Leveraging vertical COVID-19 investments to improve monitoring of cancer screening programme - A case study from Bangladesh

Abstract

Cancer screening programs from majority of the low- and middle-income countries (LMICs) report screening coverage as the only performance indicator, and that too measured through population-based sample surveys. Such information is unreliable and has very little value in assessing programmatic quality and impact. Regular monitoring of key process and outcome indicators based on data collected through a robust information system is essential to ensure quality of a screening programme. Fragmented health systems, limited resources and absence of a culture of systematic evaluation are the major hindrances for most of the LMICs to build electronic information systems to manage screening. The COVID-19 pandemic has created an impetus for the countries to customize the freely available District Health Information Software (DHIS2) to collect electronic data to track the outbreaks and manage containment measures. In the present article we present Bangladesh as an exemplar LMIC that has a (DHIS2) based integrated health information system gradually upgraded to collect individual data of the participants to the national cervical cancer screening program. Such efforts paid rich dividends as the screening program was switched from opportunistic to a population-based one. Moreover, the electronic system could report impact of the pandemic on cancer screening on a monthly basis. The aggregate number of women screened in the year 2020 was 14.1% less compared to 2019. The monthly rate of screening during peak of the outbreak was only 5.1% of the previous year. The rate rapidly recovered as the program intensified screening in the hard-to-reach regions less affected by the pandemic and expanded the outreach services. Other LMICs may emulate Bangladesh example. Customizing the information system developed for pandemic surveillance to collect cancer screening data will help them build back the screening programs better.

Keywords: Bangladesh; COVID-19; Cancer screening; Low- and middle-income countries; Screening registry.

Fig. 1

Number of women screened for cervical cancer in three consecutive years (2018,2019 and 2020) in different divisions of Bangladesh. The map shows percentage change in the number of women screened between 2018 and 2019, and 2019 and 2020. [* Percentage change in 2019 compared to 2018 (shown in blue). ** Percentage change in 2020 compared to 2019 (shown in red)]. (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)

Fig. 2

Number of women screened for cervical cancer in Bangladesh by months in 2018, 2019 and 2020; the bars show the number of COVID-19 cases detected by months in 2020.