Policy Considerations to Promote Equitable Cervical Cancer Screening and Treatment in Peru

The Peruvian government recognizes need to increase workforce and has identified in a recent policy how many health providers need to be trained in VIA, colposcopy, and cryotherapy [39]

Centralization of resources [1, 11, 13, 29, 30, 32, 40, 41]

Insufficient quality of testing and thus far, no implementation of HPV testing [16, 31, 33]

Insufficient number & training of health providers [1, 2, 29, 32, 33, 34, 36, 42]

Loss of patients to follow-up [11, 13, 16, 33, 34, 43, 44]

Decentralize and monitor resource allocation

Implement HPV testing (self-sampling)

Train health providers considering capabilities needed at different levels (eg., at health centers vs. that at hospitals)

Task-shift/task sharing to other train providers (eg., professional midwives) [22, 26]

Technological innovations [1, 29, 36, 45, 46, 47]

No comprehensive system for evaluation of these innovations [17, 33, 34]

Create system for evaluation, accountability, and implementation

Integrate emerging point of care technologies

Awareness campaigns

National health insurance plans exist (SIS and EsSalud) [16]

Lack of awareness of public health insurance [38]

Payment reform which enables care outside hospitals

Strengthen primary care and prevention actions

Alignment of Peruvian cervical cancer policy with guidelines of WHO & PAHO [2, 16, 17, 18]

Failure to implement national policies [48]

Study policy challenges and evidence for in implementation

Modify policies to address insufficient organizational competencies