUGOU PROGRAMMATIC PLAN FOR CERVICAL CANCER SCREENING
AND PREVENTION
Policy Summary
Current State of Program - Overview
Program Achievements - Summary
Programmatic Plan 1. Planning and Monitoring & Evaluation
o Overview
Needs assessment, gap analysis, mapping, knowledge management, M&E and
evidence building (impact evaluation), and research
2. Resources and capacity
o Financing
Service Budget oversight, accounting, and processes for remuneration
Budget Overview (Past overview and projections)
o Workforce Capacity
Training team (Members, training plan for maintaining capacity)
Workforce development (Providers trained and training plan for maintaining capacity) (for
each technical area)
Quality control (evidence / plan for quality of training team and workforce)
o Resources Management
Equipment and supplies management (VIA and cryotherapy equipment inventory, usage
monitoring, and functional state)
Forecasting of need / upkeep
3. Community / health activities and services
o Health Service
Service Delivery
Service Clinical Guidelines
Continuous quality improvement report
o Health Information Systems
Assurance of usage and responsiveness of patient level medical records and referral
process
Data reporting process and reliability
4. Networks, linkages, and partnerships
o Professional
Development and maintenance
o Community
Development and maintenance
5. Management, Accountability, and Leadership
o Governance
Director & management team
Service communication norms and accountability
Service management reporting norms and stewardship of resources
6. Communication and Outreach
o Advocacy
Policy development
o Social mobilization
Community mobilisers
Community stake in design, delivery, and oversight of program
Innovative use of technology
o Communication and education
Community Information and Education activities (coordination of activities to ensure
service utilization - i.e. community education)
Programmatic Needs Funds / consultation request for trainings, equipment / supplies, health information systems materials
Identify cost sharing and secondary sources of support
Specify plan for future needs
APPENDIX 6
Sedhiou Regional Meeting Attendance
Names Qualifications Fonctions Phone E mail Abdel Kader Diéye Informaticien Planificateur 770434908 [email protected]
Cellé DIAME Agent d'Assainissement
Comptable des matières 775110276 [email protected]
Ndéye Khady Diouf Technicienne Supérieur Administration
Coordinatrice Santé de la Reproduction
775447256 [email protected]
Kissouma DIEDHIOU
Agent de développement
Coordinateur de zone AFRICARE 776525547 [email protected]
Abdoulaye KA Conseiller en affaire sociale
Chef service régional de l'action sociale
776576498 [email protected]
Dr Youssoupha NDIAYE
Médecin santé publique
Médecin Chef de Région 776370453 [email protected]
Dr Abdoul Khadre SOW
Gynécologue Chef de service maternité établissement publique de santé type I Sédhiou
775509482 [email protected]
Mansour FAYE Technicien Supérieur Administration
Superviseur des soins de santé primaires
776148335 [email protected]
January 2015 Site Visit – Meeting Attendance Regional Leadership Meeting - Region Medicale de la Kédougou / District Sanitaire de Kédougou
25 January, 2015 (Sunday)
Senegal
1 Mariama Touré Coordinatrice SR du D.S. Saraya
77 541 4625 [email protected]
2 Dr. Papa Saliou Ndoye Responsable Ma D.S. Kédougou
77 534 5630 [email protected]
3 Dr. Abib Ndiaye MCR Kédougou 77 574 8752
4 Hamidou Thiam Supervseur Soins de Sante Primailes Region Kédougou
77 550 6584 [email protected]
5 Oulimata Sané Sage Femme de Khossanto
77 550 6584 [email protected]
6 Marguerite Thiaré Sage Femme de CSKdg 77 511 8478 [email protected]
7 Fatou Traoré 77 647 9536 [email protected]
8 Tess Komarek Corps de la Paix 77 118 0534 [email protected]
