pcSN12 Trip Report

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Collaborative Report

peacecare Senegal 2011 - 2012

Saraya / Kedougou, Senegal Peace Corps Senegal / University of Illinois – Chicago

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Acknowledgments

peacecare would like to acknowledge the following organizations and

individuals who have given significantly toward the successful implementation

of this project, in terms of hours of labor, financial support, and

encouragement.

Saraya District Health Leaders, Staff, and Communities. In particular:

Dr. Youssoupha Ndiaye, Saraya District Medical Director

Fatou Traore, Midwife

Kedougou District Health Leaders, Staff, and Communities. In particular:

Dr. Cheikh Senghor, Kedougou District Medical Director

Dr. Sidy Amar, Kedougou District Associate Medical Director

Dr. Mamadouba Camara, Kedougou District Surgical Oncologist

Kedougou Region Health Leaders and Staff. In particular:

Dr. Abib Ndiaye, Kedougou Region Medical Director

Fatou Ndour, Midwife

Peace Corps Senegal Admin and Volunteers. In particular:

Chris Hedrick, Peace Corps Senegal Country Director

Mamadou Diaw, Peace Corps Senegal Health APCD

Leah Moriarty, PCV Saraya

Meera Sarathy, PCV Kedougou

Marielle Goyette, PCV Nafadji

LaRocha LaRiviere, PCV Salemata

Ivy Renfro, PCV Tambacounda

The UIC Departments of Family Medicine, Obstetrics/Gynecology, Communication,

and the School of Public Health

The UIC Team

Andrew Dykens, MD, MPH

Karen Peters, DrPH

Tracy Irwin, MD, MPH

Emily Godfrey, MD, MPH

Lali Abril, PhD

Nathan McLaughlin, MD

Magda Piatek, MD

Amish Desai

Magda Kupcyk

peacecare Board of Directors

peacecare Advisory Panel

Our Families, Friends, and Colleagues and…

All those who gave a little, so that there would be enough.

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Collaborative Partners, Fiscal Supporters, and Sources of Adapted Technical

Materials

National Peace Corps Association

Alliance for Cervical Cancer Prevention (ACCP)

EngenderHealth

International Agency for Research on Cancer

JHPIEGO

Pan American Health Organization

PATH

World Health Organization

International Network for Cancer Treatment and Research

Report Distribution Copies of this report will be made available to the following stakeholders:

Senegal Ministry of Health

Kedougou Region Health Leadership

Kedougou District Health Leadership

Saraya District Health Leadership

Saraya District peacecare Project Advisory Committee

US Embassy, Dakar, Senegal

Peace Corps Senegal Headquarters

Peace Corps Office of Programming Training, and Support

University of Illinois – Chicago


Contact Information With questions or to request more information concerning this project, please

contact:

Andrew Dykens, MD, MPH, founder and executive director of peacecare.

[email protected]

You can read more about peacecare at www.peacecare.org

mailto:[email protected]

http://www.peacecare.org/

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Table of Contents Report Distribution......................................................... 3 Contact Information......................................................... 3 peacecare................................................................... 5 Collaborative Executive Summary............................................. 6 2010 – 2011 ............................................................... 6 2011 – 2012 ............................................................... 7

Phases of Collaborative..................................................... 8 Partnership Formation ..................................................... 8 Relationship Development ................................................ 8 Site Selection .......................................................... 8 Initial Site Visit ...................................................... 8 January 2011 Site Visit ................................................. 8 Partnership Formalization ............................................... 9 Project Definition ..................................................... 10 IRB Approval ........................................................... 11

Assessment ............................................................... 12 Community Health Assessment ............................................ 12 Issue Selection ........................................................ 12 Health Care Delivery Assessment ........................................ 12

Project Development ...................................................... 13 Realist Literature Review(s) ........................................... 13 Project Development / Adaptation ....................................... 14 Service Component Planning ............................................. 14 Sustainability Component Planning ...................................... 14 Global Health Education Planning ....................................... 15 Cultural Orientation Planning .......................................... 15 Logistics Planning ..................................................... 15

Project Implementation ................................................... 17 Orientation – Local Milieu ............................................. 17 Project Components ..................................................... 17 Policy Development ..................................................... 24 Collaborative Strategic Planning ....................................... 25 Global Health Education Component ...................................... 26

Project Evaluation ....................................................... 27 Outcomes Evaluation .................................................... 27 Process Evaluation ..................................................... 27

Dissemination ............................................................ 28 Future Plans............................................................... 28 Kedougou Region, Senegal Health System Strategic Planning ................ 28

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peacecare The World Health Organization estimates that there is a shortage of about 4.3

million health care workers globally. Africa has only about 10% of the

world’s population and is affected by about 24% of the global disease burden

but has only 3% of the global health care workforce. Sub-Saharan Africa is

deficient 1.5 million workers that would be necessary to provide adequate

health care to the continent. In addition, countries with better developed

primary health care systems have been found to have better health outcomes.

The GCHC model operates with the premise that in order to sustainably address

global health and adequately reduce disparity, solutions should originate and

be developed, primarily, with community involvement, through (or with the

amelioration of) existing health systems, and with the use of appropriate

technology. All solutions should, as well, prioritize capacity building

within the local health care structure through the utilization and

implementation of the principles of primary health care and public health. In

this context, the GCHC model is based on a Community Based Participatory

Research (CBPR) model establishing an equitable partnership between the

community and researchers. Each project is evaluated in terms of process and

outcomes, thus, fostering evidence-based replicability. There are multiple

phases of this model including partnership formation, assessment, project

development, project implementation, project evaluation, and dissemination.

Within each phase, the community is empowered to ensure full participation

and emphasis on priorities as perceived within the community.

peacecare leverages the training resources and scientific approach of an

academic center to support clinical service capacities through skills

transference to develop the local health care workforce; emphasize quality of

care; and improve clinical and population health outcomes as part of a

service delivery enhancement. The GCHC model is novel in that it empowers

low and middle income country communities in collaborations with academic

institutions by partnering with the Peace Corps, having over 7600 volunteers

worldwide in 75+ countries. By leveraging the established trust,

infrastructure, and resources of the Peace Corps, peacecare is well

positioned to have an immediate and sustainable impact. Peace Corps

Volunteers (PCVs), being integrated within the community and trained

extensively in cultural competency and local language, are highly qualified

field workers. These PCVs work in a highly sustainable manner by

consistently collaborating with a local counterpart. The role of Peace

Corps, in being a governmental organization, strengthens this model, as all

initial project plans and final outcomes have been and will be reported

directly to the Ministry of Health. peacecare, a nonprofit organization,

acts as the project manager as well as provides expert consultation services

for this collaborative relationship.

