Advancing the African Regional Framework for Cervical Cancer Elimination in Nigeria:
Enhancing Routine HPV Immunization and Defining the Next Steps
– The Professor O. K. Ogan Memorial Lecture
Cyril C. DIM
Department of Obstetrics and Gynaecology, College of Medicine, University of Nigeria/University of Nigeria Teaching
Hospital, Ituku-Ozalla, Enugu, Nigeria
PREAMBLE
Correspondence:
Professor Cyril Chukwudi DIM
Department of Obstetrics and
Gynaecology
College of Medicine, University
of Nigeria Ituku-Ozalla, Enugu,
Nigeria
cyril.dim@unn.edu.ng
+234 803 334 1960
I wish to express my profound gratitude to the President and Council of the Society of
Gynaecology and Obstetrics of Nigeria (SOGON) for granting me the honour of
delivering the 2024 Prof. K. O. Ogan Memorial Lecture at the 58th Annual General
Meeting and Scientific Conference in Uyo, Nigeria. As a staunch advocate for the
global campaign to eliminate cervical cancer, I was immediately drawn to this critical
area of women’s health when asked to select the lecture title. I am passionate about the
campaign, and I am happy that Nigeria is making progress. For the first time, the Ogan
Memorial Lecture will be dedicated to cervical cancer – a preventable gynaecologic
cancer. In this lecture, I will share my perspective on the way forward now that Nigeria
has started routine human papillomavirus (HPV) immunisation.
About Prof Okoronkwo Kesandu OGAN (6th January 1919 – 24th August
1980):1,2 Prof. O. K. Ogan hailed from Item, Bende LGA, Abia state He attended the
Methodist College Uzuakoli and Kings College Lagos where he distinguished himself
academically and in sports. He obtained a licentiate in Medicine from Yaba Medical
School in 1947 and trained as an Obstetrician and Gynaecologist (Ob-Gyn) in the UK
where he got his MRGOG (1958) and FRGOG (1971). He was the first Nigerian Ob-
Gyn and the first Nigerian lecturer/Consultant Ob-Gyn at UCH Ibadan (1959). He was
the first Professor and Chair of the Obstetrics and Gynaecology department at the
University of Nigeria (1967-75) and later served as Chairman of the Federal Civil
Service Commission (1975-79). According to Prof V. E. Egwuatu, the 5th Ogan
Memorial Lecturer,1 Prof O. K. Ogan was “a gentleman of impeccable manners and
amiable disposition that recognized and appreciated quality and excellence. He always
expressed his thoughts, views, and feelings unapologetically. He would always truly
and patiently listen to others. He abhors bribery and corruption, duplicity and
ostentation.” Prof. O. K. Ogan was described as a citizen of the world, an affectionate
husband and father, and a hardworking man who expressed unconditional love to his
Item community, friends, and everyone who came across him.
The SOGON 2024 Professor O. K. Ogan
Memorial Lecture
Dim CC. Advancing the African Regional Framework for Cervical Cancer Elimination in Nigeria
Tropical Journal of Obstetrics and Gynaecology (TJOG) Vol. 43 No. 4 (2025)/Published by Journalgurus
241
INTRODUCTION
Cervical cancer (CC) is a preventable malignant disease
of the uterine cervix. With the current global burden of
over 660,000 new cases and nearly 350,000 deaths per
year,3 it remains a global health concern. Painfully, about
90% of these preventable deaths occur in low-and-
middle-income countries (LMICs), especially in Sub-
Saharan Africa. As shown in Figure 1, there is a
comparatively high magnitude of CC incidence and
deaths in Sub-Saharan Africa. Concerning incidence and
mortality among women respectively, CC is the 4th and
3rd worldwide, 2nd and 1st in sub-Saharan Africa, but, in
Nigeria, its incidence and mortality among women are
second to breast cancer.3
Figure 1: Global incidence and mortality rates of cervical cancer3
Cervical cancer is an entirely HPV-attributable cancer
caused by sexually transmitted high-risk human
papillomavirus (hrHPV) types. This aetiological link
with hrHPV offers the opportunity for its primary
prevention with HPV vaccination. Furthermore, infection
with hrHPV alone does not translate to CC – often
cofactors such as immunocompromise status e.g., HIV
infection, tobacco use, etc are required to catalyse the
malignant transformation. Thus, as demonstrated in the
natural history of the disease in Figure 2, CC is a rare
consequence of HPV infection which takes several years
to manifest.4
The disease is usually preceded by a long course
of pre-malignant lesions (i.e., cervical intraepithelial
neoplasia) which offers an opportunity for secondary
prevention via CC screening including low-performance
tests such as visual inspection with acetic acid (VIA), Pap
test; and high-performance tests such as HPV DNA
testing.