9 Sarah Mollenkopf / Diabou Tounkara
Corps de la Paix 77 673 0087 [email protected]
10 Katie Wallner / Aïssatou Souaré Corps de la Paix 77 673 0111 [email protected]
11 Nicole Aspros / Niama Demba Corps de la Paix 77 883 8425 [email protected]
12 Laurie Ohlstein / Binta Barry Corps de la Paix 77 118 1185 [email protected]
USA
13 Rithvik Balakrishnan Rush University [email protected]
14 Sarah Johnson UIC [email protected]
15 Crystal Patil UIC 708 244 500 [email protected]
16 Andrew Dykens UIC / Peace Care 573 355 0452 [email protected]
26 January 2015 (Monday) District Research and Partnership Orientation
Senegal
1 Evrard Kabou MCD Saraya (Kédougou) 221 77 648 9336
2 Elhadji Mamadou Dioukhane MCD Kédougou 77 286 4244 [email protected] el.hadji.diokhane@umontréal.ca
3 Landing Sagna Superviseur des soins de santé primaire: District de Kédougou
77 505 3731 [email protected]
4 Mamadouba Camara Chirurgien Cancérologue 77 222 0096 [email protected]
5 Ngoné Gueye MSF CC Salemata 77 619 5206 [email protected]
6 Marguerite Thiare Sage Femme de CS Kdg 77 511 8478 margueritethiaré[email protected]
7 Fatou Traore Regional Head Sage Femme 77 647 9536 [email protected]
8 Yayo Sane Responsible Regional de Progammes Intrahealth (NGO)
77 735 5244
9 Katie Wallner / Aissatou Souare
Corps de la Paix - Salemata 77 673 0111 [email protected]
10 Nicole Aspros / Niama Damba
Corps de la Paix – Diakhaba 77 883 8425 [email protected]
11 Tess Komarek / Tiguida Tandian
Corps de la Paix – Missira Dantila
77 118 0534 [email protected]
12 Sarah Mollenkopf / Diabou Tounkara
Corps de la Paix - Saraya 77 673 0087 [email protected]
13 Laurie Ohlstein / Binta Barry Corps de la Paix - Kédougou 77 118 1185 [email protected]
USA
14 Rithvik Balakrishnan Rush University [email protected]
15 Sarah Johnson UIC [email protected]
16 Crystal Patil UIC 708 244 500 [email protected]
17 Andrew Dykens UIC / Peace Care 573 355 0452 [email protected]
Saraya
Name Position/Title COPE QI Meeting 27 January 2015
COPE Action Planning Meeting 29 January 2015
1 Dr. Evrard Kabou MCD de Saraya X
2 Julienne Addogue SF X
3 Ndeye Camara SF X
4 Mariana Toure MSF Saraha X
5 Balla Toure X
6 Feny Danfakha ASC X
7 Sally Fall ICP Saraya X
8 Pierrelle Mendy SF Saraya X
9 Mme. Tanga SF Saraya X
0 Goundou Danfakha Matrone X
11 Mme Diarra Head SF for Saraya District
X X
12 Makhan Danfakha Chauffeur X X
13 Youssouph Cissokho Chauffeur X X
14 Yvonne Sarr SF X X
15 Coumba Diouf SF X X
16 Fily Toumare President du Comite du Sante
X X
17 Ngone Gueye MSF du Salemata X X
18 Ngor Ndour Medecin X X
12 Elodi Mauga Infirmiere X
13 Victimae Paissa Manga MSF X
14 Mamadou S Ba Medecin X
15 Fatou Traore Coordinatrice SR X
16 Ndeye Coumba Guana SFE X
17 Landing Sagna SSP X
18 Cheikh Ba X
19 Sga Danfakha X
Research Site Orientation Meeting 30 January, 2015 (Friday)
Senegal
1 Alioune Faye ICP, Nafadji 77 609 8374
2 Ngor Ndour Medecin, Saraya 77 353 8696
3 Mariama Marena SF, Dakately 77 441 0284
4 Fatou Bintore Ndiayo Dideg
SFT Oubaolji 77 356 1715
5 Ngone Gueye MSF du Salemata 77 619 5206
6 Baba Diakhite Pdt Comite Sante, Dindefelo 77 729 6312
7 Adama Diallo SFE, Dindefelo 77 272 6741
8 Fily Foumare Saraya 77 107 4077
9 Mariama Touré Coordinatrice SR du D.S. Saraya 77 541 4625 [email protected]
10 Aban Diallo Oubadji 77 215 2391
11 Bocaou Sidebe Bandafassi 77 666 5318
12 Fatou Traoré MSF du Kedougou (region) 77 647 9536 [email protected]
13 Marguerite Thiaré Sage Femme de CSKdg 77 511 8478 [email protected]
14 Lucie Basse S Bandafassi 77 535 4718
15 Mbaye Diene Ndiaye ICP, Khossanto 77 314 1634
16 Elhadji Mamadou Dioukhane
MCD Kédougou 77 286 4244
17 Youssouph Cissokho Chauffeur, Saraya 77 810 6692
18 Landing Sagna Superviseur des soins de santé primaire: District de Kédougou
