Enhancing cervical cancer screening coverage in selected primary healthcare sites using Lean thinking: The CerviScreen programme

Background. Cervical cancer is the most common malignancy among South African (SA) women of reproductive age, with women living with HIV (WLWH) facing a six-fold higher susceptibility. The National Department of Health recommends baseline cervical cancer screening (CCS) for WLWH upon HIV diagnosis. SA’s reported CCS rate is 19.3%, despite the World Health Organization (WHO)’s recommended 2030 target of 70%. AIDS Healthcare Foundation initiated the CerviScreen programme to improve CCS rates using Lean thinking. Objectives. To evaluate the effect of the programme on CCS coverage over a 7-month period at selected sites in the Eastern Cape and KwaZulu-Natal provinces of SA. Methods. This quantitative, controlled before-and-after study retrospectively evaluated changes in CCS coverage at purposively selected quality improvement programme (QIP) sites, compared with matched control sites. Key CCS indicator data from Lean A3 tools were analysed. Repeated analysis of variance measures tested changes in CCS proportions over time, at a p<0.05 significance level. Results. Nine CerviScreen and nine control sites per province were assessed. Significant increases in CCS mean proportions were observed at QIP sites in KwaZulu-Natal (5% - 62.9%; F=8.336, p<0.001) and Eastern Cape (21.2% - 82.4%; F=15.525, p<0.001) provinces. Differences in the change of mean proportions between CerviScreen and control sites were not statistically significant in KwaZulu-Natal (F=0.022, p=0.884) and Eastern Cape (F=0.882, p=0.362). Clinically significant improvements were observed, with the estimated marginal mean at KwaZulu-Natal QIP sites consistently surpassing control sites from month 3 onwards. Eastern Cape sites maintained over 80% coverage from month 4. Screening coverage trends differed significantly between provinces (F=11.12, p=0.004). Conclusion. Lean thinking, through the CerviScreen programme, has potential to enhance and accelerate CCS among SA WLWH toward attaining the WHO target. The findings underscore the importance of adopting systematic quality improvement approaches, highlighting the need for scale-up of Lean thinking in primary healthcare settings to address underperforming indicators.