Institutional and Health System Barriers to Cervical Cancer Screening in Uganda: A Qualitative Study of Healthcare Workers' Perspectives in Greater Hoima

Introduction: Cervical cancer, a silent killer, claims far too many lives among women in Sub-Saharan Africa, including Uganda. While we often point to women's awareness or willingness as the main reasons for low screening rates, our study highlights a crucial, often overlooked, truth: the very health system itself can be a major roadblock. In Uganda, where fewer than 21% of women get screened, it's vital to understand these "supply-side" challenges to truly make a difference. Aim: Our goal was simple: to hear directly from healthcare workers in Hoima district, Uganda, about the institutional and health system issues that prevent women from getting screened for cervical cancer and stop providers from offering these vital services. Methods: We used a qualitative approach, interviewing 95 healthcare professionals nurses, midwives, clinical officers, and doctors from 20 public and private-not-for-profit health facilities across Hoima. We carefully selected facilities and participants, using semi-structured questionnaires to gather their insights. Then, we analyzed their responses to find the common themes revealing these institutional barriers. Results: What we found points to significant gaps in service provision. A major issue is the extreme centralization and scarcity of services ; shockingly, screening is only consistently available at one regional hospital for the entire district. Healthcare workers at smaller, lower-level facilities told us they simply don't have the trained staff to perform Visual Inspection with Acetic Acid (VIA). This problem is made worse by a severe lack of basic equipment and supplies , like specula and acetic acid. On top of that, staff reported an absence of supportive supervision and no clear system for referring suspected cases , making it incredibly difficult to run a proper screening program. Conclusion: Our study clearly shows that deep-seated problems within the health system and institutions are the primary reasons why cervical cancer screening isn't expanding in Hoima. Simply trying to increase demand among patients won't work if the services aren't there to meet it. To truly improve screening coverage, we must focus on bringing services closer to people, thoroughly training existing healthcare workers, and ensuring a steady supply of necessary equipment and resources.