Furthermore, the early-stage CC (FIGO stage ≤
IIA) is curable by radical surgery or radiotherapy thus
presenting another opportunity for secondary prevention
of the disease. However, the late stages of CC are
amenable to palliative care only (tertiary prevention).
Unfortunately, about 80% of CC cases in Nigeria, present
to hospitals at an advanced stage.5
Fig. 2: Natural history of HPV & relationship with cervical pre-
cancer & cancer4
Given the viral causation, natural course, and associated
effective prevention options outlined above, the World
Health Organization (WHO) developed a global
elimination prevention strategy with three major targets
(WHO-90-70-90) achievable by 2030.6
World Health Organization Cervical Cancer Global
Elimination Strategy
In November 2020, the WHO launched a global strategy
to accelerate the elimination of CC as a public health
concern. The strategy's goal is to reduce global CC
incidence to less than 4 per 100,000 women by the end of
the century.6 To be on the path to achieving this global
goal, each country should commit to achieving these
three CC prevention targets by 2030:6
i. Fully vaccinate 90% of girls by the age of 15 years
ii. Screen 70% of women using high-performance
tests twice – by 35 years and 45 years of age
iii. Treat 90% of women identified with either pre-
cancer and manage 90% of women identified with
invasive disease
Considering that 2030 is a few years away, countries are
accelerating their efforts toward achieving the set targets.
Therefore, to channel the African region which bears a
large burden of the CC toward the global CC elimination
strategy and its targets, the WHO Africa’s Regional
Committee for Africa developed a framework in July
2021.7
The African Region Framework for Implementing the
WHO-90-70-90 Strategy
The framework summarised the current ugly situation of
CC burden and prevention strategy implementation in
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Africa and presented the milestones for 2024, 2026, and
2028 under the following four key objectives.7
i. Introduce and scale up the HPV vaccine in routine
national immunization programmes.
ii. Increase coverage of and access to screening and
appropriate management of precancerous lesions.
iii. Increase coverage of, and access to diagnosis and
management of cervical cancer and palliative care
as needed.
iv. Strengthen capacity for monitoring and evaluation
of cervical cancer prevention and control for
performance tracking.
For each objective, the framework presents in a tabular
format, the baseline status in 2020, the target by 2030,
and the expected milestones by 2024, 2026, and 2028
(Annex 1). For example, by the end of 2024, the
framework expected that at least 20 member countries
would achieve 90% full HPV vaccination of girls 9 – 14
years; at least 10 member countries would achieve 25%
CC screening coverage for women aged 30–49 years
using the high-performance method, as well as 50% and
25% treatment rates for women identified with cervical
precancer and CC respectively. The question is, how
close were Nigeria and other African countries to
achieving the 2024 milestone?
Initiation of Routine HPV Immunization in Nigeria –
A Good First Step
HPV vaccination is critical to saving future generations
of girls from CC, thus, it is believed to be the most
effective of the three CC elimination interventions. The
effectiveness of HPV vaccination is supported by an
audit of the early effect of routine HPV immunisation
programme on CC and pre-cancer registrations in the
United Kingdom which concluded that the HPV
vaccination had successfully almost eliminated CC in
women born since Sept 1, 1995.8
On the 24th of October 2023, Nigeria took a bold
step toward eliminating CC by launching the HPV
vaccine into Nigeria’s Expanded Programme on
Immunization Schedule. The implementation was 2-
phased (Fig. 3).9
The HPV Vaccine Rollout aims to vaccinate 17
million girls by 2025. Despite the massive anti-vax
campaign that followed the introduction, Nigeria has
done well, according to available information—by
September 2024, over 12 million girls had been
vaccinated.10 SOGON can assist in the project evaluation
by surveying at least junior secondary school girls in
Nigeria.
