Cervical Cancer in Sub-Saharan Africa: A Narrative Public Health Policy Synthesis and Integrated Framework to Support WHO Elimination Targets

Cervical cancer remains a leading cause of cancer-related mortality among women in sub-Saharan Africa, despite being largely preventable. Persistent infection with oncogenic Human Papillomavirus (HPV) is the necessary cause of most cervical cancers. Less than two-thirds of the WHO African Region's nations had implemented HPV vaccination as of 2022, with average coverage remaining below 40%. Health-system limitations continue to hinder screening and diagnostic capabilities.

We conducted a structured narrative synthesis of public health policy from peer-reviewed literature, WHO and African Union policy documents, and regional epidemiological reports published between 2020 and 2025. We investigated how biological, environmental, social, and health-system factors interact to influence cervical cancer prevention, screening, diagnosis, and treatment in Africa using systems-thinking principles and an analytical lens guided by One Health.

Inadequate HPV vaccination coverage, restricted access to high-sensitivity screening technologies, insufficient diagnostic laboratory capacity, and disjointed governance were among the ongoing shortcomings found along the cervical cancer control continuum. We suggest an integrated public health implementation framework that prioritizes cross-sectoral cooperation, bolsters laboratory quality management systems, expands single-dose HPV vaccination through community and school-based delivery, and coordinates cervical cancer services with current HIV and reproductive health initiatives.

Cervical cancer in Africa is best understood as a complex public health and health-systems challenge, sustained by strengthening feedback loops across biological, environmental, social, and systemic spheres. Strategies for other non-communicable illnesses in low-resource countries may benefit from a coordinated, multi-sectoral strategy based on systems thinking, which can promote more equitable and sustainable progress toward the elimination of cervical cancer.

A One Health systems-thinking framework offers an integrated approach to strengthening HPV vaccination, screening, laboratory systems, governance, and cross-sectoral collaboration to accelerate progress towards the WHO cervical cancer elimination targets in sub-Saharan Africa.