Title: Accelerating Cervical Cancer Prevention in Rwanda: A Two-Year Impact Assessment of an Integrated Policy Intervention
Background
Cervical cancer remains a leading cause of cancer mortality among women in Rwanda. While HPV vaccination coverage is high, cervical cancer screening rates in 2023 were critically low at 18%, far below the WHO target of 70%. In response, Rwanda implemented a multi-component policy intervention.
Objective
This study aimed to evaluate the implementation fidelity, early impact, and operational lessons from the nationwide scale-up of an integrated policy package designed to increase cervical cancer screening coverage in Rwanda.
Methods
This study evaluates the implementation and early impact of a nationally scaled, integrated strategy combining: 1) Performance-Based Financing (PBF) for Community Health Workers (CHW) mobilization, 2) Inclusion of screening and treatment in the Community-Based Health Insurance (CBHI) scheme, and 3) Incorporation of screening targets into facility-level PBF indicators. We analyzed national program data and operational reports over a two-year implementation period (2024-late 2025).
Results
Preliminary data from the cervical cancer screening program, in 2025–2026 indicate that the total population of women eligible for cervical cancer screening is 1,637,541 and the national screening coverage increased from 18% in 2023 to 30% in 2025, a 67% relative increase. All seven districts, including Karongi, Rubavu, Nyabihu, Kicukiro, Bugesera, Ngoma, and Kirehe, which conducted structured campaigns with the strategies combining these three policy options, met or exceeded WHO-aligned screening target of screening 70% of the eligible women, with a coverage range of 70-80%. An estimated 21,771 women, representing 4.42% of the total screened women, received treatment for precancerous lesions, directly averting future cancer cases and saving diagnostic and treatment resources. Key enablers included the synergistic effect of demand creation, financial protection, and provider motivation, all underpinned by strong political commitment and the trusted CHW network.
Cervical cancer remains a leading cause of cancer mortality among women in Rwanda. While HPV vaccination coverage is high, cervical cancer screening rates in 2023 were critically low at 18%, far below the WHO target of 70%. In response, Rwanda implemented a multi-component policy intervention.
Objective
This study aimed to evaluate the implementation fidelity, early impact, and operational lessons from the nationwide scale-up of an integrated policy package designed to increase cervical cancer screening coverage in Rwanda.
Methods
This study evaluates the implementation and early impact of a nationally scaled, integrated strategy combining: 1) Performance-Based Financing (PBF) for Community Health Workers (CHW) mobilization, 2) Inclusion of screening and treatment in the Community-Based Health Insurance (CBHI) scheme, and 3) Incorporation of screening targets into facility-level PBF indicators. We analyzed national program data and operational reports over a two-year implementation period (2024-late 2025).
Results
Preliminary data from the cervical cancer screening program, in 2025–2026 indicate that the total population of women eligible for cervical cancer screening is 1,637,541 and the national screening coverage increased from 18% in 2023 to 30% in 2025, a 67% relative increase. All seven districts, including Karongi, Rubavu, Nyabihu, Kicukiro, Bugesera, Ngoma, and Kirehe, which conducted structured campaigns with the strategies combining these three policy options, met or exceeded WHO-aligned screening target of screening 70% of the eligible women, with a coverage range of 70-80%. An estimated 21,771 women, representing 4.42% of the total screened women, received treatment for precancerous lesions, directly averting future cancer cases and saving diagnostic and treatment resources. Key enablers included the synergistic effect of demand creation, financial protection, and provider motivation, all underpinned by strong political commitment and the trusted CHW network.
Conclusion
Rwanda's integrated policy approach has rapidly and significantly improved cervical cancer screening coverage. The model demonstrates that aligning community, financial, and health system incentives can overcome multiple barriers simultaneously. Sustained progress toward the 70% elimination target requires continued investment in digital health systems, targeted last-mile outreach, and human resource capacity. Rwanda's experience offers a replicable framework for accelerating cervical cancer prevention in similar resource-constrained settings.
D4H Cancer registry program manager