Breast and cervix cancer kill more women than any other cancer in the developing world and have been largely neglected when designing accessible reproductive health programmes for women, especially in rural Africa.

Yet, simple interventions exist whereby primary healthcare clinic staff can visually inspect and treat early signs of cervical cancer and can be trained to do clinical breast examinations.

The Akazi (meaning ‘women’ in Chichewa) project is a three-year initiative aimed at providing training in 10 clinics in Malawi’s southern region. Akazi provides regularly supportive supervision and training to front-line staff to assist in identifying women who may require a referral for further investigations and treatment at the nearest suitable hospital.

As this is Malawi’s first breast cancer screening project, we work with the Hope for Cancer Foundation, which leads a campaign to promote screening uptake in the community.

The Akazi project is being tested through rigorous implementation research, including measures of screening coverage and surgery undertaken at referral hospital.

Our patients' experience of screening and referral is captured by follow-up surveys and in-depth interviews of stakeholders, including the Ministry of Health, who will use the findings to design Malawi’s first national breast screening programme.

Akazi is delivered through a partnership with Management Sciences for Health.