Background
If implemented effectively, programs designed to meet the World Health Organisation (WHO) cervical cancer elimination targets will prevent 40% of new cervical cancer cases, or 5 million avoidable deaths by 2050. To achieve this, robust cancer control policy will be essential for governments and their partners to translate commitments into action. More specifically, cervical cancer elimination planning will be necessary for countries to implement and scale programs, health service workforce, and healthcare system infrastructure. While political support for the elimination agenda is strong in many nations, it is currently unknown whether published cervical cancer elimination and control plans adequately address necessary activity.
 
Objectives
This study aimed to analyse all current published global policy, strategy and plans associated with the control and elimination of cervical cancer to describe: a) policy scope and governance, b) alignment with WHO cervical cancer elimination and health system strengthening guidance literature, and c) goals, financing, and implementation facilitators.
 
Methods
Published policies were identified via the ICCP Portal, WHO NCD document repository, government websites, and PubMed. Inclusion criteria comprised current (or recently expired) national or regional policy focused on cervical cancer control. Clinical guidelines, national cancer control and NCD plans were excluded. Policies in languages other than English were translated using AI software DeepL. A custom cervical cancer elimination policy tool (CCEPT) was developed and used to guide analysis. Policy data were extracted using Covidence, then exported into Microsoft Excel for analysis. Descriptive statistics comprising frequency and proportion were employed to quantitatively summarise presence of information coded within policies aligning with CCEPT items via assigned scores based on item presence. Scoring was aggregated both across and within policies by CCEPT items.
 
Results
A total of 23 cervical cancer elimination and control policies were identified and included for analysis (17 national, 6 regional) located across all WHO regions. Analysis identified wide variation across policies regarding documentation of policy scope, leadership and governance planning, and alignment with WHO cervical cancer elimination and health system strengthening guidance material. Specifically, programs or goals associated with access to treatment, palliative care, and survivorship were less frequently documented compared with prevention (HPV vaccination) and cervical screening. Similarly, reporting of strategies to support strengthening of health workforce, availability of medicines and research were less frequently described. Overall, most policies had higher scores associated with key CCEPT item domains and goals, however, these scores reduced when assessment of provision of essential program details and implementation facilitators was included.
 
Conclusions/Implications for practice or policy
Comprehensive description of cervical cancer elimination policy, mapped against WHO guidance literature is essential to understand the current policy landscape. Our findings suggest that current policy may lack focus on programs associated with scaling treatment and palliative care,  strengthening health workforce, in addition to provision of adequate detail regarding implementation and financing. While acknowledging this is a rapidly evolving area, with contextual factors likewise relevant to understanding decisions reflected in plans, findings from this study will support development of targeted and robust cervical cancer elimination policy recommendations.