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Collaborative Executive Summary This project utilized the Global Community Health Collaborative (GCHC) model

and holds as its principle goal to positively impact global health

disparities by specifically addressing the global burden of disease, the

global shortage of health care workers, the deficiency of primary health care

in low-income countries, and the deficiency of global health research.

Access to quality health care in areas where this collaborative is focused is

difficult to obtain, primarily due to the geographically dispersed area and

the limited number of trained personnel. In training additional health care

workers and improving the skills and knowledge base of existing health care

workers, individuals in remote villages will have increased access to quality

medical care.

2010 – 2011 Through this novel approach with a Peace Corps Senegal partnership,

throughout 2010, this peacecare collaborative was formed between the health

district of Saraya, Senegal and UIC to improve health care delivery within

the local existing health care system as well as provided training in global

health and cultural competency for U.S. health care trainees. The Health

District of Saraya is located in the extreme South-Eastern part of Senegal

with an estimated population of 42,000 inhabitants and comprises seven health

posts and one health center. The focus of this pilot project was cervical

cancer screening and prevention, prevention of sexually transmitted

illnesses, and diarrhea prevention, as determined by the assessment of local

health concerns, the status of the health service delivery infrastructure,

and the priorities of the local health care leadership.

A team from the UIC Department of Family Medicine accompanied by students and

representative faculty from the UIC School of Public Health as well as the

OB/Gyne Department traveled in early 2011 during the intervention phase.

This project was led by Andrew Dykens, MD, MPH, the founder of peacecare

(www.peacecare.org) and director of the UIC Family Medicine Global Community

Health Track, and was in collaboration with Peace Corps Senegal, Country

Director, Chris Hedrick, as well as the Saraya District Director of Health

Services, Dr. Youssoupha Ndiaye.

Through this collaborative, in addition to small scale interventions

addressing diarrhea and Sexually Transmitted Infections (STI’s), we trained

five trainers in the technique of visual inspection of the cervix with acetic

acid. These trainers, in turn, trained 14 additional personnel as a

secondary training. The District level medical director, Dr. Ndiaye, as a

strategy for scaling the project, intended to have all clinicians within the

Saraya District trained by May, 2011 and hoped to discuss expanding the

training to cover the entire Kedougou region by the end of 2011. Dr. Ndiaye

expressed a desire to illustrate this model as a successful means by which to

initiate cervical cancer screening throughout rural Senegal, where few

efforts previously existed. peacecare and UIC hopes to continue to support

these trainings. Concerning next steps, UIC began initial discussions with

the Saraya Health District focused on bringing a training course in

cryotherapy as a management option for positive cervical cancer screens.

This would reinforce the local health system’s ability to manage positive

results without displacing patients.


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2011 – 2012 This collaborative between the University of Illinois-Chicago (UIC)

Department of Family Medicine, the UIC School of Public Health, the UIC

Department of OB/Gyne, the UIC Department of Communication, the District of

Saraya, Senegal, and Peace Corps Senegal, utilized the Global Community

Health Collaborative (GCHC) model in building on the prior year’s work. This

project was led by Andrew Dykens, MD, MPH, the founder of peacecare

(www.peacecare.org) and Director of the UIC Family Medicine Global Community

Health Track, and is in collaboration with Peace Corps Senegal, Country

Director, Chris Hedrick, as well as the Saraya District Director of Health

Services, Dr. Youssoupha Ndiaye, the Kedougou District Director of Health

Services, Dr. Senghor, and the Regional Level Health Systems Medical

Director, Dr. Ndiaye. In addition to faculty in the respective departments

listed above, the traveling team during the 2012 site visit also included two

resident physicians, one medical student, and one public health student.

This peacecare collaborative expanded to the Kedougou Regional level, which

is comprised of the Saraya, Kedougou, and Salimata Districts and advanced the

work of cervical cancer preventative services implementation to the regional

level as well as provided training in global health and cultural competency

for U.S. health care trainees. The Health Region of Kedougou is located in

the South-Eastern part of Senegal with an estimated population of 143,000

inhabitants and comprises twenty-three health posts, three health centers,

and the Regional Hospital.

Through this iteration of the collaborative, the local trainers continued to

train additional health personnel in the technique of visual inspection of

the cervix with acetic acid to complete access to this service throughout the

Saraya District and advance the goal of covering the entire region. Upon

completion of this iteration, 2 trainers remain in the region, 3 candidate

trainers have advanced their skills, and 39 total health workers have

completed the VIA training. The implemented service has been formally

integrated into the Regional level. A quality improvement process was

initiated to guide further service implementation and policy development.

Local Policy development as well as strategic planning discussions are

ongoing to detail guidelines and norms and provide insight into the next

steps in expansion of the project. As well, efforts have advanced the

planning of an information and education approach, strategy, and plan in the

coming months. With resources currently in place, one upcoming objective is

the determination of burden of disease within the region. A theoretical

training for cryotherapy implementation, as well, has occurred and the region

is prepared to implement this service during the coming year. As the service

continues to be developed within the Kedougou Region, there is, as well,

identified interest in advancing the service into the neighboring Tambacounda

Region. The collaborative goal is to provide self-sufficiency through the

creation of Master Trainers and a local Management Team for future scaling of

the service implementation. peacecare and UIC hopes to continue to support

this work.


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Phases of Collaborative 1st Iteration

Partnership Formation – Aug 2009 to Jan 2011

Assessment – Oct 2010 – Nov 2010

Project Development – Nov 2010 – Jan 2011

Project Implementation – Jan 2011 – Feb 2011

Project Evaluation – Jan 2011 – Ongoing

Dissemination – May 2011 – Ongoing

2nd Iteration

Partnership Formation – Jan 2011 – Feb 2012

Assessment – Oct 2010 – Nov 2010

Project Development – Feb 2011 – Jan 2012

Project Implementation – Feb 2011 – Feb 2012

Project Evaluation – Jan 2011 – Ongoing

Dissemination – May 2011 – Ongoing

Partnership Formation Jan 2011 – Feb 2012

Relationship Development peacecare began discussions with Peace Corps Senegal in August 2009 for the

development of a collaborative.

Site Selection Upon the recommendations of Peace Corps Senegal the site of the Saraya

District Health System located in the Southeastern portion of Senegal was

chosen as the collaborative site. During the current iteration this focus

expanded to the Kedougou regional level which is comprised of the Saraya,

Kedougou, and Salimata Districts. This site was chosen with the following

considerations.

There was a need for improved health care capacity,

The local community and the existing health structure and personnel

desired a collaborative relationship,

There was an existing dynamic relationship with Peace Corps,

A Peace Corps Volunteer was currently in place and integrated within

the community, and

The Peace Corps Volunteer was in a position to communicate frequently

and reliably with all collaborating partners.