77 505 3731
19 Katie Wallner / Aïssatou Souaré
Corps de la Paix, Salemata 77 673 0111 [email protected]
20 Emily Johnson / Dienaba Dansokho
Corps de la Paix, Touba Couta 77 672 0360 [email protected]
21 Tess Komarek / Tiguida Tandian
Corps de la Paix, Missira Dantila 77 118 0534 [email protected]
22 Aaron Persing / Sory Kandia Diakhaby
Corps de la Paix, Dakateli 77 673 0099 [email protected]
USA
23 Rithvik Balakrishnan Rush University [email protected]
24 Sarah Johnson UIC [email protected]
25 Andrew Dykens UIC / Peace Care 573 355 0452
Research and Project Summary
Intervention and Control Sites
Nafadji-Intervention (Saraya District) Dakately-Intervention (Salemata District) Oubadji-Control (Salemata District) Dindefelo-Control (Kedougou District) Bandafassi-Intervention (Kedougou District) Khossanto-Control (Saraya District)
- Partnership
Participation by key personnel at regional and national partnership meetings biannually and submission
of data collection Instruments in adequate number, in a timely manner, and in an appropriate fashion.
◦ Partnership questionnaire – biannually
◦ Partnership focus group - biannually
- Community Sites
Completion, compilation, and submission of data collection Instruments in adequate number, in a timely
manner, and in an appropriate fashion at each community site (one intervention and one control site in
each district).
◦ Barriers Analysis
◦ COPE process action plan – quarterly
◦ General Health Services – Client Interviews
◦ General Health Services – Self-evaluation
◦ Cervical Cancer Prevention Health Services – Self-evaluation
◦ T1:1,2 T2: 3,4,5 T3: 6,7 T4: 8,9,10
◦ COPE committee focus group – biannually
◦ Clinical productivity report – quarterly
◦ Health service leader questionnaire - annually
◦ Programmatic and policy recommendations - annually
- District Sites
Completion, compilation, and submission of data collection Instruments in adequate number, in a timely
manner, and in an appropriate fashion at each district center.
◦ COPE process action plan - quarterly
◦ COPE committee focus group – biannually
◦ Clinical productivity report – quarterly
◦ Health service leader questionnaire
◦ Programmatic and policy recommendations - annually
- Regional level
Completion and submission of a biannual report comprised of the following:
◦ General report of region-wide cervical cancer prevention activities
◦ Updated numbers of women screened, findings, and outcomes by location
◦ Updated numbers of cases of cryotherapy and referral to specialty service including outcome..
◦ Updated list of regional cervical cancer prevention personnel including:
◦ Cervical cancer prevention service leadership: directors and administrators at the
regional and district levels
◦ Master trainer team, dates of their training and refresher courses, and individual
participation and role in training others
◦ All personnel trained in VIA or cryotherapy, the dates of their training, the dates of
refresher courses completed, and the number of women screened per provider
Reasonable efforts toward the preparation of an annual regional cervical cancer prevention strategic
plan including the following components:
◦ Planning, Monitoring and Evaluation
◦ Resources and Capacity including Financing, Workforce Capacity, and Resources Management
◦ Community and Health Service Activities including Clinical Service Guidelines and Health
Information Systems
◦ Networks and Partnerships
◦ Management, Accountability, and Leadership
◦ Communication and Outreach
Reasonable efforts toward the preparation and annual adaptation of regional level cervical cancer
prevention health policy in response to the recommendations from districts and communities.
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