Application of the hub and spokes model in improving access to cervical cancer screening in Ghana.
Kofi Effah, Evans K. Attivor, Bernard Hayford Atuguba, Donatus D. Adaletey, Delali A. Ofori, Philip Diame, Ethel Tekpor, Comfort Mawusi Wormenor, Isaac Gedzah, Dominic Agyiri, Joseph Emmanuel Amuah, Patrick Kafui Akakpo, Jonathan Mawutor Gmanyami, Martin Adjuik, Hubert Amu, Margaret Kweku
Abstract
Objective: To examine the contribution of lower-level health facilities in increasing access to cervical cancer screening in the North Tongu District. Design: A descriptive cross-sectional study design was used. The Cervical Cancer Prevention and Training Centre (CCPTC) of the Catholic Hospital, Battor, served as the hub, and six health facilities (3 health centres and 3 CHPS compounds) served as the spokes. From April 2018 to September 2019, the well-resourced CCPTC trained 6 nurses at selected Community-based Health Planning and Services (CHPS) / Health Centres (HCs) (spokes) to provide cervical cancer screening services. The nurses, after training, started screening with VIA and HPV DNA testing. Participants: A total of 3,451women were screened by the trained nurses. This comprised 1,935 (56.1%) from the hub and 1,516 (43.9%) from the spokes. Main outcome measure: The detection of screen positives. Results: The screen positives were 19.4% (375/1935) at the hub and 4.9% (74/1516) at the spokes. Conclusion: We have demonstrated that a hub and spokes model for cervical cancer screening is possible in limited resource settings. Designating and resourcing a 'hub' that supports a network of 'spokes' could increase women's access to cervical cancer screening. This approach could create awareness about cervical cancer screening services and how they can be accessed. Funding: None declared.