Initial Site Visit The project leader visited Senegal over a 7 day period in April / May 2010 to

further clarify roles, responsibilities, and the scope of the project. These

meetings are outlined in the 2010-2011 Collaborative Report.

January 2011 Site Visit The initial UIC team visited Senegal to implement the first iteration of the

collaborative during which time further partnership discussions occurred

giving insight into the direction of the collaborative.

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Partnership Formalization Within this stage of the Partnership Formation phase the team was defined,

roles and responsibilities were clarified, and stakeholders were instructed

in the project process.

Team Definition:

Research Personnel Principal Investigator: Andrew Dykens, MD, MPH

Co-investigator(s):

Karen Peters DrPH

Youssoupha Ndiaye, MD, MPH, PhDc

Memoona Hasnain, MD, MHPE, PhD

Tracy Irwin, MD

Eulalia Abril, PhD

Nathan McLaughlin, MD

Magda Piatek, MD

Magda Kupczyk

Additional Key Research Personnel:

Leah Moriarty, BS – Peace Corps volunteer and Onsite Coordinator,

Saraya District

Meera Sarathy, BA – Peace Corps volunteer and Onsite Coordinator,

Kedougou District

Catherine Lind, MA – UIC Qualitative Data Analyst

Amish Desai – Medical Student

Local Advisory Board

Mr. Moussa Danfakha

Mrs. Sadio Danfakha

Mrs. Cire Diaby

Mr. Mamoudou Kaaba

Support Personnel

Peace Corps Chris Hedrick, Country Director Peace Corps Senegal

Mamadou Diaw, Associate Peace Corps Director for Health

Marielle Goyette, PCV, Logistics and project planning, French and local

language translation at project level

LaRocha LaRiviere, PCV, Logistics and project planning, French

translation at project level

Ivy Renfro, PCV, Logistics and project planning

peacecare Eric Markin, peacecare – Budget

Michael Swaine, peacecare – Project Advisor

Stephen Stabile, MD, peacecare – Project Advisor

Rithvik Balakrishnan – RPCV Senegal – Process Documentation

Melody Mumford – French Translation

Cedric McCay – French Translation

Fanny Durand – French Translation

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Garth Lewis – French Translation

Coraline Rigouin – French Translation

Charlie Caldi – French Translation

David Jaglowski – French Translation

Kane, Khadidjatou – French Translation

Samantha Kyrkostas – French Translation


Project Definition Global health disparities are significantly impacted by workforce shortages,

and communities drastically need access to educational resources for health

systems strengthening. US universities have extensive resources but limited

presence in low resource settings. The Peace Corps is a trusted agency with

extensive infrastructure, though limited technical expertise. This Global

Community Health Collaborative (GCHC) model, being piloted by UIC, is a

uniquely efficient and effective model of collaboration that links these

stakeholders and has been endorsed by the National Peace Corps Association.

This project, organized through the University of Illinois - Chicago Global

Community Health Program in the Department of Family Medicine builds capacity

within the health care delivery system of Kedougou Region site in Senegal.

Through a collaboration between Kedougou, Senegal, UIC, the Peace Corps, and

Peace Care, a US 501c3, we will have provided cervical cancer preventive

services to Southeastern Senegal. Our project will also evaluate the

effectiveness of the GCHC model in terms of process and outcomes of the

existing collaborative and the feasibility of expansion through an additional

partnership.

Specific Aims The specific objectives are to:

identify the state of health and health delivery challenges and assets

affecting those residing in the Kedougou Region in Senegal;

prioritize the health service delivery issues (in collaboration with

UIC Global Community Health Program leadership and the Senegal Site

leadership) within the Kedougou Region in relation to favorable options

for intervention;

identify the health delivery challenges affecting those residing in the

Kedougou Region in Senegal as it relates to the 2010-2011 Senegal

Collaborative identified issue of cervical cancer;

develop curricula to address the identified issues: namely cervical

cancer.

implement the training curriculum to health care workers and community

members at the Senegal site, and

evaluate the collaborative process activities and outcomes.

Model Objective We proposed that the GCHC model which links academic resources to a community

through a partnership with the Peace Corps:

Successfully creates within the existing health care delivery systems,

health initiatives, which develop new local research and clinical

service capacities through skills transference to:

o develop local health care workforce;

o enhance quality of care; and,

o improve clinical and population health outcomes as part of a

service delivery enhancement; and

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o Creates a bi-directional educational/ training program, providing

training in community health and cultural competency for U.S.

students and residents participating in the service experience.

Research Rationale This pilot project is focused on the health of the community located in the

Kedougou Region of Senegal. This project is focused on developing and

implementing on-site training to the local Peace Corps Volunteer, health

workers at the Kedougou Region clinical site, and interested community

members and leaders in Senegal. In addition, this program provides global

health experience and training for the participating residents and students,

participating as part of the visiting University of Illinois - Chicago team.

IRB Approval While this Community Based Participatory Research Project carries minimal

risk it upholds the highest ethical standards of human research. In regards

to this, all key personnel with access to research data and with a role in

terms of project evaluation completed the required ethics and IRB course on

research with human subjects. In addition, the submitted protocol was

approved by the Institutional Review Board as part of the Office for the

Participation of Research Subjects at the University of Illinois-Chicago.

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Assessment October 2010 – November 2010

Community Health Assessment The baseline health assessment of the Saraya district in Senegal was

conducted in November 2010 by Chris Brown, PCV, and the field ethics trained

local advisory board. Using the interview tools, community member focus

groups and key informants, including health care workers, were interviewed

with the goal of obtaining information regarding community assets for health

care, primary health problems within the community, the state of health care

utilization, and the state of patient satisfaction. This information is

outlined in detail in the 2010-2011 Collaborative Report.

Issue Selection Through the baseline health assessment, several health issues were identified

by the community as primary health concerns, notably sexually transmitted

infection (STI) prevention and diarrhea.

An additional issue, Cervical Cancer Screening, was initially identified by

the Chief Medical Officer at the district level as a health service need by

this community. It was noted that, at that time, no cervical cancer

screening program was in place. While lacking from the community level

assessment data, it was noted to be a significant public health issue from

the analysis of the collected epidemiological data.

Health Care Delivery Assessment After the community health assessment and issue identification, the Peace

Corps Volunteer and the Local Advisory Board performed a focused assessment

of the local health care delivery system directed at the selected issues,

and, along with local health care workers and the guidance of peacecare,

identified the assets and needs of the local community in this regard. This

work was accomplished along with the local board of health to foster

sustainability and local autonomy.

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Project Development Nov 2010 – Jan 2011, Feb 2011 – Jan 2012

Realist Literature Review(s) An informal literature review was conducted to identify the curricula for STI

prevention and treatment as well as diarrheal prevention. A realist

synthesis of the literature was performed to guide the team in the

development of the curriculum for the issue of cervical cancer. Please See

Appendix 2 for a description of the Realist Synthesis.

