# Health system barriers and facilitators influencing the uptake of cervical cancer screening among women in sub-Saharan Africa: systematic review and meta-synthesis

## TL;DR

This study reviews health system challenges and supports that affect cervical cancer screening uptake among women in sub-Saharan Africa.

## Contribution

The paper provides a systematic review and meta-synthesis of health system barriers and facilitators to cervical cancer screening in sub-Saharan Africa.

## Key findings

- Health workforce and service delivery barriers were the most significant obstacles to cervical cancer screening.
- Health information systems and provider communication were key facilitators for screening uptake.
- Limited qualitative attention was given to treatment and follow-up pathways in existing studies.

## Abstract

Cervical cancer ranks among the most frequent cancers and is the fourth leading cause of death among women globally. In Sub-Saharan Africa (SSA), it is the leading cause of cancer-related mortality for women. Although there are primary and secondary preventative interventions available, they are not widely used. This systematic review and meta-synthesis aimed to identify health system barriers and facilitators that influence the uptake of cervical cancer screening among women in SSA.

A comprehensive search was conducted across four electronic databases to identify English-language papers that highlighted health system barriers and facilitators that impact women in SS. As uptake of cervical cancer screening. Health system barriers and facilitators were extracted and categorized using the World Health Organization’s (WHO) Health Systems Framework: service delivery, health workforce, health information, medical products and technologies, financing, and leadership/governance. The review was carried out following the methodology for systematic reviews and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Seven qualitative studies were included in this review. The five categories under which these elements of the health system were categorized were the delivery of health services, the health workforce, health system financing, the health information system, and necessary medications and technology. The most frequent barriers preventing women from getting screened for cervical cancer were those related to the health workforce (lack of appropriate personnel trained in cervical cancer screening), and the health service delivery (lack of screening services in health facilities and long travel distance to screening centres) while the health information system (information from healthcare providers on screening) was identified as a key facilitator for cervical cancer screening.

This review concluded that key health system barriers, such as a lack of properly trained personnel in cervical cancer screening, screening centers, qualified health professionals, and a high cost of consultation, hindered women from accessing screening for cervical cancer in SSA. Resolving these highlighted health system limitations should be the primary focus of strategies to increase cervical screening adoption and usage in SSA. Our review found limited qualitative attention to the treatment and follow-up pathway; strengthening screening programs must include investments in referral systems, diagnostic capacity, and affordable treatment services.

The online version contains supplementary material available at 10.1186/s12913-026-14003-5.