Understanding referral of patients with cancer in rural Ethiopia: a qualitative study

TL;DR

This study explores the challenges and opportunities in referring cancer patients in rural Ethiopia, highlighting the need for better systems and support.

Contribution

The paper introduces a qualitative analysis of referral systems in rural Ethiopia, emphasizing the need for standardized protocols and support networks.

Findings

Referral systems in rural Ethiopia lack clear communication protocols and formal linkages.

Emergency referrals have improved with a new hub-system, but non-emergency referrals remain underdeveloped.

Patients face transportation, accommodation, and language barriers, and are often directed to costly private pharmacies.

Abstract

Cancer incidence is increasing in Ethiopia mainly due to increased life expectancy, while oncological capacities remain limited. Strong referral linkages between different levels of the healthcare system are key to provide timely access to cancer care. In this qualitative study, we assessed limitations and potential of cancer patient referral in the rural Southwest of Ethiopia.

We held four focus group discussions (FGD) with health professionals at one primary and three secondary hospitals and conducted eight in-depth interviews (IDI) with the hospitals´ medical executives and local health bureau representatives. Data was analysed inductively using thematic analysis and emerging themes were categorized within the revised concept of access by Penchansky and Saurman.

The inevitable referral of patients with cancer in the rural Southwest of Ethiopia is characterized by the absence of clear communication protocols and the lack of formal referral linkages. The newly implemented hub-system has improved emergency referrals and could be expanded to non-emergency referrals, sensitive to the needs of advanced oncological care. Liaison officers can pave the way but need to be trained and equipped adequately. Referred patients struggle with inadequate transportation systems, the lack of accommodation close to specialized facilities as well as the inability to navigate at those sites due to language barriers, illiteracy, and stigmatization. Few Non-Governmental Organizations (NGOs) help but cannot compensate the limited governmental support. The shortage of medications at public hospitals leads to patients being directed to costly private pharmacies. In the light of those challenges, cancer remains to be perceived as a “death sentence” within the rural communities.

Standardized referral linkages and a multi-faceted support network throughout the cancer care continuum are necessary to make oncology care accessible to Ethiopia´s large rural population.

The online version contains supplementary material available at 10.1186/s12885-024-12294-7.