Figure 3: Nigeria HPV Vaccine Rollout Plan – Phasing of the States9
DEFINING THE NEXT STEPS
With the nationwide rollout of routine HPV
immunisation for eligible girls, Nigeria must establish a
comprehensive roadmap to enhance the program and
expedite the implementation of the remaining two pillars
of the cervical cancer elimination strategy. These next
steps should include:
A) Enhancing Routine HPV Immunization
To accelerate the coverage of routine HPV immunisation,
every effort should be channelled towards building trust
regarding the safety and effectiveness of the vaccine.
These can be achieved through continued education of
parents and the girl child. The National Primary Health
Care Development Agency (NPHCDA) and its partners
are doing much in this area. Also, the efforts of
professional bodies like the Medical Women Association
of Nigeria (MWAN) and the Paediatric Association of
Nigeria (PAN) are helpful. SOGON is encouraged to
straighten its input in this respect. Education channels
should include women's groups (religious, community),
school clubs/societies, etc.
To sustain HPV vaccine education in the long
term, vaccine-preventable reproductive cancer education
should be incorporated into the junior secondary school
curriculum and General Studies (GS) of universities in
Nigeria. SOGON can champion these initiatives.
Also, to ensure the quality of the vaccine coverage
data published by Nigerian agencies & partners, SOGON
can be involved in the monitoring and evaluation (M &
E) of routine HPV immunization in Nigeria – funding
support is possible for that. Since professionals residing
in Nigeria often face challenges in accessing people in
power to offer their assistance to the government,
SOGON serves as an excellent platform for engaging
with the government and its agencies effectively. Outside
M & E activities, SOGON can develop implementation
research strategies that can improve the HPV vaccine
uptake in Nigeria.
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B) Self-Reliance in Vaccine Procurement and
Production
While we are building trust among community members
and expanding HPV immunisation coverage, self-
reliance in HPV vaccine procurement (and possibly
production) by Nigeria is very important for routine HPV
immunisation sustenance. As shown in Figure 4, though
the investments in HPV vaccination in LMICs rose
substantially in 2023, 86% were from the funders of
Gavi, the Vaccine Alliance while only 5% were self-
funded by LMICs.11 The obvious implication is that
without support, LMICs including Nigeria cannot
support routine HPV immunisation!
Figure 4: Cervical Cancer Prevention Funding in LMICs in 2023 11
C) Develop Routine Cervical Cancer screening
The second target of the WHO-90-70-90 calls for the
screening of 70% of women at least twice (35 & 45 years)
with high-performance screening methods, essentially
HPV DNA testing; though HPV mRNA testing was
recently approved.12 Countries are encouraged to
continue with quality-assured cytology while working to
transition to HPV testing. However, “existing
programmes using VIA as the primary screening test
should transition rapidly because of the inherent
challenges with quality assurance.13 While vaccination is
critical to saving future generations of girls from this
disease, screening and early treatment can save lives
today - both interventions are therefore critical for
realizing the promise of CC elimination, now and in the
future.11
Unfortunately, in Nigeria, there is no national
programme for CC screening as obtainable in the
developed world, we are not screening enough with
either the VIA or Pap test and the effort to transition to
high-performance tests is yet to take shape. To solve
these problems, multi-faceted approaches are necessary
including:
1. Screening for CC should be routine like HPV
immunisation: this means that out-of-pocket payment
should be removed to encourage a majority of healthy
women to use it. The challenging economic situation
forces citizens to prioritize their spending, and
unfortunately, cancer screening for asymptomatic
women ranks low on their list of priorities. This has
exacerbated the prevalence of the "Not-My-Potion
syndrome,"14 where individuals underestimate their
risk of developing cancer. So, CC screening should be
free through direct government sponsorship and
funding by all existing health insurance.
Unfortunately, the 2023 data suggests that though
investments in HPV vaccination increased
substantially, that for screening and pre-cancer
treatment fell, creating a worrisome disproportionate
response to CC prevention efforts.11
Health is in the concurrent legislative list of
Nigeria so, all tiers of government (i.e., federal, state,
and local) must commit jointly and independently to
the global call to eliminate cervical cancer. Budgeted
planning for CC prevention by all tiers of government
is encouraged – SOGON has a role in advocating for
this to the government!
