Table 5.

Strengths and weaknesses of the healthcare system to support cervical cancer screening and treatment in Kenya.

Health system building block	Strength	weakness
Leadership and governance	Some form of governance structure exists, with either reproductive health or non-communicable disease coordinator taking charge of cervical cancer screening and treatment planning at county level and sitting in the County Health Management Team.	Data-driven decision making has not been adequately embraced at facility and county level.
Service delivery	Services, where available, are spread out in multiple delivery points.	Treatment of cervical pre-cancerous lesions is available in very few hospitals. Primary health care hospitals, which constitute the majority of hospitals, have in sufficient service availability and readiness.
Health system financing	At health centre and dispensary level (level 2 and 3), cervical cancer screening and treatment is offered free of charge.	Cervical cancer screening is not covered under the National health Insurance Fund (NHIF); funding for screening is relegated to the background and priority given to curative programs. While screening is free at primary care hospitals (dispensaries and health centres), service provision is limited by trained workforce and health products stock-outs in these hospitals since they lack planning and budgeting autonomy.
Health workforce	Screening and treatment services are provided by multiple cadres, including nurses, clinical officers, medical officers, and gynaecologists.	High attrition rate of HCWs trained on cervical cancer screening and treatment makes it impossible to sustain highly trained and motivated teams.
Medical products, vaccines, and technologies	Most hospitals had the bare minimum screening commodities; speculums, gloves, and acetic acid.	Screening commodities supply is not prioritized, making it erratic and prone to frequent stock-outs. For instance, cryotherapy gas is commonly unavailable even where the equipment is available, therefore making many screening hospitals unbale to offer treatment.
Health information systems	A comprehensive cancer screening register has been developed and disseminated. Aggregated cervical cancer screening and treatment data is collected using primary and summary registers at facility level and uploaded into the Kenya Health Information System (DHIS2).	The paper-based system is inefficient in ensuring proper follow-ups and linkage to further evaluation/treatment. This is especially critical when clients with positive tests are referred for treatment in a different hospital.