Cervical cancer: The illusion of global progress in elimination
OPINION
On paper, cervical cancer elimination is one of the most achievable public health goals of our time. The tools exist. The science is clear. The WHO 90–70–90 targets have created unprecedented political will. Yet, from the vantage point of communities in low- and middle-income countries (LMICs), and at the grassroots where effects of cervical cancer are seen and felt in the most raw form, progress remains fragile. Women continue to fall through the cracks due to deeply entrenched social, health-system, and socio-economic barriers.
Misinformation, fear, and stigma still deter women from screening. Health facilities face stock-outs, weak referral systems, and inconsistent provider capacity. Out-of-pocket costs, long distances to access care, and fragmented patient follow-ups lead to late diagnoses and avoidable deaths.
These realities are not theoretical – they are documented daily by CSO actors responding to women who arrive too late, or not at all, and often, people blame the woman for this. Yet one of the most persistent and under-acknowledged barriers is financial: the way funding for cervical cancer programmes is designed and delivered.
The Cost of Community Exclusion – An Honest Analysis of Our Failures
Across Africa, CSOs repeatedly witness a cycle of pilot traps; I call them “pilots without permanence”. Short-term projects that come packaged as the magic silver bullet, introduced as innovations, often create parallel systems in existing healthcare systems, with limited government and/or community ownership. Implemented at bullet speed to meet donor requirements and publication deadlines.
Then funding ends, trained staff are redeployed, commodities & supplies lapse, and communities are left confused or disillusioned. The result is fragmentation, duplication, and erosion of trust – especially along patient referral, follow-up, and treatment pathways.
Compounding this problem is a troubling practice: the performative inclusion of CSOs. Global donors invest in LMICs through large international organisations and require “local engagement of CSOs”, which is often reduced to generic letters of support. These letters are increasingly used as proxies for participation, rather than proof of meaningful involvement in programme design, governance, implementation, or resourcing.
A recent request for a letter of support, absent of any discussion of roles, budgets, or decision-making capacity, triggered me enough to write this article. By the way, this was not an isolated incident – in my 15 years of advocacy, I have written countless letters of support, and the next time I hear about any of these projects is when I spot the publication online. So much for "we will engage once awarded" or "the meaningful engagement" that is the magic word that won those grant proposals. No, this is not unique to me or us as CSOs; it is a reflection of a systemic issue in global health financing: CSOs and the communities we serve are treated as endorsers, not as system actors. Health interventions are something that happens for them (us), not something we co-create as equal partners!
Reality Check: What Communities Know that Grant Proposals Miss
Across Africa, ACHA member organisations work daily with women facing overlapping vulnerabilities: those living in rural and hard-to-reach areas, women in urban informal settlements, families operating in "under-a-dollar-a-day" low-income households, women living with chronic conditions or disabilities, and some even displaced by war, famine or conflict.
Based on the complexities of life, our women do not experience cervical cancer as a “vertical programme”. They experience it as part of a complex life context shaped by poverty, gender inequality, stigma, and weak systems.
Community-anchored approaches that have proven effective precisely because they address these realities are routinely under-budgeted or excluded from donor proposals, despite being critical to uptake, continuity of care, and long-term impact.
Enough Whining. What needs to be done Now?
Across the continent, governments are aligning with elimination targets and seeking high-impact, measurable wins in women’s health. The recently launched Cervical Cancer Elimination Action Plan in Kenya signals political will and national intent. This is a narrow but powerful window of opportunity to shift from short-term projects to policy-backed, scalable, and community-owned interventions.
Engaging communities should no longer be a tick-box grant proposal requirement; it must become the undeniable recipe for success.
I listened to Pracksidis Wandera speak during the launch, and she elucidated the barriers, burdens, struggles and realities of cervical cancer survivors so well through a tool we use in KILELE Health called StoryTellingforImpact, and I couldn't have been more proud of her and all the other mentees who have taken their raw lived experiences, coupled with our training, to shift it to a tool for policy advocacy and community engagement. But ask a funder to dedicate some resources to support this training, and the majority will say it is not in the workplan. Bottom line, soft skills, such as storytelling, are not fundable.