Cervical Cancer

The World Health Organization Report on Cervical Cancer in Senegal reports,

"Senegal has a population of 3.20 million women ages 15 years and older who

are at risk of developing cervical cancer. Current estimates indicate that

every year 1197 women are diagnosed with cervical cancer and 795 die from the

disease. Cervical cancer ranks as the most frequent cancer among women in

Senegal, and the most frequent cancer among women between 15 and 44 years of

age. About 12.6% of women in the general population are estimated to harbor

cervical HPV infection at a given time and 43.6% of invasive cervical cancers

are attributed to HPVs 16 or 18.”

The abstract of the realist synthesis as performed by Yury Parra, a UIC

medical student, under the direction of Andrew Dykens, MD, MPH can be read in

Appendix 2 and concluded that despite its limitations, VIA is currently a

safe and feasible screening test for low-resource settings. It also showed

that this method can allow developers to identify elements that could be

incorporated into new interventions.

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Project Development / Adaptation Based on the assessment phase findings high quality curricula and training

materials were adapted for implementation. These curricula are based on

materials developed or approved by the World Health Organization, as listed

below.

Curriculum Development - Cervical Cancer Screening

Alliance for Cervical Cancer Prevention (ACCP): Planning and Implementing

Cervical Cancer Prevention and Control Programs: A Manual for Managers.

Seattle: ACCP; 2004.

English: http://screening.iarc.fr/doc/ACCP_screen.pdf

French: http://screening.iarc.fr/doc/MfM_French_final.pdf

Sankaranarayanan R, Wesley R (2003) A Practical Manual on Visual Screening

for Cervical Neoplasia, IARC Technical Publication No. 41. Lyon: IARC Press.

English: http://screening.iarc.fr/viavili.php

French: http://screening.iarc.fr/viavili.php?lang=2

World Health Organization (2006) Comprehensive cervical cancer control: A

guide to Essential Practice.

English: http://screening.iarc.fr/doc/cervicalcancergep.pdf

French: http://screening.iarc.fr/doc/text_fr.pdf

Digital learning series. A training course in visual inspection with 5%

acetic acid (VIA). IARC, 2005.

English: http://screening.iarc.fr/digitallearningserie.php

French: http://screening.iarc.fr/digitallearningserie.php?lang=2

A Training Course in Visual Inspection using 4% Acetic Acid (VIA) - theory

and practice. IARC

English: http://screening.iarc.fr/movieVIA.php

French: http://screening.iarc.fr/movieVIA.php?lang=2

Sankaranarayanan R, Wesley. Quick Clinical Reference Chart for Visual

Inspection with Acetic Acid (VIA). IARC

English: http://screening.iarc.fr/doc/schartvia.pdf

French: http://screening.iarc.fr/doc/schartviafr.pdf

Sellors J, Camacho Carr K, Bingham A, Winkler J. Course in Visual Methods for

Cervical Cancer Screening: Visual Inspection With Acetic Acid and Lugol’s

Iodine. Seattle, WA: PATH; 2004.

Service Component Planning Discussions identified an opportunity for the visiting UIC physicians to

observe clinical services. It was noted that the season during which the UIC

team would be visiting is routinely slower in terms of clinical services.

However, this is positive in terms of allowing time for the educational

activities.

Sustainability Component Planning Cervical Cancer Screening

During this phase, The UIC team initiated discussions concerning

implementation of the proposed screening program into the existing health

structure with consideration of expansion to the regional level. Discussions

were carried out with Dr. Abib Ndiaye, Dr. Youssoupha Ndiaye, and Dr. Cheikh

http://screening.iarc.fr/doc/ACCP_screen.pdf

http://screening.iarc.fr/doc/MfM_French_final.pdf

http://screening.iarc.fr/viavili.php

http://screening.iarc.fr/viavili.php?lang=2

http://screening.iarc.fr/doc/cervicalcancergep.pdf

http://screening.iarc.fr/doc/text_fr.pdf

http://screening.iarc.fr/digitallearningserie.php

http://screening.iarc.fr/digitallearningserie.php?lang=2

http://screening.iarc.fr/movieVIA.php



http://screening.iarc.fr/movieVIA.php?lang=2

http://screening.iarc.fr/doc/schartvia.pdf

http://screening.iarc.fr/doc/schartviafr.pdf

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Senghor to preliminarily address the following considerations and create a

formalized Local Cervical Cancer Preventive Services Policy Document and a

Kedougou Region Cervical Cancer Preventive Services Implementation Plan of

Action:

Program Governance

Program Financing

Resources Management

Workforce Development Planning

Health Information Systems

Service Delivery Guidelines

Public Health Information and Education

Strategic Partnerships and Available Resources

Global Health Education Planning The participation of the two resident physicians from the University of

Illinois – Chicago Department of Family Medicine in this global health

experience was a component of their participation in the Global Community

Health Track. The UIC Department of Family Medicine Global Community Health

Track is a unique opportunity for resident physicians to expand their

perspective on disparity. The course work takes an in-depth look, through a

longitudinal track, at issues surrounding community health with a balanced

focus on domestic and international considerations. There is offered

mentorship, support, and guidance in the broad discipline of global health

for the resident scholars to develop a cynosure (focus topic) project. This

longitudinal project spans our resident scholars' community medicine and

scholarship activities. Scholars, as well, have ample opportunity to develop

presentations, attend conferences, and experience global community health

through an international experience. The global health service experience

manifests through the GCHC model. The UIC team, as well, included a 4th year

medical student for this global health elective.

Cultural Orientation Planning The Peace Corps Volunteers prepared formal lectures and informal discussions

for the visiting UIC team orientation covering the following topics:

Cultural orientation,

Language learning,

Personal safety, and

Confronting the challenges of work in this environment.

Logistics Planning

Visiting Team Logistics

Transportation, Accommodations, Meals, Financing

A preliminary calendar and agenda for the four week visit by the UIC

team was put in place through discussions with all stakeholders.

Fundraising for the UIC team international travel was conducted at the

institution level through an email campaign soliciting donations.

Adequate funding was raised to support the resident physician’s and

student’s international travel and in-country lodging by fundraising at

the institution level, primarily through the UIC Department of Family

Medicine support and solicitation of individual donations. Faculty

team members were responsible for garnering the funds necessary to

support their own travel.

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International travel was planned by the visiting team stateside.

The previous site visits occurring previously allowed for the

identification of in-country travel and accommodations for the visiting

team. The Peace Corps Volunteers, in addition, were invaluable

resources for specific recommendations and planning. The Volunteers

assisted greatly with securing in-country lodging, travel, and

arranging orientation and administrative meetings.

