Cervical cancer remains one of the most preventable yet devastating cancers affecting women in Nigeria. Data from the Ibadan Population-Based Cancer Registry from 2009-2010 show an age-standardised incidence rate (ASR) of 36.0 per 100,000 women, one of the highest burdens in the country. Behind these numbers are families, mothers, daughters, and communities deeply affected by a disease we now have the tools to prevent.
According to a 2022 Nigerian National Bureau of Statistics and UNICEF report, Oyo State has the highest proportion of out-of-school (OOS) girls (22.2%) in South-West Nigeria. This intersection of high cervical cancer burden and a large population of underserved adolescent girlsdemands urgent, innovative, and community-driven solutions.
Why Out-of-School Girls Matter
School-based HPV vaccination programs have proven highly effective in many low- and middle-income countries (LMICs). However, girls who are not in school are often left behind. These girls represent one of the most underserved and hardest-to-reach populations in Nigeria.
Tracking OOS girls is particularly difficult due to the absence of centralised records. Without formal school registers, identifying eligible girls for vaccination becomes a major operational challenge. Community outreach efforts targeting OOS girls have historically been less successful than school-based programs, further widening inequities in access.
Our Community-Driven Approach
Our project is designed to address low HPV vaccine uptake and vaccine hesitancy among out-of-school girls in Oyo State through trusted community platforms.
We are partnering with the Oyo State Child Protection Network, headed by Dr. Rosemary Odigbo. The network provides informal education to girls aged 9–14 years who do not have access to formal schooling. These existing structures offer a natural entry point for engagement.
Community-Based Organisations (CBOs) already have knowledge of and relationships with OOS girls and vocational training centres. By embedding HPV health education and vaccination services into these trusted spaces, we create a supportive and culturally familiar environment for care delivery.
Engagement of team Lagos with Oyo State Child Protection Network
Our strategy includes:
• HPV vaccination for eligible girls
• Free cervical cancer screening for mothers and guardians
• Joint counselling sessions to strengthen understanding of HPV and its link to cervical cancer
• Co-delivery of health interventions to maximize impact and efficiency
By engaging both daughters and mothers, we aim to address intergenerational knowledge gaps and strengthen community-wide prevention efforts.
Tackling Vaccine Hesitancy Through Culture and Trust
Despite strong scientific evidence confirming the safety and effectiveness of HPV vaccines, hesitancy remains a significant barrier—particularly in rural and underserved settings.
To address this, we are using the EPIS framework because it studies interventions at multiple levels and takes into consideration the local context in which interventions are delivered.
Rather than imposing messages, we are co-creating culturally appropriate communication materials with the community.
These should include:
• Posters and leaflets in local languages
• Simple visuals of girls being vaccinated and remaining healthy
• Radio jingles
• Storytelling sessions
• Local drama and songs
Evidence from multiple African settings suggests that culturally grounded communication strategies can be highly effective. Most importantly, the materials are being developed with community input to ensure they reflect local values, beliefs, and language.
Empowering Girls as Peer Educators
We also plan to select adolescent girls as peer educators, young ambassadors who can spread accurate information within their networks. Peer influence is powerful during adolescence, and empowering girls to lead conversations about health strengthens ownership and sustainability. To support this, we hope to incorporate non-monetary incentives such as recognition awards.
Learning from Regional Success
Similar community-based approaches have been successfully implemented in Ethiopia, where women’s groups played a key role in identifying and engaging out-of-school girls for vaccination. These examples reinforce the importance of leveraging existing community structures rather than creating parallel systems.
The Challenge: Limited Resources
While our vision is clear, our greatest challenge remains limited resources.
Reaching OOS girls requires resources for:
• Continuous tracking and follow-up
• Engagement with stakeholders (Oyo state CPN)
• Communication materials in local languages, story telling etc
• Materials for screening of mothers/guardians for cervical cancers
• Trained health personnel for vaccination and screening
• Incentive for peer educators
Unlike school-based campaigns, community-based outreach demands more time, coordination, and financial investment. Yet it is essential if we are to close the equity gap in HPV vaccine access.
Moving Forward
Our work in Oyo State represents more than a vaccination campaign. It is an equity-focused effort to ensure that no girl is left behind because she is out of school. By partnering with trusted community organisations in Oyo State, such as the CPN, and embedding services within existing vocational and informal education platforms, we are addressing hesitancy through culturally grounded communication and empowering girls as peer leaders. This approach is building a sustainable pathway toward cervical cancer prevention.
The burden of cervical cancer in Ibadan and across Oyo State is high but it is preventable. With community trust, strategic partnerships, and adequate support, we can reach out-of-school girls, protect future mothers, and move closer to eliminating cervical cancer in Nigeria.
The challenge is real. But so is our commitment.
Team Lagos- Change challenge 2025