2. Strengthening the Primary health care system to offer
CC screening: This is the only way CC screening can
reach the communities effectively. Considering
Nigeria’s weak health system and poor health
financing system among other health sector
challenges,15 the government should motivate the
political will to effect change, especially at the PHCs.
There should be a unity of purpose between the local
government and State government agencies including
the state’s Ministry of Health and Primary Health
Care Development Agency to avoid retrogressive
inter-agency turf wars.
Large-scale training of medical doctors and
nurses in basic CC screening skills with appropriate
monitoring/evaluation is critical to the success of the
PHC strengthening. SOGON National and Chapters
have roles in these areas. Health outreaches which we
often organise are good but their long-term impact on
public health may be limited without sustainable
planning. Medical school curriculum should include
cervical and breast cancer screening knowledge &
skills as a must-know. Likewise, obstetrics and
gynaecology residency curricula should ensure that
every trainee gains proficiency in advanced CC
screening and pre-invasive cervical disease treatment
before graduation.
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Very importantly, the strengthening of PHCs
has a lot to do with paying the health staff a living
wage. Their salary structure should be the Federal
government scale (with additional rural allowance as
appropriate) – this is the only way they can be
retained as long as the ongoing emigration of medical
and health workers (Japa syndrome) will allow.
3. There should be a registry of CC screening and a
system of inviting eligible women for CC screening
and re-screening - the telecommunication companies
in Nigeria can be mobilised to assist in this respect.
D) Scaling up Pre-cancer Treatment
Pre-cancer treatment goes with CC screening thus, the
training and scaling up of the CC screening at the PHCs
must include treatment of pre-cancerous cervical lesions
– screening without the opportunity for treatment of
screen-positive individuals is unethical. I recommend the
see-and-treat and see-triage-treat approaches followed by
ablative treatment in a single-visit approach for the
general population. There should be a clear and
functional system for referral and linkage for women
ineligible for ablative treatment for further evaluation.
In the screen-and-treat approach, the decision to
treat is based on a positive primary screening test only
while in the “screen, triage and treat approach”, the
decision to treat is based on a positive primary screening
test followed by a positive second test (i.e., “triage” test),
with or without histologically confirmed diagnosis.13 The
triage tests include high-risk HPV DNA partial
genotyping, cytology, dual-stain cytology, VIA and
colposcopy (with or without biopsy for histological
diagnosis). Details of the algorithms in the two
approaches are shown in Figure 5. The “screen, triage and
treat approach” is believed to give a more precise
diagnosis thus reducing the overtreatment inherent in the
screen-and-treat approach and is specifically
recommended for the women living with HIV (WLHIV).
Figure 5: Recommended Algorithm for CC Screening and Treatment13
As part of defining the next steps, Nigeria should adopt
algorithms 2 (Figure 6) and 4 (Figure 7) and ablative
treatment (for eligible women) in a single-visit approach
at the PHCs. Both algorithms involve high-performance
screening and are easy to set up and operate. The scale-
up of PHCs' human and infrastructural resources required
for the effective implementation of these algorithms is
achievable if Local and State governments have the
political will.
Figure 6: Algorithm 2 - Primary HPV DNA Test Screening (See & Treat
Approach)13
Where to start is the PHCs and other health facilities with
GeneXpert Instrument (or TB-LAMP) for TB evaluation
as we did during the COVID-19 pandemic. The PHCs
within each state will be grouped and linked to one or two
referrals secondary or tertiary health facilities for the
management of screen-positive women ineligible for
ablative treatment or those with suspicious lesions.
SOGON as a body has the capacity to assist such
program planning, staff training, volunteer services, as
well as program monitoring and evaluation.
E) Scaling up of cervical cancer treatment
The WHO-90-70-90 strategy hopes to treat 90% of
cervical cancer as appropriate depending on the stage.
Early-stage CC is curable by radical surgery or
radiotherapy while the advanced stages can only be
palliated - unfortunately, most CC cases in Nigeria and
LMICs present late. In a study of 351 patients in a
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teaching hospital in Kumasi, Ghana,16 334 (95%)
presented late, and the most common barrier was
financial constraints (50%) – each increasing level of
income was associated with a 51% decrease in late-stage
presentation. Interestingly, of all late presenters, 99.1%
never had a Pap test.
