Background Globally, breast cancer is the most common cancer type and the leading cause of cancer mortality among women in developing countries. A high prevalence of late breast cancer diagnosis and treatment has been reported predominantly in Low- and Middle-Income Countries (LMICs), including those in Asia. Thus, this study utilized a mixed-methods systematic review to synthesize the health system barriers influencing timely breast cancer diagnosis and treatment among women in Asian countries. Methods We systematically searched five electronic databases for studies published in English from 2012 to 2022 on health system barriers that influence timely breast cancer diagnosis and treatment among women in Asian countries. The review was conducted per the methodology for systematic reviews and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, while health system barriers were extracted and classified based on the World Health Organization (WHO)‘s Health Systems Framework. The mixed-methods appraisal tool was used to assess the methodological quality of the included studies. Results Twenty-six studies were included in this review. Fifteen studies were quantitative, nine studies were qualitative, and two studies used a mixed-methods approach. These studies were conducted across ten countries in Asia. This review identified health systems barriers that influence timely breast cancer diagnosis and treatment. The factors were categorized under the following: (1) delivery of health services (2) health workforce (3) financing for health (4) health information system and (5) essential medicines and technology. Delivery of health care (low quality of health care) was the most occurring barrier followed by the health workforce (unavailability of physicians), whilst health information systems were identified as the least barrier. Conclusion This study concluded that health system factors such as geographical accessibility to treatment, misdiagnosis, and long waiting times at health facilities were major barriers to early breast cancer diagnosis and treatment among Asian women in LMICs. Eliminating these barriers will require deliberate health system strengthening, such as improving training for the health workforce and establishing more healthcare facilities.

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Poor patient safety practices may result in disability, injury, poor prognosis, or even death and are primarily associated with a common concern in Africa. This study synthesized the factors influencing the maintenance of patient safety in Africa’s healthcare institutions. There was an in-depth search in PubMed Central, CINAHL, Cochrane library, web of science, and Embase using the PICO framework. The search results were filtered for Africa and from 2011 to September 2021 to yield 9,656 titles after duplicates were removed using endnote software, and 211 titles were selected for full-text reading as 16 were selected based on predetermined criteria. The quality appraisal was done using the Mixed Methods Appraisal Tool. A matrix was developed, discussed, accepted, and used as a guide for the data extraction. A convergent synthesis design was adopted for data analysis as the data was transformed into qualitative descriptive statements. Patient safety ratings ranged from 12.4% to 44.8% as being good. Patient safety was identified as an essential structure to improve patient outcomes. The factors associated with patient safety were level of education, professional category, hours worked per week, participation in a patient safety program, reporting of adverse events, openness in communication, organizational learning, teamwork, physical space environment, exchange of feedback about error, and support by hospital management. Poor patient safety environment could lead to the staff being prosecuted or imprisoned, lack of respect and confidence by colleagues, embarrassment, loss of confidence and trust in the health team by patients, documentation errors, drug errors, blood transfusion-related incidences, development of bedsores, and disability. These strategies by health institutions to promote patient safety must focus on reducing punitive culture, creating a culture of open communication, and encouraging incidence reporting and investigations to ensure continuous learning among all health care professionals.

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