**9. Geographical variations in screening programmes in gynaecological cancer**

Screening of gynaecological cancers is largely dependent on the cancer burden in the respective country with each country strategizing to reduce the burden. Before the 1940s there was a notable rise in the incidence and mortality associated with cancer such as cervical cancer necessitating the organization of organized screening programmes especially in the `Nordic countries which were largely nationwide and population based resulting in a near nation wide coverage. This was largely achieved by the direction of national resources aided by wellformulated policies by the respective Governments with resounding achievements.

Converse is the case in developing countries with limited resources competing for numerous challenges. The screening programmes of countries are largely opportunistic, poorly organ‐ ized and not entered on national coverage of the population. The obvious lack of political will on the part of the various Governments has also compounded this problem. Most times screening programmes in these countries are cost driven With governments relying on methods that are relatively less expensive though not necessarily ideal screening methods. The absence of suitable manpower to handle more complex screening methods make such methods unavailable for generality of the population. Thus screening for cervical cancer in developing are usually based on the traditional cytology using the spatula with its drawbacks already highlighted as opposed to liquid based cytology. Less expensive methods for screening such as VIA and cervicography are also used to meet up with the challenges of the draught of the challenges of the draught of histopathologist to analyse samples collected. The absence of histopathologists puts a lot on pressure on already burdened histopathologists resulting in delays of screening results with a back lash on the patients zeal for further follow up in subsequent appointments. The lack of information on credible treatment plans for those diagnosed is also as rate limiting step in achieving national coverage in most of these countries.
