Cervical cancer screening using visual inspection with acetic acid: operational experiences from Ghana and Thailand

Reprod Health Matters. 2008 Nov;16(32):67-77. doi: 10.1016/S0968-8080(08)32401-X.


Thailand in 2000 and Ghana in 2001 initiated cervical cancer prevention programmes using a single-visit approach with visual inspection with acetic acid (VIA) with cryotherapy for pre-cancerous lesions. This service was integrated into existing reproductive health services, provided by trained nurses. The providers maintained a high level of competence and performance, including after the withdrawal of external funding. In Ghana, independent co-assessments revealed a high level of agreement in diagnosis between providers and a Master Trainer. In Thailand, high quality performance was associated with quality assurance mechanisms such as peer feedback and review of charts and service statistics. Provider performance was maintained at a high level in both countries: an average of 74% of providers from both countries met 85% or more of performance standards. The successful transition from a demonstration project to a national programme in Thailand was dependent on a strong commitment from government health bodies and health professionals. In contrast, the lack of health infrastructure and political will has prevented scale-up to a national programme in Ghana. However, this study shows that a single-visit approach with VIA and cryotherapy is programmatically feasible and sustainable and should be considered in national investments to control cervical cancer.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acetic Acid*
  • Colposcopy
  • Cryotherapy
  • Female
  • Ghana
  • Humans
  • Indicators and Reagents*
  • Mass Screening / methods*
  • Primary Prevention / organization & administration*
  • Quality Assurance, Health Care / methods
  • Thailand
  • Uterine Cervical Neoplasms / diagnosis*
  • Uterine Cervical Neoplasms / therapy


  • Indicators and Reagents
  • Acetic Acid