Achieving effective cervical screening coverage in South Africa through human resources and health systems development

South Africa's cervical screening policy recommends three free Pop smears at ten-year intervals for all women over 30 years of age, aiming to achieve 70% coverage by 2010 by targeting the age group most at risk of developing pre-cancerous cervical lesions. Attaining wide coverage requires an adequate supply of motivated and supported public sector health workers with appropriate training and skills, working in a functional health system. Given the dearth of doctors in South Africa, professional nurses were tasked with performing the bulk of Pop smears at primary core level. Coverage remains sub-optimal and a significant proportion of women with precursor lesions do not receive treatment. Further, health system strengthening - essential for cytology-based screening - has not happened. Research to evaluate alternative screening technologies has proliferated in recent years, but regrettably, strengthening of the health system required to Make the new technology work has not received similar attention. Using the South African experience, this article argues that technological interventions and innovations alone ore not sufficient to improve cervical screening programmes. Task-shifting is limited unless other human resource concerns (e.g. training, increasing demands on personnel, attrition, and skills Mix) are concurrently addressed within a comprehensive workforce development strategy, alongside work to make the health core delivery system functional. (C) 2008 Reproductive Health Matters. All rights reserved.