Figure 7: Algorithm 4 - HPV DNA Screening & HPV 16/18 Triage
(Screen, Triage & Treat Approach)13
Therefore, because of the perennial poor resources, the
focus of CC elimination in Nigeria and LMICs should
be HPV vaccination and CC screening & pre-cancer
treatment. Nevertheless, an effective routine CC
screening system will assist in the early identification of
cervical cancer with the opportunity for cure.
Unfortunately, there is an existing sub-optimal
surgical capacity and radiotherapy services for CC
treatment in Nigeria and LMICs. Gynaecologists with the
skills for quality-assured radical pelvic surgeries for early
CC disease are limited which is a big challenge to
achieving the milestones for this target. Current efforts at
narrowing the surgical capacity gap include:
i. The National Postgraduate Medical College of Nigeria
and West African College of Surgeons’ subspecialty
training programs in Gynaecologic oncology. The
programs are just starting so; it is at best a medium to
long-term intervention.
ii. International Gynecologic Cancer Society (IGCS)
Global Gynecologic Oncology Fellowship Program – a
part of IGCS Mentorship and Training.17 This is a
comprehensive two-year education and training
program designed for regions around the world that do
not currently have formal training in gynaecologic
oncology. Nigeria has four sites – Enugu, Lagos,
Ibadan, & Kaduna. About 52 fellows have been
graduated since 2019 – none from Nigeria. So, for the
purpose of accelerating CC Elimination in Nigeria, I
consider this programme as a medium to long-term
term intervention.
iii. Observership programs in Gynae-oncology in high-
income countries: the lack of hands-on surgical
activities during such programs is an obvious limitation
of such training.
iv. Distance training using online lectures and video
demonstrations such as the Gynecologic Didactic
Training Lecture Series facilitated by Memorial Sloan
Kettering Cancer Center through the African Research
Group on Oncology (ARGO) hosted at the Obafemi
Awolowo University, Ile-Ife, Nigeria.
The above approaches merit further development
and expansion. However, they alone will not sufficiently
accelerate the reduction of the suboptimal surgical
capacity gap required to achieve a 50% treatment rate for
women diagnosed with early cervical cancer by 2018.
Therefore, a stopgap measure is urgently needed.
Focused Surgical Intensification Program
This is an innovative and competency-based program
developed by a group of African-American Gynae-
oncologists in Zambia after trying out several live
demonstration projects in other under-served
environments).18 The program is focused because
experienced gynaecologic oncologists train general
gynaecologists to perform a single surgical procedure
i.e., radical abdominal hysterectomy, bilateral pelvic
lymphadenectomy. It is surgical intensification because it
uses high-volume repetition (several cases/day) of the
procedure over a short time interval. So, it can serve as
the stopgap intervention needed to achieve the African
regional milestone in 2028.
The African-American Gynae-oncologist group
or other willing groups need invitation which is where
SOGON and willing tertiary centers should come in to
facilitate the program. It will work well if we can develop
routine CC screening to ensure a high throughput of early
CC cases for the focused training. The existing Cancer
Health Fund (CHF) program of the Federal Ministry of
Health can assist in funding the program.
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Further Necessary Interventions To Improve
Advanced Cervical Cancer Treatment
More regional radiotherapy centers need to be equipped,
and the CHF program already developed by the Federal
government should be expanded to make it more
accessible. Private partnerships' involvement in
radiotherapy services at our public hospitals should be
streamlined to reduce costs and improve patients’
accessibility. Histopathology services of secondary and
tertiary health facilities should be strengthened to
facilitate the see-triage and treat approach and CC
diagnosis and treatment.
To avoid civil service bureaucracy, the CC
elimination strategy at all tiers of government should be
managed as a project within an agency or action
committee coordinated by medical experts in CC
prevention who should report directly to the chief
executive. The Cervical Cancer Elimination
Agency/Action Committee will align with the African
Region Framework, guided by the established milestones
for each priority intervention. The committee’s activities
will include robust monitoring and evaluation processes
to ensure progress and accountability.
