Improving cervical cancer prevention in a developing country.
OBJECTIVE
to enhance the delivery of services, using continuous quality improvement, and an outreach strategy.


METHODS
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.


METHODS
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.


CONCLUSIONS
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.
Agurto
Irene
I
Pan American Health Organization, Washington, DC 20037, USA. iagurto@yahoo.es
Sandoval
Jorge
J
De La Rosa
Maribel
M
Guardado
Maria Elena
ME
D000328:Adult; D019411:Clinical Laboratory Techniques / Q000592:standards; D003159:Community-Institutional Relations; D003906:Developing Countries; D004544:El Salvador; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000458:organization & administration / Q000592:standards*; D008875:Middle Aged; D010175:Pan American Health Organization; D010348:Patient Care Team; D017410:Practice Guidelines as Topic; D011322:Primary Prevention / Q000458:organization & administration / Q000592:standards*; D011635:Public Health Administration / Q000592:standards; D013997:Time Factors; D017749:Total Quality Management / Q000379:methods*; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000517:prevention & control*; D014932:Women's Health Services / Q000458:organization & administration / Q000592:standards*