Complex care systems in developing countries

Abstract

BACKGROUND:As the global visibility and importance of breast cancer increases, especially in developing countries, ensuring that countries strengthen and develop health systems that support prevention, diagnosis, and treatment of a complex chronic disease is a priority. Understanding how breast cancer patients navigate health systems to reach appropriate levels of care is critical in assessing and improving the health system response in countries to an increasing breast cancer burden in their populations. Ethiopia has accelerated attention to breast cancer, expanding clinical and public health efforts at diagnosing and treating breast cancer earlier and more efficiently. METHODS: This project used a mixed-method approach to assessing patient navigation of the healthcare system that resulted in care at the cancer referral hospital for Ethiopia (Tikur Anbessa Hospital [TAH]). In total, 69 patients representative of the entire breast cancer clinical population at TAH were interviewed. RESULTS: Navigation chains are widely divergent and typically involve 3 or more care nodes until they reach the referral hospital. Patients who consult traditional healers have significantly more care nodes to reach the referral hospital than others, and patients who have direct access to local and regional hospitals have the smallest number of care nodes. Patients report moving laterally from 1 health institution to another or regressing to lower levels of care, sometimes complicated by reinvolving traditional healers. CON-CLUSIONS: The care system can be streamlined for breast cancer patients in Ethiopia to facilitate patient access to available and clinically effective diagnostic and treatment services in the country, largely through improving local primary care and hospital capacity to provide basic breast cancer services and improve detection and referral. Cancer 2010;116:577-85.

Patterns of seeking medical care among Egyptian breast cancer patients: Relationship to late-stage presentation

“…Unlike a recent study in Ethiopia examining breast cancer patient navigation through the health care system which found that patients typically visited three health facilities before being referred to a specialized cancer center, 21 most patients in our study had arrived at the TCC by the third node of care. However, on average, patients in our study experienced longer system delays than patients in studies conducted on other international populations in both developed and developing countries.…”

“…Finally, patients who initially visited a general surgeon followed by a visit to a surgical oncologist were more likely face a delay in reaching the TCC as a result of the Egyptian health care system. Thus, the type of physician a patient comes in contact with initially as well as the patient’s navigation pathway play an important role in obtaining timely treatment, 10,21 indicating that barriers to breast cancer diagnosis and treatment exist within the Egyptian health care system.…”

“…21,30–39 The first breast cancer patient navigation program, created in Harlem, New York, was found to increase the percentage of early stage diagnosis from 6% among low-income women who did not use patient navigators to 41% among low-income women who used patient navigators. 40,41 Patient navigators may be especially useful in Egypt as feasible solutions to the inefficient Egyptian health care system.…”

Sources of delayed provision of neurosurgical care in a rural kenyan setting

“…[10] Through the analysis of sources of delay in accessing medical care in low-income nations, the following themes have emerged as the fundamental causes: Cultural beliefs and practices, financial restrictions, knowledge and skills of primary care providers and the public's perception of same, and transportation. [8911222931]…”

A Review on Breast Cancer Care in Africa

“…The patient navigation chain has a lot of barriers until the patients eventually reach the central cancer center. At a minimum, patients face 3 or more nodes that are widely divergent [44]. A study done in Ghana found that being a member of the Islamic religion, seeking treatment at traditional healers, and a lack of awareness of national health insurance coverage for BC treatment were the main factors that affected treatment completion [45].…”