Project Logistics

Calendar, Activities, Facilities, Materials Management, Purchasing,

Communication, Financing

Fundraising for project implementation in 2012 was provided by the

National Peace Corps Association. peacecare was awarded this grant

through the Global Community Project Competition as part of the 50th

Anniversary of Peace Corps Celebration in Washington, DC in September

2011.

Dr. Youssoupha Ndiaye and the Peace Corps Volunteers were responsible

for finalizing the logistical plans of the training seminar. This

planning included:

o Securing meeting space and ensuring availability of necessary

multimedia tools,

o Arranging lodging and meals for the visiting team and

participating health workers,

o Finalizing the training budget (this included advising peacecare

on all necessary costs and local expectations / norms of seminar

implementation),

o Selection and invitation of the appropriate participants, and

o Coordination of daily logistical concerns.

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Project Implementation January 2012 – February 2012

Orientation – Local Milieu The UIC team is very fortunate to have Peace Corps Volunteers and Peace Corps

Senegal Administration guide us on certain practical components of the manner

in which we should respect local norms and assimilate into the local culture.

The UIC team participated in several formal lectures and, in addition, the

Peace Corps Volunteers continued to offer informal advice and education on

these topics throughout our stay in country. The topics included the

following:

Local Culture and Norms

Personal Safety

Local Language

Local Health System

Project Components

Cervical Cancer Preventive Services

Executive Summary The cervical cancer component of the 2012 Peace Care trip entailed three

didactic sessions including two in VIA (visual inspection with acetic acid)

and one in cryotherapy, all held in Kedougou. Most participants in the VIA

didactics participated in at least one of four mass screenings held in

surrounding areas in the Saraya and Kedougou region. All didactic and clincal

sessions were overseen by Peacecare for quality control and assessment. The

first didactic session was a continuing education course in VIA for those

identified to train and supervise other in VIA. The second session, a VIA

refresher course for people trained in January, July and October of 2011.

Finally, a cryotherapy didactic course was held for trainers and physicians

to introduce to procedure and technique. Four trainers, all of whom were

Sage Femmes trained within the prior year, attended the continuing education

VIA course and the following day led the trainee refresher course, which

consisted of 19 trainees from the Kedougou and Saraya Districts. Clinical

mass screenings VIA were conducted at four separate sites in Bandafassi,

Ninefescha, Bambadji, and Toubacouta. A total of 13/19 trainees who had

attended the trainee refresher course, also attended one clinical screening.

Ninety-three women were screened, of which four were found to be positive and

two were equivocal. Two area physicians and two Sage Femme trainers attended

the cryotherapy didactic course. Barriers identified include retaining Sage

Femme trainers; only one of the four training Sage Femmes, attended the

original Peace Care training course in 2011. Three Sage Femmes trained in

the original training course were no longer in the Kedougou region. Future

directions include expanding VIA training to all Sage Femmes in the Kedougou

region, which includes solidifying the didactic curriculum, clarifying

certification, and clarifying transitions in training to within the health

system. We also intend to develop a clinical training curriculum for

performing cryotherapy and introduce cryotherapy to the Kedougou region in

2013.

Calendar Event listed with attendees (Name, Title, Date of Original Training)

Continuing Education for Trainers in VIA, Monday August 30th

18

Diouma Diallo (Madame Diop), CNM, Kedougou CS, October 2011

Ndella Diouf (Madame Diallo) CNM, Kedougou CS, July 2011

Mariama Toure (Madame Diarra), CNM, Saraya CS, July 2011

Fatou Traore (Madame Dembele), CNM, Saraya CS, January 2011

Trainee Refresher in VIA, Tuesday August 31st

Youssou Diene ICP, Medina Baffe, Saraya District, January 2011

Aissatou Sarr, CNM, Kedougou, Kedougou District, July 2011

Agathe Elvire Faye, CNM, Daloto, Saraya District, January 2011

Edouard Waly Diouf, ICP, Syllacounda, Kedougou District, October 2011

Mohammed Ibrahima Faty, ICP, Sabodala, Saraya District, October 2011

Diounkou Diop, ICP, Sainsoutou, Saraya District, July 2011

Ibrahima Sory Tounkara, ICP, Dimboli, Kedougou District

Aissatou Sarr, CNM, Kedougou, Kedougou District, July 2011

Ismaila Lindor Diop, ICP, Missira Dantila, Saraya District

Ndeye Penda Diop, CNM, Salemata, Salemata District, July 2011

Ige Sylviane Mbinby, CNM, Nenefesha, January 2011

Pena Adele Bangar, CNM, Kedougou, Kedougou District, October 2011

Mame Ngone Ndiaye, CNM, Dindefelo, Kedougou District, July 2011

Mariama Marena CNM, Diakateli, Salemata District, October 2011

Insa Gassama, ICP, Bambadji, Saraya District, January 2011

Ouilimata Sane, CNM, Khossanto, Saraya District, January 2011

Kaosso Diatta, ICP, Diakhaba, Saraya District, January 2011

Lucie Basse Sarr, CNM, Bandafassi, Kedougou District

Aissatou Sarr, CNM, Tomboronkoto, Kedougou District, July 2011

Diouma Diallo (Madame Diop), CNM, Kedougou CS, October 2011

Ndella Diouf (Madame Diallo) CNM, Kedougou CS, July 2011

Mariama Toure (Madame Diarra), CNM, Saraya CS, July 2011

Fatou Traore (Madame Dembele), CNM, Saraya CS, January 2011

Cryotherapy Didactics Sunday February 5th

Fatou Traore (Madame Dembele), CNM, Saraya

Mariama Toure (Madame Diarra), CNM, Saraya

Dr. Sidy Amar, Adjunct to Head MD of Kedougou District

Dr. Mamadouba Camara, Surgical Oncologist , Kedougou District

Objectives of Sessions Continuing Education in VIA for Trainers

o We brought trainers from January 2011 training to review VIA and

discuss experiences a didactic session. We assessed knowledge

by a 20 questions photo test (80% was required for passing). We

introduced a standardized slide set of instructional materials

that the trainers can use and adapt in future trainings. We

oversaw clinical sessions for quality assurance purposes and

confirmation that the trainers provided adequate supervision and

teaching to trainees.

Trainee Refresher in VIA

o We brought trainees from January, July and October 2011 training

sessions to review VIA and discuss experiences in a didactic

session. We assessed knowledge by a 20 question photo test (80%

was required for passing). We oversaw clinical sessions for

19

quality assurance purposes and monitoring of infection control

and appropriate technique.

Cryotherapy

o We introduced cryotherapy in regards to procedure, utility in low

resource settings, equipment necessary, side effects and

potential complications to trainers and physicians that are key

stakeholders in the region. We addressed physician concerns and

reviewed a de-centralized public health approach to VIA and

cryotherapy.