What people miss, yet it is glaringly evident, is that CSOs are uniquely positioned to bridge political commitment with lived realities: translating policy into demand, holding systems accountable, and sustaining engagement long after funding cycles end. But this can only happen if donor agencies and their grantees move from transactional engagement to true partnership.
Political Will as Africa’s Golden Opportunity: From Endorsement to Investment
Here is my two-cents' worth of insights. If cervical cancer elimination targets and momentum are to be sustained beyond 2030, donors must fundamentally rethink how they engage civil society actors. We must:
- Move beyond letters of support to letters of commitment. I believe it is not too far fetched to ask that the proposed CSOs submit that letter directly, or call them and verify their role in the grant, before awarding that grant. We do it when we hire staff, why not when we award millions of dollars to support work?
- Put frameworks in place to ring-fence funding meant for CSO-led functions that are essential yet often invisible: community engagement, champions training, demand generation, patient navigation, psychosocial support, survivor engagement, and community-led monitoring and accountability tools. What if donors put mechanisms in place to verify meaningful CSO engagement at design stage, as well as implementation stage - not through participant lists and group photos at events, but with clear roles, budgets, and governance responsibilities?
- Recognise CSOs as long-term system actors, not as peripheral implementers, symbolic stakeholders, or even token feel-good add-ons; but as a strategic safeguard for impact. Who picks the ball once the pilot ends, and what does the sustainability plan say about the ownership beyond the grant cycle?
The bottom-line as I see it: cervical cancer elimination will not be achieved through policy documents, pilots, group photos at conferences, boardroom discussions or press releases alone - even though these do help move the needle forward and we have seen it over time. For real change to happen, and for us to sustain this movement beyond 2030 to the 2130 goal of elimination, success will be achieved (or missed) at the community level. Where every man, woman and girl must see elimination as a personal call to action - or, mark my words, we will all fail miserably.
- This article was originally published by the author on her LinkedIn page. The headline has been changed, and the article has been edited for length and clarity. Read the full article on the author's LinkedIn page.
Misinformation, fear, and stigma still deter women from screening. Health facilities face stock-outs, weak referral systems, and inconsistent provider capacity. Out-of-pocket costs, long distances to access care, and fragmented patient follow-ups lead to late diagnoses and avoidable deaths.
These realities are not theoretical – they are documented daily by CSO actors responding to women who arrive too late, or not at all, and often, people blame the woman for this. Yet one of the most persistent and under-acknowledged barriers is financial: the way funding for cervical cancer programmes is designed and delivered.
The Cost of Community Exclusion – An Honest Analysis of Our Failures
Across Africa, CSOs repeatedly witness a cycle of pilot traps; I call them “pilots without permanence”. Short-term projects that come packaged as the magic silver bullet, introduced as innovations, often create parallel systems in existing healthcare systems, with limited government and/or community ownership. Implemented at bullet speed to meet donor requirements and publication deadlines.
Then funding ends, trained staff are redeployed, commodities & supplies lapse, and communities are left confused or disillusioned. The result is fragmentation, duplication, and erosion of trust – especially along patient referral, follow-up, and treatment pathways.
Compounding this problem is a troubling practice: the performative inclusion of CSOs. Global donors invest in LMICs through large international organisations and require “local engagement of CSOs”, which is often reduced to generic letters of support. These letters are increasingly used as proxies for participation, rather than proof of meaningful involvement in programme design, governance, implementation, or resourcing.
A recent request for a letter of support, absent of any discussion of roles, budgets, or decision-making capacity, triggered me enough to write this article. By the way, this was not an isolated incident – in my 15 years of advocacy, I have written countless letters of support, and the next time I hear about any of these projects is when I spot the publication online. So much for "we will engage once awarded" or "the meaningful engagement" that is the magic word that won those grant proposals. No, this is not unique to me or us as CSOs; it is a reflection of a systemic issue in global health financing: CSOs and the communities we serve are treated as endorsers, not as system actors. Health interventions are something that happens for them (us), not something we co-create as equal partners!