CONCLUSION
The cervical cancer burden in Nigeria is high and its
elimination is achievable. The routine nationwide HPV
immunization already established is the necessary first
step. However, to achieve the African Regional
Framework milestones and WHO 90-70-90 targets in
Nigeria, the next steps should include enhancing routine
HPV immunization, achieving self-reliance in vaccine
procurement and production, developing routine cervical
cancer screening, and scaling up cervical pre-cancer and
cancer treatment.
If Prof. O. K. Ogan, the first Nigerian Ob-Gyn and
founding President of SOGON, were alive today, he
would undoubtedly urge the President, Council, and
members of SOGON to collaborate with the government
and other key stakeholders to implement these well-
crafted strategies aimed at accelerating the elimination of
cervical cancer in Nigeria.
Declaration
The 2024 Professor O. K. Ogan memorial lecture was
delivered at the 54th Annual General Meeting and
Scientific Conference of the Society of Gynaecology and
Obstetrics of Nigeria (SOGON) in Uyo, on 27th
November 2024
REFERENCES
1. Egwuatu VE. Reflections on Maternal Mortality in Nigeria
- The Fifth Okoronkwo Kesandu Ogan Memorial Oration.
Trop J Obstet Gynaecol. 2003; 20(1): 76-82
2. Biographical Legacy & Research Foundation (BLERF).
Who’s Who in Nigeria, 186 -: OGAN, (Dr) Okoronkwo
Kesandu. Available from:
https://blerf.org/index.php/biography/ogan-dr-okoronkwo-
kesandu. Accessed [05 November 2024]
3. Ferlay J, Ervik M, Lam F, Laversanne M, Colombet M,
Mery L, et al. Global Cancer Observatory: Cancer Today
(version 1.1). Lyon, France: International Agency for
Research on Cancer; 2024. Available from:
https://gco.iarc.who.int/today. Accessed [05 November
2024]
4. Schiffman M, Castle PE. The promise of global cervical
cancer prevention. N Engl J Med. 2005; 353(20): 2101-4
5. Ola IO, Okunowo AA, Habeebu MY, Miao Jonasson J.
Clinical and non-clinical determinants of cervical cancer
mortality: A retrospective cohort study in Lagos, Nigeria.
Front Oncol. 2023; 13: 1105649
6. World Health Organization (WHO). Accelerating the
elimination of cervical cancer as a global public health
problem. Geneva: WHO; 2020
7. WHO Regional Office for Africa. Framework for the
implementation of the Global Strategy to accelerate the
elimination of cervical cancer as a public health problem in
the WHO African Region. Brazzaville: WHO Regional
Office for Africa; 2021
8. Falcaro M, Castanon A, Ndlela B, Checchi M, Soldan K,
Lopez-Bernal J, et al. The effects of the national HPV
vaccination programme in England, UK, on cervical cancer
and grade 3 cervical intraepithelial neoplasia incidence: a
register-based observational study. Lancet. 2021;
398(10316): 2084-92
9. National Primary Health Care Development Agency
(NPHCDA). HPV Vaccine Key Messages. Available from:
https://nphcda.gov.ng. Accessed [05 November 2024]
10. United Nations Children's Fund (UNICEF). Generations
unite in Nigeria’s HPV vaccine campaign. Available from:
https://www.unicef.org/stories/generations-unite-nigerias-
hpv-vaccine-campaign. Accessed [07 November 2024]
11. Together for Health. Investing in Global Cervical Cancer
Prevention: Resources for Low-Income and Lower Middle-
Income Countries in 2023. November 2024. Available
from: https://togetherforhealth.org/wp-
content/uploads/funding_report_2023_Nov_17_web.pdf.
