Boosting Cervical Cancer Prevention by Optimizing HPV Vaccination Demand in Ethiopia

A health care worker vaccinates an adolescent girl during an outreach in Derashe woreda, South Ethiopia. Photo: Girl Effect

Cervical cancer is a significant health problem in Ethiopia, where the 36.9 million women who are 15 years and older are at risk of developing it. Every year, 5,338 of the 7,445 women (72 percent) who are diagnosed with cervical cancer die from the disease, which is the second most-frequent cancer among women in Ethiopia. The Ministry of Health (MOH) has identified human papillomavirus (HPV) vaccination as a key to reducing cervical cancer.

In November, the MOH began a campaign to vaccinate 7.2 million 9–14-year-old girls against HPV. JSI and partner Girl Effect are implementing theDemand Creation on HPV to Increase Coverage in Ethiopia project in collaboration with the MOH, using a multi-pronged intervention strategy focusing on vaccine demand and supply.

Other partners, including UNICEF, CHAI, PATH are also supporting the MOH efforts to expand HPV vaccination. However, there is little evidence about which interventions are best to reach in- and out-of-school girls in Ethiopia. Our project is conducting a process evaluation to determine how demand interventions are reaching communities, which resonate, and if they are leading individuals and families to vaccinate against HPV. In November, as part of the MOH’s vaccination campaign, we conducted an intervention comprising the following elements to generate vaccine demand in Jigjiga and Derashe Districts:

• Raising awareness in schools: We educated students and teachers about the risks of cervical cancer and the protective benefits of the HPV vaccine. We also facilitated peer education among boys and girls and distributed factsheets and brochures to generate positive attitudes about vaccination.
• Reaching out-of-school girls: Before the campaign, we trained health extension workers to mobilize people, organize discussion sessions with community members, religious leaders and local civil society organizations, and also worked to educate people about vaccination through home visits. We also developed TV and radio announcements in local languages.
• Posting on social media: We used social media platforms to respond to cervical cancer-related concerns and answer girls’ questions and clarify misconceptions about the vaccine.

Project Reach

Our work contributed to the following results in Jigjiga and Derashe:

• 112,921 people were reached through community and school engagements, and an additional 114,600 people received our messages through social media campaigns.
• 8,214 9–14-year-old girls from eight schools and 13 kebeles (lowest administrative unit within Ethiopia) were vaccinated against HPV (over 100 percent of our target). Of those girls, 1,813 were out-of- school, who are hard to reach.
• We strengthened the health care workforce and schools’ ability to deliver key messages on cervical cancer prevention by training health extension workers and school facilitators.

In addition to the Demand Creation project, JSI has been providing technical support to the MOH at national and subnational levels in planning and developing guidelines and training materials, facilitating training, and monitoring the performance of HPV vaccination for the past year. This assistance is part of the preparation for switching HPV vaccination from two to a single dose and to a multi-age cohort vaccination for girls 9–14 years.

Our comprehensive approach to cervical cancer prevention is contributing substantially to Ethiopia’s effort to vaccinate over 7 million girls. We anticipate that MOH will use the results of our process evaluation to design future demand creation interventions for HPV vaccination and similar interventions to benefit adolescents.

In addressing the demand, supply, and system sides of vaccination, JSI is protecting girls and strengthening health care systems. As JSI continues this work, it will further reduce the prevalence of cervical cancer in Ethiopia.

For further information, contact the immunization project director at tewodros_alemayehu@et.jsi.com