The WISH model will be added to a well-functioning line of women’s health services during the early stages (vertical integration), and then integrated more broadly across the healthcare system (horizontal integration) for sustainability. Training and skill-building such as just-in-time or in-service training will be used for practicing providers in early implementation. Over time, capacity and skill development will be shifted to pre-service training of providers who are new to these practices. Similarly, initial integration will address changes in clinical care flow or community-based care, as well as equipment supply and maintenance with short term solutions. Longer term broader and sustainable integration will be informed by the lessons learned in the process of initial integration.

Members of the WISH team have a long history of effectively working with key stakeholders of local and national governments in Peru and Kenya, our priority sites, as well as across Africa, Asia and South America. We will work with Ministry-led Technical Working Groups or subnational provincial or district leaders to tailor our approach to country-specific proven methods. We will address the inclusion of costs into the appropriate national or subnational budgets, and work to address any policy or scope of practice changes needed to assure inclusion in national essential packages of care. In addition, the team will establish a supply chain pathway for the technologies and ancillary supplies and create protocols for workforce pre-training.

As we scale beyond individual countries, we will work with international organizations like WHO, especially those with country representatives, as well as relevant private sector or NGO groups that are providing women’s healthcare, to address training and equipment supply chain issues for broader implementation. Further, we will ensure the inclusion of private sector providers of women’s health care (for example, NGOs), especially at the community level, into Ministry training and systems to meet their needs.   

Members of the WISH team have successfully demonstrated the effectiveness of a women centered model for self-HPV screening test for cervical cancer, in which women in the target population co-create models for training, delivery and education and then become front line workers within that community. This model empowers women in the community to reframe the solutions for cervical cancer screening in their own terms.  This is the strategy that will be used across health care providers including midwives, nurses and community health providers.

There is on-the-ground evidence for the effectiveness of peer to peer networks translating to improved self-advocacy and consequently improved health outcomes. There are many examples of this globally – two specific cases worth noting are the Mothers to Mothers program which hires women with HIV to counsel and provide care for other women with HIV in their community and the HOPE program, developed by a member of the WISH team, which uses the same model as Mothers to Mothers to employ women in the community to educate and empower their peers to self-screen for cervical cancer.

There are several ways in which we have already used storytelling to create agency in the context of cervical cancer prevention. Through one on one interactions with community health providers, women are able to understand why it is important to seek preventative care before symptoms occur. We have also held educational workshops, led by a local midwife, bringing women together in the local community center to have a broader group discussion about cervical cancer and providing an opportunity to discuss their questions. In addition to in-person interactions, we have compiled Whatsapp recording videos from women who have cervical cancer, women who have been able to prevent cancer through preventative care and community health providers (women) who have delivered care.

The recommended age range for screening is between 30 and 50 years. However, in HIV prevalent populations which are at increased risk for cervical cancer, the recommended age of screening can start as early as 21 years of age.

The software and cloud services that we create will be directly linked to district and tertiary hospitals through referral agreements. Additionally, confirmation of patient referral and placement will be set up in the software.  In the short term, digital linkages will be supported by physical interactions to reduce the number of missed cases or delayed referrals.  Simultaneously, direct follow up with patients either in-person or text to assess both successful follow-up as well as compliance. In the longer term, these processes will be used as quality control measures for continual refinement of the referral process.  

HPV is prevalent not only in women, but also in men. In addition, it is a precursor for oral and anal cancers which affect both genders. The model we have created focuses on cervical cancer, an international priority, for which we have created innovative technologies and delivery strategies. Proving the impact of this patient-centered framework to cancer prevention is essential to and will benefit other cancers, particularly, anal cancers which occur in marginalized populations that suffer from barriers associated with shame and stigma.

The co-creation of implementation strategies adapted to each country and community, as well as the iterative process we use, will ensure that the technologies introduced through WISH will be adopted and empower women, rather than exacerbate shame and stigma. We have already had experience in multiple countries in South America, Africa and North America which have shown us that women from both urban and rural communities have a powerful and positive response to the technologies we have introduced that give them privacy and control over their own bodies.

Expertise in oral history will ensure that the project will incorporate well-established methodologies to capture women’s histories.  Specifically, the methodologies will be used to minimize the influence of unconscious bias or cultural factors, that could confound the authentic narratives of the women who participate.

The WISH team will create training and quality control processes to promote accountability and ownership in order to minimize improper handling or misuse of the technologies that have been introduced into the communities. The peer to peer network is again important in this regard as has been shown with the HOPE cervical cancer screening model implemented by a WISH team member.  In the rural communities in which HOPE operates, women with little or no academic credentials are trained and equipped as empowered peer leaders who collectively ensure that their peers adhere to the best practices, particularly when their livelihoods depend on this responsibility.

Short term support for the WISH model will be through international donors, foundations and government faders. When possible, community-based models may be used to create sustainable jobs in which local health providers can charge a small fee for their services, which has been demonstrated to be an extremely cost-effective way to disseminate community-based care. In the longer-term, the WISH model will be integrated into essential care packages or services that are incorporated into subnational budgets at provincial, state or district levels to cover service costs.