Accessed [07 November 2024]
12. WHO. Guideline for screening and treatment of cervical
pre-cancer lesions for cervical cancer prevention: use of
dual-stain cytology to triage women after a positive test for
HPV. Geneva: WHO; 2024
13. WHO. Guideline for screening and treatment of cervical
pre-cancer lesions for cervical cancer prevention. Geneva:
WHO; 2021
14. Dim CC. “Not My Portion” Syndrome: The Bane of
Cervical Cancer Prevention and Women’s Health
Promotion in Nigeria. 152nd Inaugural Lecture: University
of Nigeria; 2019 June 20. Nsukka, Nigeria: University of
Nigeria Press Ltd; 2019. ISBN:978-978-49804-8-7
Dim CC. Advancing the African Regional Framework for Cervical Cancer Elimination in Nigeria
Tropical Journal of Obstetrics and Gynaecology (TJOG) Vol. 43 No. 4 (2025)/Published by Journalgurus
247
15. Omoleke II, Taleat BA. Contemporary issues and
challenges of health sector in Nigeria. Research Journal of
Health Sciences. 2017; 5(4): 210-6
16. Appiah-Kubi A, Konney TO, Amo-Antwi K, et al. Factors
associated with late-stage presentation of cervical cancer in
Ghana. Ghana Med J. 2022; 56(2): 86-94
17. International Gynecologic Cancer Society (IGCS). Global
Gynecologic Oncology Fellowship Program. Available
from: https://igcs.org/mentorship-and-training/global-
curriculum. Accessed [08 November 2024]
18. Hicks ML, Mwanahamuntu M, Butler R, Bloomfield H,
Mutombo A, Anaclet MM, et al. The evolution of a novel
approach to building surgical capacity for cervical cancer in
Africa. Ecancermedicalscience. 2022; 16: 1469
Dim CC. Advancing the African Regional Framework for Cervical Cancer Elimination in Nigeria
Tropical Journal of Obstetrics and Gynaecology (TJOG) Vol. 43 No. 4 (2025)/Published by Journalgurus
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Annexe 1: Summary of Objectives, Targets, & Milestones of African Region Framework 7
Objectives
Current status/baseline
(2020)
Targets by 2030
Milestones
By 2024
By 2028
To introduce
and scale up
HPV vaccine
in routine
national
immunization
schedules
33% of Member
States have introduced
HPV vaccine
Three Member States
(Ethiopia, Mauritius and
Rwanda) have HPV
coverage of 80% and
above for girls 15–year
old in 2019.
90% of girls are
fully vaccinated
with the HPV
vaccine by the age
of 15 years in all 47
Member States
90% full HPV
vaccination of girls by
the age of 15 years
achieved in at least 20
Member States
90% full HPV
vaccination of
girls by the age
of 15 years
achieved in at
least 40
Member
To increase
coverage of,
and access to
screening and
appropriate
management
of
precancerous
lesions
Data not available.
Conduct regional
survey
70% of women are
screened with a
high-performance
test by the ages of
35 and 45 years in
all 47 Member
States
25% cervical cancer
screening coverage using
high-performance tests,
for women aged 30-49
years achieved in at least
10 countries
50% cervical
cancer
screening
coverage using
high-
performance
tests, for
women aged
30-49 years
achieved in at
least 30
Member States
To increase
coverage of,
and access to
diagnosis and
management
of cervical
cancer and
palliative care
as needed
Data not available.
Conduct regional
survey
90% of women
identified with
cervical
precancerous
lesions receive
treatment in all 47
Member States
50% treatment rate for
women identified with
cervical precancer
achieved in at least 10
Member States
60% treatment
rate for women
identified with
cervical pre-
cancer
achieved in at
least 30
Member States
Data not available.
Conduct regional
survey
90% of women
identified with
cervical cancer
receive treatment in
all 47 Member
States
25% treatment rate for
women identified with
cervical cancer achieved
in at least 10 countries
50% treatment
rate for women
identified with
cervical cancer
achieved in at
least 30
Member
To strengthen
capacity for
monitoring
and evaluation
and the health
management
information
system
(HMIS) for
cervical
cancer
prevention
and control
for easy
global,
regional and
national target
tracking
Data not available.
Conduct regional
survey
Data collection and
HMIS for cervical
cancer prevention
and control
strengthened,
ensuring regular
monitoring and
evaluation of
activities under the
framework
Monitoring and
performance indicators
identified, and quality
control mechanisms
defined for planned
interventions in all 47
countries.
Challenges and lessons
learnt documented and
utilized for decision-
making in all Member
States.
Capacity to report and
use cervical cancer data
increased from 10% in
2019 to 50% in all
countries
Strong data
systems for
cervical cancer
available at the
national and
regional levels