Women's Health Initiative
Written by Dr. Doreen Ramogola-Masire, Consultant Obstetrician & Gynaecologist, Botswana UPenn Partnership

Cervical cancer is a relatively rare disease in the developed world thanks to organized screening and appropriate treatment of pre-cervical cancer lesions. The story in the developing world is different; cervical cancer is one of the commonest cancers found in women, and Botswana is no exception. There are around 500,000 new cases of cervical cancer worldwide each year. A staggering 300,000 women die from this preventable cancer yearly, and 80% of these deaths occur in the developing countries. The incidence rates of cervical cancer in various countries are therefore inversely correlated with the presence of proper screening and treatment of pre-cervical cancer lesions.

Cervical cancer is an AIDS defining illness. There is a growing body of evidence suggesting that HIV positive women develop the disease at least 10 years earlier, and it tends to run a more aggressive course. With prevalence rates of HIV as high as they are for Botswana, it is no surprise that this has become a new public health crisis. As part of a comprehensive preventative strategy, the need for cervical care in HIV positive women has become critical. For the screening programme to work optimally there has to be a properly functioning infrastructure.

The Botswana-UPenn Program, in collaboration with the Government of Botswana Ministry of Health, and funded by PEPFAR through BOTUSA, is setting up a Women’s Health Initiative to address the above concerns. The program will start with two pilot clinics; one in Francistown to serve the Northern region, and the second one in Gaborone catering to the the Southern region. These will provide one-stop shop service provision in terms of screening and treatment of pre-cervical cancer lesions. Once established, work will extend to training of health care personnel to enable roll-out of the program to strategic District Hospitals. Focusing on prevention rather than cure of invasive cervical cancer will not only save lives but will also free up valuable resources to deal with other health issues. This is a very challenging, but exciting undertaking, with great potential to benefit the women of Botswana!