Takemi Program in International Health
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Evaluation of the continuum of care for cervical cancer in Argentina:
A mixed-methods analysis using the SUMAR Program database (2019-2023)
Camila Volij,1,2 Adolfo Rubinstein,2 and Michael R. Reich 1
¹ Takemi Program in International Health, Harvard T.H. Chan School of Public Health, Boston, MA
² Center for Implementation and Innovation in Health Policies (CIIPS) – Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
Study Context
Cervical cancer is the third most common cancer among women in Argentina. Mortality rates in poorer jurisdictions such as Misiones are up to five times higher than in wealthier areas like the Autonomous City of Buenos Aires (CABA).
Through a results-based financing scheme, the SUMAR Program aims to expand access to essential healthcare services for the uninsured, who account for almost 40% of the population.
Administrative and clinical data collected by the SUMAR Program on cervical cancer can be used to assess public health system performance and disease management across jurisdictions. However, limitations in data quality and completeness may constrain the use of administrative data.
Objectives
- Describe the coverage of cervical cancer-related services recorded in the SUMAR Program across the continuum of care (screening, diagnosis, and treatment) in CABA and Misiones.
- Assess the validity and reliability of administrative records through stakeholder interviews and explore systemic and contextual factors affecting data quality.
Methods
Design: Sequential explanatory mixed-methods study combining a retrospective quantitative analysis of administrative data with a qualitative component based on key informant interviews.
Quantitative component:
- Setting: Administrative records from the SUMAR Program (2019–2023) were analyzed to describe cervical cancer care trajectories among uninsured women aged 25 to 69 with exclusive public health coverage in CABA and Misiones.
- Outcome Measures: Percentage of women screened (PAP or HPV test), diagnosed (colposcopy, biopsy, histological diagnosis), and treated for cervical cancer.
- Analysis: Descriptive statistics were used to identify coverage trends over time within each jurisdiction.
Qualitative component:
- Participants: Twenty-two interviews were conducted (Misiones: 10, CABA: 9, National level: 3). Participants were selected through purposive sampling.
- Analysis: A thematic analysis with an inductive approach was conducted to identify systemic, contextual, and institutional factors influencing registration practices.
Ethical Approval
The study protocol was approved by the Ethics Committee of the Province of Misiones and by the CEMIC Ethics Committee in Buenos Aires (CABA).
Results
CABA
- Significant underreporting is likely across the cervical cancer continuum of care.
- There are no alternative data sources available to validate population-level information.
- Among different stages of care, screening data appear to be the most reliable.
- Pathological results may not accurately reflect the epidemiological profile.
- The percentage of treated pathological lesions is likely underestimated.
Misiones
- Data could be validated against a national source, the SITAM (National Cervical Cancer Screening Information System), as Misiones adheres to this public health registry. However, validation focused on the number of services provided, rather than person-level data.
- Underreporting in the SUMAR database compared to the SITAM registry across the entire cervical cancer continuum of care, except for the treatment stage.
Conclusions
- Coverage assessment: The SUMAR database currently lacks sufficient reliability to assess cervical cancer coverage, particularly in CABA. While Misiones demonstrates better data collection—likely due to earlier implementation, greater financial relevance within the provincial public health budget, and a more centralized and organized service delivery model—evaluating the full continuum of cervical cancer care remains limited. Improvements in data quality and completeness are needed to enable more accurate assessment.
- Continuum of care assessment: Considering the first step of the cervical cancer care continuum, improving the registration of both screening procedures and positive PAP and HPV test results is essential to accurately evaluate the subsequent stages of cervical cancer care (diagnosis and treatment).
- Comparison of jurisdictions: While the SUMAR Program administrative and clinical data (through quantitative analysis) allow jurisdictional comparison along the cervical cancer continuum of care, interpreting these results requires a nuanced understanding of the local context (through qualitative analysis) based on a direct engagement with stakeholders.
- Policy implications: The results of this study reflect the necessity to improve the quality of data collected and the quality of the registration system for SUMAR Program in various provinces, to measure and manage the objective of improving health system performance for cervical cancer.
Acknowledgments
Margaret A. McConnell, Takemi Program in International Health and Center for Implementation and Innovation in Health Policies (CIIPS) – Institute for Clinical Effectiveness and Health Policy (IECS)
Ethics & Contact
Ethical Approval: The study protocol was approved by the Ethics Committee of the Province of Misiones and by the CEMIC Ethics Committee in Buenos Aires (CABA).
Contact: cvolij@hsph.harvard.edu, cvolij@iecs.org.ar