Operationalizing cervical cancer elimination: a health-system archetype framework for implementation

Cervical cancer elimination is considered an achievable global health objective, yet progress toward the World Health Organization 90-70-90 targets remains highly uneven across countries and regions. Despite the effectiveness of human papillomavirus vaccination and human papillomavirus-based screening, implementation continues to be shaped by substantial variation in health-system readiness, program maturity, governance capacity, and service delivery infrastructure. This analysis proposes a pragmatic health-system archetype framework to support context-sensitive implementation of cervical cancer prevention strategies. The framework was informed by a multi-regional expert convening and an iterative synthesis of global evidence, World Health Organization guidance, and implementation experience. Three broad archetypes are described (evolving, transitional, and consolidated health systems), each reflecting distinct structural constraints and implementation capacities. In evolving systems, the primary challenge is establishing functional delivery platforms capable of supporting simplified, high-impact screening approaches. In transitional systems, the priority is consolidating program architecture during the shift from cytology-based to human papillomavirus-based screening. In consolidated systems, the focus shifts toward optimization, equity, and long-term sustainability of elimination gains. Across all archetypes, progress depends less on the availability of effective technologies than on their integration within health systems able to ensure continuity, accountability, and population reach. This framework is not intended as a country classification tool but as an analytical lens to support policy and program design. By aligning implementation pathways with system readiness, it offers a pragmatic approach to translate global targets into feasible, system-adapted action and accelerate equitable progress toward cervical cancer elimination.