Clinical Screening Wednesday Feb 1nd

o Bandafassi

Trainers- Fatou Traore and Ndella Diouf

Edouard Diouf

Pena Adele Banga

Ibrahima Sory Tounkara

Mame Ngone Ndiaye

Ndeye Penda Diop

21 screened

0 positives

o Ninefescha

Trainer- Diouma Diallo (Madame Diop)

Mohammed Ibrahima Faty

Aissatou Sarr

Ige Sylviane Mbinby

Kaousso Diatta

Mariama Marena

34 screened

0 positives

Thursday Feb 2nd

o Bambadji

Trainer- Fatou Traore

Inga Gassama

31 screened

3 positives

2 equivical

Friday Feb 3rd

o Toubacouta

Trainers: Fatou Traore, Mariama Toure (Madame Diarra)

Ismaila Diop

Ouilimata Sane

7 screened

1 positive

Total # Screened 93

Total # Positive 4

Total # Equivocal 2

4.3% positive rate

20

Barriers Sustainability of Sage Femme trainers. Four of the five initially

trained trainers were not present for the refresher course. Two were

posted to other areas, one left the country and one was away on other

business.

Obtaining enough VIA positive to initiate and sustain successful

training of a cadre of cryo trainees

Lack of systematic approach of key personel to be trained in

cryotherapy.

Procurement of cryotherapy gas tank (either NO or CO2) within Senegal.

Plan of Action Education

o Continue to use WHO Comprehensive Cervical Cancer and IARC VIA

textbooks

o Standardize adapted VIA slide set for reference and/or use by

Sagge Femme Trainers

o Transition VIA trainings to within health system

All Sagge Femmes

ICPS that are interested and/or do not have Sagge Femme at

health post

o Determine certification/maintenance of certification standards in

both VIA and cryotherapy

Treatment of VIA positive and Cervical Cancer

o Introduction of Cryotherapy as a treatment in Kedougou Region

Secure NO or CO2 gas tanks within the country

Identify appropriate personnel to be trained

Determine best location for cryotherapy

o Introduction of palliative care for women with cervical cancer

unable to seek definitive treatment

Clinical Procedures

o Solidify referral procedure and treatment options available to

patients

o Improve documentation and referral to determine baseline

prevalence

Cervical Cancer Preventive Services Quality Improvement A Quality Improvement Process was led by the Resident Physicians, Nate

McLaughlin and Magda Piatek. The tool utilized was the Client Oriented

Provider Efficient (C.O.P.E) model developed by EngenderHealth. The C.O.P.E

model involves clinic/community leaders to:

Self assess problems and determine solutions with a point person for

each problem and a timeline for completion without involvement of

external parties,

Assess effectiveness at future visits, and

Allow for a continuous process of quality improvement.

Summary of Process

Topics

Days, including people in attendance

o Day 1: Introduction

What is quality and why it is important?

Introduction to COPE model

21

People In attendance:

o UIC QI Process Leaders: Magda Piatek and Nate

McLaughlin

o UIC Team Members: Amish Desai, Tracy Irwin,

Emily Godfrey, Andrew Dykens

o Peace Corps Team Members: Meera Sarathy, Leah

Moriarti, Ivy Renfro

o Cervical Cancer Preventive Services Leaders:

Fatou Traore, Madam Diop, Madam Diallo, Madam

Diara

o Day 2: Overview of Self assessment tools

Review of Assessment questionnaires (except for “Clients’

Right to Dignity, Comfort and Expression of Opinion” ; and

”Staff needs for Materials, Equipment and Infrastructure”)

People in attendance:

o Same as Day 1, in addition to LaRocha,

Marielle, Ivy, Lali, Magda Kupczyk

o Day 3: Self assessment tool with Celle (Saraya Resources Manager)

Review of Staff needs for Materials and Infrastructure with

Celle who is in charge of logistics at the Saraya Hospital

People in attendance

o Magda, Nate , Andrew, Leah, Celle, Sy (social

worker)

Summary of Responses

o See attached document for full responses

Problem Action Item(s) Point Person Timeline/Date for

completion

Not all staff

trained in VIA

and/or cervical

cancer education

1) Develop

training

curriculum for

cervical cancer

and VIA education

2) Train remaining

midwives

3) Train IPCs and

other health

workers in

cervical Ca edu

1) Master trainers

will develop

curriculum along

with Dr. Ndiaye

2) Master trainers

will train

remaining midwives

3) Master trainers

will train health

workers with

aforementioned

curricula

1) End of March

for development of

curriculum

2) Train Midwives

in May

3) Begin training

health workers in

April, finish by

July

Not all support

staff trained in

infection control

1) Bring

standardized

training to Saraya

2) Hold refresher

course for

providers

1) Dr. Ndiaye

2) Dr. Ndiaye and

health brigade

Volunteers will

check in with Dr.

Ndiaye monthly for

progress

No organized

community outreach

activities

1) Facilitate

village aunts to

institute

community outreach

1)

Matrones/village

aunts

1) After

completion of

trainings. July-

August

Pamphlets and

posters not

available for pt

education

1) Find posters

and or educational

material that

already exists at

ministry of health

level

1) Madam Diara 1) Check in with

her 1-2

times/month to

check on progress

22

Community outreach

activities are not

sufficient to

reach target

population

1)Reach larger

population by

implementing

Cervical Cancer

Awareness during

National Midwives

day

.

1)All midwives

present at today’s

meeting

1)May, after

National Midwife’s

Day

2)Feb, after

regional midwife

meeting

Not enough lights

in examination

rooms

1)LED lamps or

head lamps may be

utilized when

light supply is

not reliable

1)Dr. Ndiaye or

NGO for funding

1)Check by April

Next Steps, Plan of Action

o For issues related to VIA, see attached document

o QI moving forward

Follow up interventions for identified problems. Assess

success and failure of interventions developed at initial

QI meeting. Discuss in detail interventions that have

failed or have not been completed within a designated time

frame.

Cervical Cancer Information and Education To increase the success of a cervical cancer screening campaign, it is

critical to understand how Senegalese women receive and transmit health

information to the community, and how they react to this information. Our

study suggests that Senegalese women are, in general, interested in their

health, and in particular about cervical cancer, especially if appropriate,

clear and relevant information is provided in their own language.

Barriers for some women who are in the target age to be tested for cervical

cancer include cultural barriers, such as the way older woman who are no

longer having children value a test like this in terms of their future

health, or women who need their husbands’ permission before receiving a

consultation. Aside these barriers, women, when taught about cervical cancer

screening in the context of their fertility and future children will agree to

have a health worker screen them for cervical cancer.

