Table 5 Themes from interviews and focus groups

Limited availability of services at the primary care level

Lack of in-service training on cervical cancer and screening

Lack of infrastructure and supplies for screening and treatment

Lack of supportive services for cervical cancer patients

Women leapfrog primary care facilities to seek care from secondary facilities

Lack of supportive services for cervical cancer patients: family as main support

Weak referral networks

Few systems in place to follow up on referred patients

Ad hoc systems used to track patients

Barriers to initiating and continuing care

Patients’ low awareness and low perception of risk

Lack of finances and transport for follow up care/referrals

Patients’ low awareness and low perception of risk: Women do not think they are at risk if they are monogamous or not sexually active

Lack of finances and transport for follow up care/referrals

Stigma, which delays care initiation and seeking follow-up care

Societal barriers, namely rural women’s need for partner approval to seek care

Sources of delay in accessing appropriate treatment

Loss to follow-up after referrals, mainly due to financial barriers and long wait times for referral appointments

Misdiagnosis of cervical cancer

Lack of equipment, laboratory services, and beds

Long wait times for referral appointments

Patient-provider communication

Difficulty communicating due to shy and uncomfortable patients

Unclear or missing communication, particularly about diagnosis

Power imbalance and fear of repercussions in asking questions

Difficulty communicating due to language barriers

Recommendations for change

Expand and decentralize the provision of services: Increase training, availability of supplies, and equipment at local level

Expand health education and outreach for the general public and leaders

Expand and decentralize the provision of services: Increase service availability at local level

Expand health education and outreach, especially for rural community members