More community health workers needed for cervical cancer prevention and screening in Zimbabwe

Umboe clinic is around 200 kilometres away from Harare, the capital city of Zimbabwe. Soon after reaching the city of Chinhoyi in Makonde district, paved roads disappear. After another 2 hours of driving along the dirt road, the clinic appears: a solitary building with only a few houses close by. This is where nurse Josephine Matare works.

The clinic was built in the 1970s, and the infrastructure is old. Its rooms are simple, with handwritten health messages on the walls. There is barely any furniture in the clinic except a few basic beds and desks.

Umboe clinic serves around 10 000 people in the community. The furthest village, Ringari, is about 14 kilometres away. Without roads and transport, people often walk to reach the clinic.

Nurse Matare is one of only two health care workers in the clinic that are trained in cervical cancer prevention and screening. After 10 years of working in the provincial hospital, she chose to come back here to serve her community. But due to the remoteness of the area and low salaries, rural areas in Zimbabwe struggle to retain community health workers. She is an exceptional case, as she has been working here tirelessly for the past 3 years.

Cervical cancer prevention, Umboe Health Clinic, Zimbabwe, April 2024.
Photo credit: WHO / Jin Ni

Cervical cancer remains a significant public health concern in Zimbabwe, ranking fourth globally and regionally, with alarming incidence and mortality rates. Annually, approximately 3043 women in Zimbabwe are diagnosed with cervical cancer, and tragically, 1976 lives are lost to the disease.

While Zimbabwe has established screening programmes, access remains uneven. As of 2019, only 20% of the population had access to screening services. At the end of 2023, Zimbabwe introduced the use of HPV DNA tests, a more accurate and sensitive screening method than previous options. Around 200 clinics around the country like Umboe received self-sampling testing kits for health workers to disseminate and collect in their catchment area.

"These kits really change things for the women here because they don't need to visit a provincial hospital to get a test that they know nothing about. We can just give these to them with instructions, and they could do it in the privacy of their own homes," says Nurse Matare. "But of course, there are challenges, issues of stigma or confusion on the collection of the sample for example, so we really had to explain very well and convince them that it's a good test so that if you are found to have a disease, you can be treated as soon as possible."

Cervical cancer prevention, Zimbabwe, April 2024.
Photo credit: WHO / Jin Ni

Once the samples are collected, they are sent to the Chinhoyi Provincial Hospital laboratory for processing. Over 3000 samples have been tested since the start of the operation. But the laboratory faces its own challenges. Regular power cuts are a persistent issue, and as demand for the test increases, staff are looking for more sustainable systems to meet needs such as solar power.

"Zimbabwe had made a lot of effort towards eliminating cervical cancer, but we still face major challenges. We have a shortage of community health workers who are critical in the mobilization of cervical cancer screening as well as other health priorities," observed Douglas Mombeshora, the Minister of Health and Child Care of Zimbabwe during a meeting with WHO in 2024. "We have 64 000 health workers now, but we need to double this number to 128 000 by 2028 to meet the health care needs. We need to give them good incentives, so that we can retain our personnel."

Cervical cancer prevention, Harare, Zimbabwe, April 2024.
Photo credit: WHO / Jin Ni

The shortage of health care workers can be felt across the country. On the outskirt of Harare, communities sometimes rely on advocates as their only source of health information. Tariro is from one such community, and has taken matters into her own hands. Having survived cervical cancer, she now runs a youth community centre and advocates about healthy lifestyles and the importance of HPV vaccination and cervical cancer screening.

Cervical cancer elimination programme in Harare, Zimbabwe, on 21 April 2024.
Photo credit: WHO / Kudzai Tinago

Zimbabwe introduced the national HPV vaccination programme in 2018 and over 1 million girls have been vaccinated to date. The country however experienced setbacks from the COVID-19 pandemic, slowing down the progress. To increase vaccination coverage to 90%, Zimbabwe is conducting school-based vaccination campaigns, along with integrated vaccination outreaches to ensure that even girls out of school are not left behind. This is another area where more health workers are needed.

Back in Umboa clinic, Nurse Matare felt emotional. The Minister spoke and commended her and other frontline health workers for their hard work. She knows that they are training new health workers at the provincial hospital and is hopeful that she will get more support in the coming months.

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