Implementing a Fee-for-Service Cervical Cancer Screening and Treatment Program in Cameroon: Challenges and Opportunities

UMMS Affiliation

School of Medicine; Department of Obstetrics and Gynecology; Graduate School of Nursing; Department of Medicine, Division of Infectious Diseases And Immunology

Publication Date


Document Type



Community Health and Preventive Medicine | Health Services Administration | International Public Health | Obstetrics and Gynecology | Oncology | Translational Medical Research | Women's Health


BACKGROUND: Cervical cancer screening is one of the most effective cancer prevention strategies, but most women in Africa have never been screened. In 2007, the Cameroon Baptist Convention Health Services, a large faith-based health care system in Cameroon, initiated the Women's Health Program (WHP) to address this disparity. The WHP provides fee-for-service cervical cancer screening using visual inspection with acetic acid enhanced by digital cervicography (VIA-DC), prioritizing care for women living with HIV/AIDS. They also provide clinical breast examination, family planning (FP) services, and treatment for reproductive tract infection (RTI). Here, we document the strengths and challenges of the WHP screening program and the unique aspects of the WHP model, including a fee-for-service payment system and the provision of other women's health services.

METHODS: We retrospectively reviewed WHP medical records from women who presented for cervical cancer screening from 2007-2014.

RESULTS: In 8 years, WHP nurses screened 44,979 women for cervical cancer. The number of women screened increased nearly every year. The WHP is sustained primarily on fees-for-service, with external funding totaling about $20,000 annually. In 2014, of 12,191 women screened for cervical cancer, 99% received clinical breast exams, 19% received FP services, and 4.7% received treatment for RTIs. We document successes, challenges, solutions implemented, and recommendations for optimizing this screening model.

CONCLUSION: The WHP's experience using a fee-for-service model for cervical cancer screening demonstrates that in Cameroon VIA-DC is acceptable, feasible, and scalable and can be nearly self-sustaining. Integrating other women's health services enabled women to address additional health care needs.

IMPLICATION FOR PRACTICE: The Cameroon Baptist Convention Health Services Women's Health Program successfully implemented a nurse-led, fee-for-service cervical cancer screening program using visual inspection with acetic acid-enhanced by digital cervicography in the setting of a large faith-based health care system in Cameroon. It is potentially replicable in many African countries, where faith-based organizations provide a large portion of health care. The cost-recovery model and concept of offering multiple services in a single clinic rather than stand-alone "silo" cervical cancer screening could provide a model for other low-and-middle-income countries planning to roll out a new, or make an existing, cervical cancer screening services accessible, comprehensive, and sustainable.


UMCCTS funding, Breast cancer, Cameroon, Cervical cancer, Family planning, Fee‐for‐service, Nurses, Screening, Sustainability, Visual inspection with acetic acid

DOI of Published Version



Oncologist. 2017 Jul;22(7):850-859. doi: 10.1634/theoncologist.2016-0383. Epub 2017 May 23. Link to article on publisher's site

Journal/Book/Conference Title

The oncologist


Geneva DeGregorio and Preetam Cholli are medical students at the University of Massachusetts Medical School.

Related Resources

Link to Article in PubMed

PubMed ID