Reality Check: What Communities Know that Grant Proposals Miss
Across Africa, ACHA member organisations work daily with women facing overlapping vulnerabilities: those living in rural and hard-to-reach areas, women in urban informal settlements, families operating in "under-a-dollar-a-day" low-income households, women living with chronic conditions or disabilities, and some even displaced by war, famine or conflict.
Based on the complexities of life, our women do not experience cervical cancer as a “vertical programme”. They experience it as part of a complex life context shaped by poverty, gender inequality, stigma, and weak systems.
Community-anchored approaches that have proven effective precisely because they address these realities are routinely under-budgeted or excluded from donor proposals, despite being critical to uptake, continuity of care, and long-term impact.
Enough Whining. What needs to be done Now?
Across the continent, governments are aligning with elimination targets and seeking high-impact, measurable wins in women’s health. The recently launched Cervical Cancer Elimination Action Plan in Kenya signals political will and national intent. This is a narrow but powerful window of opportunity to shift from short-term projects to policy-backed, scalable, and community-owned interventions.
Engaging communities should no longer be a tick-box grant proposal requirement; it must become the undeniable recipe for success.
I listened to Pracksidis Wandera speak during the launch, and she elucidated the barriers, burdens, struggles and realities of cervical cancer survivors so well through a tool we use in KILELE Health called StoryTellingforImpact, and I couldn't have been more proud of her and all the other mentees who have taken their raw lived experiences, coupled with our training, to shift it to a tool for policy advocacy and community engagement. But ask a funder to dedicate some resources to support this training, and the majority will say it is not in the workplan. Bottom line, soft skills, such as storytelling, are not fundable.
What people miss, yet it is glaringly evident, is that CSOs are uniquely positioned to bridge political commitment with lived realities: translating policy into demand, holding systems accountable, and sustaining engagement long after funding cycles end. But this can only happen if donor agencies and their grantees move from transactional engagement to true partnership.
Political Will as Africa’s Golden Opportunity: From Endorsement to Investment
Here is my two-cents' worth of insights. If cervical cancer elimination targets and momentum are to be sustained beyond 2030, donors must fundamentally rethink how they engage civil society actors. We must:
- Move beyond letters of support to letters of commitment. I believe it is not too far fetched to ask that the proposed CSOs submit that letter directly, or call them and verify their role in the grant, before awarding that grant. We do it when we hire staff, why not when we award millions of dollars to support work?
- Put frameworks in place to ring-fence funding meant for CSO-led functions that are essential yet often invisible: community engagement, champions training, demand generation, patient navigation, psychosocial support, survivor engagement, and community-led monitoring and accountability tools. What if donors put mechanisms in place to verify meaningful CSO engagement at design stage, as well as implementation stage - not through participant lists and group photos at events, but with clear roles, budgets, and governance responsibilities?
- Recognise CSOs as long-term system actors, not as peripheral implementers, symbolic stakeholders, or even token feel-good add-ons; but as a strategic safeguard for impact. Who picks the ball once the pilot ends, and what does the sustainability plan say about the ownership beyond the grant cycle?
The bottom-line as I see it: cervical cancer elimination will not be achieved through policy documents, pilots, group photos at conferences, boardroom discussions or press releases alone - even though these do help move the needle forward and we have seen it over time. For real change to happen, and for us to sustain this movement beyond 2030 to the 2130 goal of elimination, success will be achieved (or missed) at the community level. Where every man, woman and girl must see elimination as a personal call to action - or, mark my words, we will all fail miserably.
- This article was originally published by the author on her LinkedIn page. The headline has been changed, and the article has been edited for length and clarity. Read the full article on the author's LinkedIn page.
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