Health system constraints affecting treatment and care among women with cervical cancer in Harare, Zimbabwe

Abstract

BackgroundCervical cancer is a major cause of morbidity and mortality among women yet access to treatment and care remains a huge challenge in Zimbabwe. The objective of this study was to investigate health system constraints affecting engagement into treatment and care by women with cervical cancer in Harare, Zimbabwe.MethodsA sequential explanatory mixed methods design was used for this study. Phase 1 comprised of two surveys namely: patient and health worker surveys with sample sizes of 134 and 78 participants respectively. Validated structured questionnaires programmed in Android tablet with SurveytoGo software were used for data collection during the surveys. Univariate analyses were conducted using STATA® version 14 to generate descriptive statistics. In phase 2, 16 in-depth interviews, 20 key informant interviews and 6 focus groups were conducted to explain survey results. Participants were purposively selected and sample sizes were informed by saturation principle. Participants in phase 1 and 2 were different. English transcripts were manually coded line by line in Dedoose software using the thematic codes that had been established from the survey data. The final codes were used to support and explain the survey data at the interpretation stages.ResultsHealth system constraints identified in surveys were: limited or lack of training for health workers, weakness of surveillance system for cervical cancer, limited access to treatment and care, inadequate health workers, reliance of patients on out-of-pocket funding for treatment services, lack of back-up for major equipment. Qualitative inquiry revealed the following barriers to treatment and care: high costs of treatment and care, lack of knowledge about cervical cancer and bad attitudes of health workers, few screening and treating centres located mostly in urban areas, lack of clear referral system resulting in bureaucratic processes, and limited screening and treating capacities in health facilities due to lack of resources.ConclusionThe results of this study show that health system and its organization present barriers to access of cervical cancer treatment and care among women. Strong political will, mobilization of resources both domestically and from partners in addition to sound policies are imperative to address key health system challenges.

Reduced cervical cancer screening in Zimbabwe as an indirect impact of the COVID-19 pandemic: implications for prevention

“…Unfortunately, the long-term impacts of this neglect may be more devastating than the pandemic itself [ 3 ]. Zimbabwe has a high burden of cervical cancer [ 7 , 8 ]. According to the Zimbabwe National Cancer Registry, this cancer leads among malignancies in women, and constituted 33.2% of the cancer burden in this population with 1308 cases in 2016 [ 7 ].…”

“…A healthcare system that was reported as fragile before the onset of the pandemic may emerge weaker at the end, and fail to cope with increased disease burden [ 2 ]. The prevailing health system and its organisation in Zimbabwe presents significant barriers to the uptake of cervical cancer care and treatment [ 8 ], necessitating the need to restore preventive health services urgently, including cervical cancer screening. Teaching services for undergraduate and postgraduate medical students were negatively impacted.…”

The COVID-19 pandemic and its implications for cervical cancer treatment and prevention in Zimbabwe: perspectives and recommendations

“…In 2016, according to the Zimbabwe National Cancer Registry, 1308 new cases were reported, and the cancer constituted 33.2% of all female malignancies [ 1 ]. Whilst Zimbabwe has a comprehensive cancer registry, reporting may be confounded by failure to access diagnosis and utilisation of services, thus the cervical cancer burden could be much higher than reported [ 2 , 3 ]. The cancer remains a significant public health challenge and a major concern for gynaecologists, oncologists and public health practitioners.…”

“…Human Papilloma Virus (HPV), the necessary aetiological factor [ 4 ] is detectable in over 99% of specimens from patients with histologically confirmed cancer [ 2 , 5 ]. While persistent infection with high-risk HPV genotypes, particularly HPV 16 and 18 causing over 70% of cases, is necessary, failure to access preventive services presents the greatest risk factor for development of invasive cancer [ 2 , 3 ]. Studies have established beyond reasonable doubt the efficacy and safety of HPV vaccines in primary prevention of HPV persistence and premalignant lesions [ 5 - 7 ].…”

“…Patients suspected to have cancer are referred to gynaecologists at higher-level hospitals for diagnosis, evaluation and appropriate treatment, based on stage of disease. Late presentation with very advanced disease is common [ 2 , 3 ]. The country has two gynaecological oncologists, who work at the tertiary Parirenyatwa Group of Hospitals and serve the whole of Zimbabwe.…”