Cervical Cancer Awareness in Kenya

Cervical continues to be one of the greatest threats to women's health globally. It is the second most common cancer worldwide and the leading cause of cancer-related deaths among women in developing countries. The incidence of new cervical cancer cases in 2020 is 19.7% of the overall new cases reported. This accounts for 5,236 cases out of 26, 550 cases. This is more than 7 times higher than incidence in western countries. Studies have shown that women are more likely to die in low-resource settings because there is simply no viable infrastructure to support screening or treatment.

We seek to demystify cultural beliefs that revolve around cervical cancer and the screening process in the rural areas through the engaging community health workers as educators and enablers at the community level. Through a mobile- based application they will capture and enroll the participants to the screening and treatment programme. This data will be used to enhance knowledge of cervical cancer demographics and awareness, and will contribute also to the foundation of information that has been brought together to generate new surveillance insights that improve the ability to project and target the impact of interventions.

We have developed a web application that monitors awareness through survey questions asked during the registration of each participant. Once a participant has been registered, the system sends messages when the participants are scheduled for their screenings to ensure action on the participants’ side. When a participant goes for screening, the system monitors their results and allows referrals to other hospitals for further treatment. The development of this system included creating content on cervical cancer awareness, training and working with the community health workers, nurses, and healthcare professionals to talk to the women and encourage them to go for screening.

The focus group for our implementation are women especially in rural and deep rural areas in Kenya. Our aim is to increase awareness of cervical cancer risks and encourage preventive measures such as regular screening at the health facilities in the communities. Our pilot program was done in Bungoma County in the Western Region of Kenya. Since healthcare in Kenya is devolved to the county level, we are working with the Ministry of Health in Bungoma County and Bungoma County Referral Hospital to implement the system. We are also in processes of engaging other health facilities in the area to adopt the system.

Leveraging on the experience we have in application development, implementation, and training on health information systems in hospitals, we are expanding to work with the community health workers and the targeted women in rural areas. Solutions to some of the challenges such as language barriers, technological savvy of the community health workers and participants and creating partnerships with the nurses broaden the scope of work of the project. Our organisation is based in Kenya, and therefore, we understand the importance of our project to the community.

The mentorship provided by the MITSolve program will give us a platform to share our experience with the world as well as gain input from experts from the program on how to plan our project better. We are preparing outputs from the pilot project by writing white papers and papers to different journals. The conferences organised by the MITSolve program will give us access to potential partners and interested parties to work with us. This program will also allow us to network and engage with other like minded project owners working on different solutions where we can gain new perspectives to our solutions, and thus will allow us to expand our capacities. 

We would like to expand our capacity to other regions in the country. Our pilot project showed a huge gap in awareness among the women with 92% of the 348 participants never going for screening in their lives despite the resources available at the health facilities. This and other statistics from the pilot program have encouraged us to seek more funding to support our project.

The design of this project is end to end, starting with creating awareness among marginalised women who have little access to information about cervical cancer. Next, we encourage them to go for screening at a health facility of choice, including highly subsidised government supported health facilities where HPV vaccination is free. After screening, we focus on the treatment where those who need further treatment are monitored through the system by the health officials (nurses, clinicians, doctors and oncologists).

The technologies used in the development of the system are cutting edge using current programming languages and development practices. The methodology used was an agile co-design approach to ensure input from the community health workers and nurses on the functionality of the system is captured. 

The system is online with offline capabilities and can be accessed using a mobile app. This was a key requirement since creating awareness is a mobile activity where community health workers interview and register women in different locations.  During treatment and referral, the system can download a copy of the results that the participant/patient can take to the oncologist for review. Automated SMS reminders are sent to each participant indicating when and where the next appointment will be.

Our project is aimed at increasing awareness on cervical cancer and its risks as well as increasing awareness on preventive measures. We are working closely with the government and healthcare officials to support our program and ensure their buy-in. More women should regularly go for screening in the health facilities and get vaccinated if possible. They will receive reminders on their phones on their scheduled appointments and when their results are ready. Since screening is typically done after either one year or three years depending on the critical factors, our aim is to have one participant screened at least twice within the next five years.

Our project is aligned with the UN SDG goal, Good Health and WellBeing, on access to reproductive healthcare services including information and education, and integrating with the national programme on HPV vaccination in our rural and deep rural communities in Kenya. This is a long term effort which we would like to make sustainable within the next five years. 

To measure our impact, we are monitoring the number of women going for screening, getting treatment and following up on their appointments. Since screening is typically done after either one year or three years depending on the critical factors, our aim is to have one participant screened at least once within the first year; and the first group from the first year screened at least twice in the next five years.

Since our pilot program focused on one rural part of the country, Bungoma County in the Western region of Kenya, we are continuing to monitor the women’s responses as they get registered and continue engaging with the community health workers to support our efforts.

Our project is designed to be end to end intervention, starting with creating knowledge and ending with hospital visits at various stages, we are encouraging women to go for cervical screening with, by extension, checks for cervical cells. Preventive measures can be taken early to mitigate cervical cancer risks thus reducing mortality. This shall strengthen the capacity for early detection, treatment, risk reduction and overall management of cervical cancer.

The web application is developed using current programming languages - ReactJS (Javascript) in its front end and the Laravel framework in its backend. The development process followed DevOps lifecycle of design, build, test and deploy. The build and test features were integral in the development process to ensure each use case is captured, including security and access to data. The data collected is sensitive as it contains the participants bio data, therefore ownership and access is at the health facility level with non-essential users of the system having limited access to the data. The health facilities and, by extension, the county government owns the data collected by the system

The system uses SMS reminders on appointments to the participants. Once enough data has been collected, or after one year of data collection, we plan on adding machine learning capabilities on predictive analysis to determine the frequency of screening visits based on dates and regions. Other variables will be determined in due course.

Demo Site

This project is women-centered, focusing on marginalised communities. The core team working on the project have both genders from different backgrounds in the country. The entire team composition includes project manager, software developers, community health workers, healthcare professionals, representatives from the county government and project advisors. The community health workers are primarily women who are best to bridge the cultural and language barrier in reproductive matters to the targeted women. The project advisors include oncologists, technical program managers and business analysts.

Our business operations leverage the social enterprise business model. This model ensures we generate revenue to continue scaling, supporting, and starting new research projects while making remarkable social impact. 

The business model involves;

1. Grants through partnerships with local and international partners.

2. Through SMS subscription to get cervical broadcasts. These broadcasts will be done when there is free screening, consultations or any other cervical cancer service drive.

Being a not for profit, non-governmental organization, we will be working on grants to support the project to move from piloting to growth stage. To ensure sustainability, we shall strive to reach new local and international individuals or organizations to come onboard and partner with. We will also be pushing for the adoption of the solution by the county and national government to ensure support through internal government budgets. 

Since our application is open source, through the input of the wider community, technology scaling and upgrades will be cheaper in the long run.

The pilot program was funded by a grant from the Finnish Non-Governmental Organizations, (FINGO). We are in the process of seeking subsequent funding for our next phase following the success of the pilot project. 

Some of our other partners and projects include;

CDC/MoH - Basic Laboratory Information System - Kenya (BLIS - Kenya).

FIND/MoH - HIV quality assurance Kenya.

EU/Horizon2020 - m-Health Kenya.

WHO/World Bank/MoH - Kenya Health Research Observatory (KHRO)