More than 85% of cervical cancer deaths worldwide occur in low- and middle-income countries. Cervical cancer is the second-most common cancer and the leading cause of cancer-related deaths among women in South Africa and Rwanda. These two countries are using cause-of-death data from national civil registration and vital statistics (CRVS) systems to inform and prioritize cervical cancer prevention and early detection interventions.

South Africa expands school-based HPV vaccinations

In 2023, with support from the Bloomberg Philanthropies Data for Health Initiative’s Data to Policy (D2P) Program, a team of public health professionals in South Africa analyzed national morality data alongside the national cancer registry. They discovered that far more women had died of cervical cancer than were listed in the cancer registry. The data revealed a clear picture: Women were dying of cervical cancer, undiagnosed.

The team used the CRVS data to understand who was dying of cervical cancer, at what age, and where, to design interventions. “The CRVS data helped us a lot,” said Sizeka Mashele, Epidemiologist at South Africa’s National Institute for Communicable Diseases and member of South Africa’s 2023 D2P cohort. “We didn’t know how many women were dying who had never appeared in the healthcare system.” In rural areas, Mashele explained, many women rely on traditional types of medicine, and signs and symptoms of cervical cancer are sometimes viewed as natural or normal. As a result, women are dying of cervical cancer without knowing, and the cancer is only detected after death, through autopsy.

Nearly all cervical cancer cases are caused by human papillomavirus (HPV) infection, and HPV vaccinations are the most effective way to prevent cervical cancer. When Mashele and the team were assessing potential cervical cancer interventions in 2023, the national school health program already provided HPV vaccinations, with parent consent, to girls aged nine in all public schools. But in a country where 22% of girls attend private schools, many students were left behind. The team proposed a new policy that added private schools to the school health program’s HPV vaccination campaigns. The policy proposal was adopted by the Ministry of Health in 2024, and as of 2025, HPV vaccinations are provided to girls aged nine and up in private schools on an annual basis.

The August 2025 campaign alone reached 80 percent of all private schools in the country, and 42 percent of girls in grades five through seven received the vaccination. With continued catch-up campaigns, private school students’ HPV vaccination rates could reach that of public-school students, which was 92% in the February 2026 campaign. Through consistent school health program vaccination campaigns, South Africa aims to increase HPV vaccination coverage and prevent future cases of cervical cancer.

Rwanda scales up cervical cancer screening efforts

In Rwanda more than 90% of girls under age 15 are already vaccinated against HPV. Yet screening rates have remained low, leaving unvaccinated women in the gap between prevention and early detection.

In 2023, with support from the D2P Program, a team of public health professionals analyzed CRVS and cancer registry data and found that 40% of women diagnosed with cervical cancer died within five years. They also looked at screening data and realized that only 18% of women at risk of cervical cancer were receiving screening services, far below the World Health Organization’s (WHO) target of 70%.

“This data gives us the real picture of what’s going on and tells us the truth about our health system,” says Daniel Sabushimike, Data for Health Initiative Cancer Registry Program Manager, working with the Rwanda Biomedical Centre, and member of Rwanda’s 2023 D2P cohort. “Otherwise, you can’t tell the story by looking at patients in a hospital. With death data, you really know the cause of the bad outcomes that we are facing. It is the best option that any government can use to tackle a specific health problem.”

Sabushimike and the team developed a policy proposal to increase cervical cancer screening efforts by including cervical cancer screening in Rwanda’s Community-Based Health Insurance (CBHI) scheme, adding screening targets to facility-level performance indicators, and training and mobilizing community health workers to initiate door-to-door screenings.

The Ministry of Health adopted the proposed interventions in 2024. Since cancer screening was added to the CBHI scheme, 700 healthcare providers have been trained in cervical cancer screening. Additionally, hospitals across the country are required to track screening rates, and providers and incentivized to provide screenings to more patients.

The community-level interventions have also proven successful. Each village in Rwanda has four dedicated community health workers who, as trusted members of their communities, are well-positioned to squash rumors and break down stigma that prevent women from seeking screening. Within the first two years of the door-to-door screening program, 26,000 community health workers across 13 districts and more than 6,000 villages were trained on cervical cancer transmission, symptoms, and screening procedures, and supplied with at-home screening kits. The government also approved new performance-based financing for incentivization, where community health workers receive payment based on how many women they refer for screenings.

The accessibility of at-home screening kits meets women where they are—in their communities—without requiring clinic appointments or travel. The community health workers deliver the sampling kits to women at home, and the women collect the samples themselves. The community health workers then deliver the samples to the nearest health center, where a provider picks them up for testing of high-risk HPV. The women receive their results by text message. At-home sampling kits are also available for free at health clinics.

As a result of these efforts, national screening coverage increased from 18% in 2023 to 30% in 2025.  More than 21,000 women screened received treatment for precancerous lesions, stopping cancer in its tracks.

National cervical cancer elimination plans guide path forward

CRVS data analysis began to tell the stories of cervical cancer in both South Africa and Rwanda. With these stories, both countries have designed targeted interventions to save women’s lives through prevention and early detection programs.

Since introducing HPV vaccinations in private schools, South Africa has published its 2026 – 2030 strategy for the elimination of cervical cancer. As part of the strategy, the country plans focus on another group of women at-risk of cervical cancer—adults who did not receive the HPV vaccine as children. As a next step, the country will work toward increasing screening rates for women over 25 to detect HPV infection, identify pre-cancerous lesions, and provide treatment.

Rwanda’s Accelerated Plan for the Elimination of Cervical Cancer in Rwanda 2024-2027 also guides ongoing interventions. Rwanda continues to pursue WHO’s cervical cancer screening target of 70% to detect cancer early, treat it, and save women’s lives.