Rationale

The collaborative work of peacecare in Senegal can have an incredible impact.

Women who have the chance to be screened for precancerous cells on their

cervix have a reduced chance of developing cancer in the future. If many

women aged 30-50 in Senegal were screened, the rate of cervical cancer in

Senegal could be significantly reduced. However, two factors may potentially

inhibit the success of PeaceCare’s efforts: (a) if women do not receive and

understand the information about cervical cancer, and where and when

screenings are held; and (b) any potentially existing barriers (beliefs,

norms, attitudes…) to getting screened. To this end, a Communications team

was brought in the Collaborative. Because there is little existing literature

(academic or otherwise) regarding the health communication practices of

communities in Senegal, before tackling (a) and (b) above, we deemed

necessary to conduct an exploratory study in situ collecting original data.

23

Focus groups and open-ended interview were chosen as the main methods of data

collection, along with observation and informal exchanges. The Instrument for

the focus groups is enclosed at the end. A list of the focus groups and

interviews conducted, along with the conclusions and next steps follow.

Calendar of activities: focus groups and interviews

Date Venue Participants

1/30/2012 Maternity ward, Kedougou

Hospital

2 skilled birth attendants & 1

midwife

1/31/2012 Training facility, Kedougou

Hospital

2 midwives trainers


Hospital

3 midwives trainees


Hospital

3 men nurses

2/1/2012 Health post, Bandafassi 3 women (some with babies)

2/1/2012 Health post, Bandafassi 3 women (mid-age to older)

2/1/2012 On the street, Bandafassi 8 men (mid-age to older)

2/2/2012 At Leah's place, Saraya 3 women (young to old)

2/2/2012 Saraya Radio, Saraya Radio Director

2/3/2012 At the village, Tubacouta 5 women (mid-age to old)

2/3/2012 At the village, Saraya 30 women (50% with babies, rest

older)

2/5/2012 Village Chief's home, Saraya Village Chief

2/7/2012 On the street, Saraya 7 older men- imam, village chief,

neighborhood chief

2/7/2012 Near the market, Saraya 4 women (3 older, 1 younger)

The number of participants represents an average, in most of the focus groups

people would come and go, so it was a challenge to keep the original group

constant. Moreover, most women are illiterate, not used to discuss these

aspects with a foreigner, and the local languages (except French) lack the

vocabulary to speak about specific health issues in detail–which altogether

made it difficult to gather specific information. All interviews/focus groups

were conducted with at least one Peace Corps volunteer, who acted as an

interpreter.

Conclusions

*Women are concerned about their health when the issue of cervical cancer is

clearly presented, its effects understood, and the importance of screening

clarified.

*Women learn about health issues through health talks in the village, the

radio, and word of mouth. With our instrument, we cannot gather data to

calibrate which one is more important, but they all seem to affect each

other.

*For younger women, framing the issue of cervical cancer as relevant to their

fertility and the future of their children is key. This should persuade most

women of child-bearing age.

*The challenges for a cervical cancer campaign would be to ensure people

understand that the screening using VIA is free or inexpensive, painless, and

critical for their health; similarly, that we will not draw blood, give an

injection, and that they will get treatment.

*Barriers to accept the screening test include that (a) older women do not

see the need for cervical cancer screening, because they are finished having

children, and because of their religious views, often seeing fate as more

important than science, and thus not understanding the importance of using

24

western medicine. Yet, the interview with the village chief and the focus

groups that included various chiefs suggested that these chiefs may have

convincing power over these older women. Finally, that (b) some women need

their husbands' permission to get screened, though there is no strong

indication that husbands would have a problem with it (in most cases).

Next steps/plan of action

1) Write an article summarizing the results of this exploratory study

including the design of a plan of action. Deadline (full paper) is 4/1/2012

for the AEJMC (association for the Education in Journalism and Mass

Communication) conference in Chicago in August 2012.

2) Present a brownbag at the Department of Communication at UIC.

3) Develop the manuscript into a publishable manuscript. Outlet yet TBD.

4) Design and produce the messages that will be broadcasted on the radio.

Design health talks on cervical cancer. Provide visual aids for these talks.

Work with Peace Corps volunteers.

5) Messaging can be both toward mass screenings and toward regular screenings

(during health care visits or visits just for cervical cancer) at health

posts (all of them in Saraya; in other regions less) or hospitals. However,

there are advantages to launching the campaign before a mass screening. If

so, the first step is to establish a calendar of events for the messages and

the health talks on the radio (and during village meetings), once the

calendar for future screenings is completely set. Additionally, design and

produce messages that encourage regular screenings within a regular visit or

just for cervical cancer screening.

6) Evaluate impact of the campaign after a screening (need input from Peace

Corps volunteers) and compare to baseline (non-exiting at the moment, so we

need this too from Peace Corps). If possible, evaluate the difference in

number of regular screenings between regular screenings after the campaign +

mass screening, and regular screenings after just the campaign–if the

campaigns end up being comparable.

7) Work toward next Collaborative.

Policy Development Through discussions during the training of trainers and with the Regional

Level health officials, guidelines were drafted for the implementation of

cervical cancer preventive services into the existing health structure.

Health Service Implementation

Identification of target Population

Public Health Education Outreach

Clinical Patient Management

o Referral and Management options

o Patient follow-up

Documentation

o Documentation of Results

o Health Center and District Level reports

Health Service Management

Identification of managerial body and delineation of oversight process

Health Service Financing

Patient Level Screening Costs

Financing for referral and management

Quality Control

Certification of Clinicians

25

Certification of Trainers

Confirmation of Results

In-service training / refresher course for trained health workers

Project Strategic Planning

Expansion of services and trainings for additional health workers

within Kedougou Health Region

Population Mass Screening Campaign

Information and Education Campaign

Projection of subsequent peacecare partnerships and additional service

implementation

Preliminary plan for expansion of services to neighboring districts and

regions.

Collaborative Strategic Planning Meetings were held with District Level and Regional Level health system

leadership over the course of several days.

26

Global Health Education Component Clinical Teaching

Most mornings the resident physicians and medical student had the opportunity

to participate in morning hospital rounds with the Saraya or Kedougou medical

teams. The time of year for this particular visit was a relatively slow

period for the medical service. Nonetheless, we were able to see several

interesting cases.

Formal Didactics

During the course of our visit our resident physicians and medical student

(as well as the entire team) participated in didactics exchange with local

health care staff.

Medical Education

The UIC team resident physicians and medical student received invaluable

experience throughout the planning and implementation stages through the

following:

Participated in the planning and implementation of a community based

participatory research project,

Prepared and delivered the Quality Improvement Process

Global Health Theory

During the course of the implementation phase, the UIC team also participated

in dynamic discussions concerning:

Health disparities,

Health systems utilization,

Global health ethics,

Health care financing,

Health infrastructure development, and

Development and international aid.

