CANCER TRAINING AND EDUCATION
82 CANCER CONTROL 2015
teaching and mentoring; curriculum development for preservice
training; learning placements in the region or United
Kingdom; distance mentoring and coaching and e-learning;
and development of protocols, policies and systems at
department and institution level. They may emphasize
clinical, professional, leadership or other skills.
Partnership project objectives are based on an
institutional needs assessment, a shared vision, joint
ownership and a clear understanding of each other's
institutional structures and context. In-service training is
designed to fill observed skills gaps, and, while broadly
aligned with both national priorities and institutional needs,
partnerships are often strong advocates for areas of work
not prioritized by existing frameworks. For example, a health
partnership might work to address gaps in an existing course
or in cases where an institution may be unable to attract,
employ or pay the appropriate cadre needed to provide the
health services required by the population, the health
partnership works to upskill other health workers or lay
people (more positively expressed as task shifting).
Despite their diversity, health partnerships have certain
shared characteristics - peer-to-peer professional
relationships, a long-term perspective and an adaptable
nature - that enable them to achieve results that other
development interventions often find difficult.
Personal and professional relationships between health
workers are at the heart of health partnerships and are
crucial to their success and to the sustainability of what they
achieve. Whether it is doctor-to-doctor, midwife-to-midwife
or administrator-to-administrator, those working within
health partnerships have direct insight into the day-to-day
challenges faced by their counterparts and are in an
excellent position to tackle challenges and to work inside
existing systems for improved harmonization and alignment
The most commonly cited changes reported by LMIC
partners are improved knowledge, skills and practice of staff.
Being involved in improvements to service delivery and
seeing the changes this resulted in, also bolsters staff morale
and confidence. Trainees frequently report that their
personal and professional development benefits at an
individual level, empowering them to challenge and change
Health-care professionals from the high-income partner
volunteer their technical expertise to act as advisers,
academic coordinators, mentors and trainers. During an
approach SVA). SVA avoids the woman having to return for
treatment. 1-2% of women screened might need to have
treatment with the thermocoagulator under local
anaesthetic which can successfully treat CIN (95% cure
rates). This is safe, effective, intervention and requires
minimal health professional training unlike other methods.
The planned pathway (Figure 3) involves community
screening of 1,000 women/camp over five days.
Approximately 50 women will screen positive and need a
colposcopy and 10-20 may require treatment which may
potentially prevent cervical cancer development.
What we have done so far? Over the last seven years we
have carried out hands-on colposcopy workshops, exchange
visits, nurse training, screening camps, training for
pathologists and biomedical scientists and quality
assurance. There are fully operational colposcopy clinics in
the hospitals we work with in Nepal.
Why is our partnership different to other similar
cervical cancer prevention projects? We provide a
"western" style model of care with: 1) effective treatment
with the thermocoagulator superior to cryotherapy
(freezing the cervix) used by other centres; 2) a focus on
colposcopy as an additional step in the pathway so to avoid
unnecessary treatment of women and 3) task-shifting
colposcopy roles from doctors to nurses.
What we value? 1) high quality training /education for
colposcopists, pathologists and laboratory staff; 2) quality
assurance and a focus on outcomes of the overall
programme and 3) research as integral part of project
Challenges: The main challenge in cervical cancer
screening in any setting is to screen large populations with
an effective test and successfully treat pre-invasive disease
with minimal harm. In a low-resource setting this can be
challenging especially in Nepal which is largely rural.
Therefore the delivery of this strategy relies on
governmental support, committed teams and close working
between the all the stakeholders such as women's groups,
community leaders and screening groups.
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