Evaluation of the cervical cancer surveillance system in Kigali City, Rwanda: a descriptive cross-sectional study, January 2023–June 2025

Cervical cancer is a disease that begins with a virus called human papillomavirus, or HPV. This virus is common, but for most people, the body clears it on its own. For some women, however, the virus stays in the body for a long time and can slowly change healthy cells into cancer. Because this process takes years, doctors can find the early changes before they become dangerous. The key to stopping the disease is finding these changes early through screening and then treating them right away. In many parts of the world, women do not have easy access to these tests, which means the disease often goes unnoticed until it is too late. To fix this, countries are building systems to track who gets tested, who has the virus, and who receives treatment. These systems act like a map, showing health officials where the gaps are and how well their efforts are working. Without a clear map, even the best medical tools can fail to reach the people who need them most.

In Rwanda, health officials have built a digital system to track cervical cancer screening and treatment in the capital city, Kigali. This system records data from hospitals and health centers, aiming to ensure that no woman falls through the cracks between her first test and her final cure. A team of researchers from the University of Rwanda and other local institutions decided to check how well this system was actually working. They wanted to know if the digital tools were easy to use, if the data arrived on time, and if the people running the system felt it was helpful. They looked at records from January 2023 through June 2025, covering nearly 20,000 women who visited clinics in Kigali for screening.

The researchers found that the system is performing very well in several important areas. The data arrived quickly, the records were complete, and the system remained stable even when power went out. Most of the health workers who use the system said it was useful for making decisions about patient care and that they were willing to keep using it. The system successfully tracked which women had been tested and what the results were. In fact, the overall performance of the system was rated as "very good" for its ability to provide useful information, its reliability, and the quality of the data it collected. The health workers found the system easy enough to use, and it was flexible enough to handle new types of information when needed.

However, the study also uncovered a significant problem that threatens to undo the good work of the system. While the system successfully identified women who tested positive for the virus, many of these women did not return for the next step in their care. Of the women who tested positive for HPV, only about one-third came back to get a follow-up test to confirm if they needed treatment. This means that two out of every three women who were found to be at risk did not complete the process to get the care they needed. The researchers noted that this drop-off in follow-up is a major weakness. Even though the system is excellent at finding the problem, it is not yet strong enough to ensure that every woman who needs help actually receives it.

The study also looked at who is running the system. The work is mostly done by nurses and data managers, with very few doctors directly involved in the daily tracking. While this division of labor is common and effective in many places, the researchers noted that having fewer doctors involved might mean that the data is not always used as fully as it could be in clinical decisions. Additionally, the system showed some signs of strain when rules or definitions changed, suggesting that the system could be more adaptable to new guidelines. The researchers concluded that while the foundation of the surveillance system is strong, the country needs to focus on keeping patients engaged after they get a positive result. By improving how they follow up with women and making the system even more flexible, Rwanda can move closer to its goal of eliminating cervical cancer as a public health threat.