Personal Reflection

The UIC team residents and student kept a daily journal of their experiences.

In addition, they answered a series of questions about their Pre-trip and

Post-trip expectations and perceptions.

27

Project Evaluation January 2011 – Ongoing

Outcomes Evaluation Data collection tools based on WHO recommended forms were adapted to work

within the local health system. Through population based data collection the

outcomes evaluation of this project will give further clarification to

prevalence of cervical cancer and pre-cancers as well as screening rates and

referral data. These data will be gathered and evaluated quarterly and will

give the researchers insight into project impact and future direction.

Process Evaluation A complete report on project process evaluating this model of collaboration

is forthcoming. The process evaluation will consider viewpoints and feedback

from all involved stakeholders in regards to each of the following project

phases:

Partnership Formation

Assessment

Project Development

Project Implementation

Project Evaluation

Project Dissemination

28

Dissemination May 2011 – Ongoing

All outcomes and results in addition to recommendations for future

collaborative work will be published in report and presentation form.

Future Plans Upon concluding the UIC team visit to Senegal, formal meetings were conducted

with the Saraya District and Kedougou Region Health System administrators and

the Peace Corps Senegal leadership and contributing volunteers. peacecare

and the University of Illinois – Chicago anticipate continuing fruitful

collaboration in the years to come.

Kedougou Region, Senegal Health System Strategic Planning Regional Strategic Planning continues with the current plan of action (as

follows):

1 year plan Global Health Education

● Twice annual Global Community Health Collaborative Service Trips

initiated by UIC upon invitation of local health leadership and

community members and continued support of Peace Corps Senegal.

October 2012 and February 2013.

Collaborative Focus

● Kedougou Regional Level Cervical Cancer Preventive Services

Implementation

● Saraya District Workforce Development (Continuing Education)

○ Identified issues of health services level intervention include

Diabetes, Emergency triage and trauma response

○ Identified topic for CME targeted at reading ECG’s

Cervical Cancer Prevention

● Partnerships

○ Continue to strengthen the working relationship between the

Saraya District and Kedougou Region health services, Peace Corps

Senegal, and the University of Illinois – Chicago.

○ Strengthen collaborative relationship with the National Ministry

of Health and the National Cancer Program conducting work through

the Thies Regional Project.

○ Strengthen relationships and collaborate when possible and

mutually beneficial with similarly focused agencies and

nongovernmental organizations working or desiring to work in the

area.

● Regional Level Policy Development

○ Draft Kedougou Regional level Health Services Cervical Cancer

Preventive Services Policy Action Plan

● Workforce Development: VIA Screening

○ Complete clinical skills training for all remaining midwives and

nurses in the Kedougou Region

○ Conduct Clinical Skills Refresher Course

● Workforce Development: Cryotherapy

○ Conduct Clinical Skills Course

○ Conduct Clinical Skills Refresher Course

● Training Team Installation for Cervical Cancer Preventive Services

○ Conduct Clinical Training Skills Course

29

○ Conduct Advanced Training Skills Course

○ Conduct Instructional Design Course

○ Conduct Materials Development Workshop

● Regional VIA Prevalence Study Action Plan

○ 12 mass screenings over the course of the next year.

○ Region wide 10 day Mass screening campaign for prevalence

determination

● Information Systems

○ Define necessary materials and system for registration, clinical

assessment, referral, population level data collection, and case

tracking.

○ Produce formal materials for utilization and the health post,

center, hospital, and administrative levels

○ Distribute and implement information systems utilization.

● Quality Improvement Action Plan

○ Finalize QI report from February 2012 UIC team visit.

○ Submit quality recommendations to local leaders and team.

○ In Spring 2013 conduct follow-up QI assessment of interval

action.

● Information and Education Action Plan

○ Create I&E Curriculum

○ Train Lay Midwives and Village Aunts through implementing

curriculum

5-10 Trainings of 20 women each to be completed by August 2012.

○ Lay Midwives and Village Aunts to implement community outreach in

conjunction with Prevalence study to take place in October 2012.

3 year Plan Global Health Education




Collaborative Focus

● Kedougou Regional Level Cervical Cancer Preventive Services

Implementation Finalization.

● Scaling of Cervical Cancer Preventive Services to neighboring regions

in accordance to regional expressed priority and national health

priorities.

● Advancement of Secondary Kedougou Regional Level Policy Issue Action

Planning.


○ Continued community based participatory assessments for

identified and prioritization of additional issues for potential

health services level intervention and collaborative focus.

○ Twice annual collaborative Saraya District workforce continuing

education courses in locally selected topic areas.

○ Maintenance of certification and refresher courses for completed

continuing education courses.

Cervical Cancer Prevention

● Partnerships




30







area.

● Regional Level Policy Development

○ Kedougou Regional Cervical Cancer Preventive Services Policy

Finalization, Formalization, and Implementation.

● Workforce Development: Cervical Cancer Preventive Services

○ Continuing workforce development and maintenance of workforce

capacity and quality: VIA Screening

○ Continuing workforce development and maintenance of workforce

capacity and quality: Cryotherapy

○ Expansion of palliative care services within the region.

○ Training Team Installation for Cervical Cancer Preventive

Services through Master Trainer Qualification and Implementation

of Training Team Norms and Guidelines.

● Regional VIA Prevalence Study follow-up.

○ Conduct impact / outcomes evaluation at 3 years post prevalence

study.

● Information Systems

○ Evaluate information systems utilization, efficiency, and

effectiveness.

● Quality Improvement

○ Conduct yearly Quality Improvement process for evaluation of

action plan implementation and identification of next steps.

● Information and Education Action Plan

○ Maintenance of Information and Education Team capacity and

quality through collaboration with Lay Midwives and Village Aunts

○ Continue periodic community outreach for encouragement of system

utilization.

5 year Plan Global Health Education




Collaborative Focus

● Kedougou Regional Secondary Issue Policy and Services Implementation

Finalization.

● Scaling of Secondary Issue Policy and Service to neighboring regions in

accordance to regional expressed priority and national health

priorities.

● Advancement of Tertiary Kedougou Regional Level Policy Issue Action

Planning.


○ Continued community based participatory assessments for

identified and prioritization of additional issues for potential

health services level intervention and collaborative focus.

○ Twice annual collaborative Saraya District workforce continuing

education courses in locally selected topic areas.

31

○ Maintenance of certification and refresher courses for completed

continuing education courses.

● Partnerships










area.

● Continuing workforce development and maintenance of workforce capacity

and quality, information and education initiatives, information systems

reinforcement, quality improvement, and impact and process evaluation.

pcSN12 Trip Report

Documents

Transcript of pcSN12 Trip Report