About AUD 86 per valid HPV result
AUD 407,525 over 24 months reaches an estimated 4,760 women with a valid result at the 70% target.
Flagship project · seeking support of AUD 407,525
Kushalam: cervical screening that comes to the estate
A private HPV self-test for tea estate women in Nuwara Eliya, during work time, with no loss of pay. Delivered by government Public Health Midwives, so it stays in the public system after the pilot ends.
At a glance
- tea estates
- 20
- Ambagamuwa and Kotagala, around Hatton
- women aged 35–55
- ~6,800
- Unscreened or overdue for five years
- contacts per woman
- 3
- Information, private self-collection, results
- months
- 24
- January 2027 to December 2028
The gap
The highest cervical cancer rate in Sri Lanka. The lowest screening.
Nuwara Eliya has the highest recorded incidence of any district, at 14 per 100,000 (FPA, 2024). Yet only 9% of ever-married estate women have ever had a Pap test, against 22% of rural women (FHB & UNFPA, 2019).
Screening is offered in clinics, on weekdays, only at ages 35 and 45, and a clinic visit costs a tea plucker half a day's wage. Most cervical cancer can be prevented when it is found early.
Infographic
Out of every 100 women…
Each figure is one woman. Kushalam aims to take estate women from the lowest screening rate in Sri Lanka to well above the national average.
9
Estate women today
ever had a Pap test
22
Rural women today
ever had a Pap test
70
Kushalam target
with a valid HPV result by July 2028
Sources: FHB & UNFPA (2019) Well Woman Programme National Strategic Plan; Kushalam project targets.
Infographic
Five barriers, five answers
77% of estate women report serious barriers to health care. Kushalam is designed around each one.
Screening only in distant clinics
A private booth on every estate
A clinic visit costs half a day's wage
Done in work time, with no loss of pay
Offered only at ages 35 and 45
Every woman aged 35 to 55 invited
Fear and embarrassment of an examination
Self-collection in private, no doctor exam
Information rarely given in Tamil
Tamil-speaking midwives and picture guides
Infographic
One woman's journey, from invitation to care
Step 1
Learn
Short Tamil session at an existing estate meeting
≥85% consent
Step 2
Self-collect
Private booth on the estate, in work time
~15 minutes
Step 3
Lab test
HPV DNA test with genotyping for types 16 and 18
≤28 days turnaround
Step 4
Result in person
Every woman is called back, positive or negative
95% within 30 days
Step 5
Follow-up
Triage or colposcopy at DGH Nuwara Eliya if HPV-positive
90% linked in 3 months
Step 6
Treatment
Midwife stays with her; travel and wages paid
90% of CIN2+ treated
On the estates
From the tea fields to the clinic
Illustrative images generated for this assignment.
Why support Kushalam
Modest, accountable support that moves a district toward WHO's 90-70-90 targets
No parallel system
No new clinics, workforce or database. 24 government midwives deliver from day one.
Funds released by gate
Expansion from 4 to 8, 12 and 20 estates only after quality gates are met. Unspent funds return to DFAT.
Built to continue
After 2028, kits (about US$13.50 per woman) move to national HPV procurement and companies keep booth time.