Department of Surgery, Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West 11103, Dar es salaam, Tanzania.
Department of Community Health, Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West 11103, Dar es salaam, Tanzania.
BMC Health Serv Res. 2024 Sep 30;24(1):1154. doi: 10.1186/s12913-024-11580-1.
Access to quality prostate cancer services remains a global challenge, particularly in Low- and Middle-Income countries. This is often due to weak health systems that struggle to meet the population's needs. The provision of quality health services to patients with prostate cancer requires a comprehensive approach involving multiple stakeholders and structural inputs. However, few studies have comprehensively assessed the relationship between these structural inputs and prostate cancer treatment outcomes. This study, therefore, aimed to determine the availability of selected structural inputs and descriptions of how they influence the provision of quality services to patients with prostate cancer in Tanzania.
We conducted a cross-sectional study using an explanatory sequential mixed-method approach to collect data from five tertiary hospitals providing cancer services in Tanzania. A validated checklist was used to collect information on available structural inputs for prostate services at tertiary hospitals. A semi-structured interview guide was used to conduct 42 in-depth interviews with 20 healthcare providers, five hospital managers, and 17 patients undergoing treatment for prostate cancer. Descriptive analysis was performed for the quantitative data, and thematic analysis was conducted with the aid of NVivo 14 qualitative software for the interview transcripts.
All five assessed tertiary hospitals had inadequate human resources for health to provide prostate cancer services. Only one had 70% of the required HRH, while none had above 40% of the required HRH. Within the hospitals, the skill mix imbalance was severe across cadres. Five themes emerged: inadequate infrastructure, delays in diagnosis, delays in treatment, shortage of human resources for health (HRH), and inefficient organization of prostate cancer services.
The findings of this study, underscore the major health system deficiencies for the provision of prostate cancer services in tertiary hospitals. With the increased aging population, strong health systems are vital in addressing conditions of old aging, including prostate cancers. Studies on optimization of the available HRH and infrastructure are needed to improve the provision of prostate cancer in tertiary hospitals as an interim solution while long-term measures are needed for improving the HRH availability and conducive infrastructure.
获得高质量的前列腺癌服务仍然是一个全球性挑战，尤其是在低收入和中等收入国家。这通常是由于卫生系统薄弱，难以满足人口需求。为前列腺癌患者提供高质量的卫生服务需要采取综合方法，涉及多个利益攸关方和结构投入。然而，很少有研究全面评估这些结构投入与前列腺癌治疗结果之间的关系。因此，本研究旨在确定选定结构投入的可用性，并描述它们如何影响坦桑尼亚前列腺癌患者获得优质服务。
我们采用横断面研究和解释性顺序混合方法收集数据，从坦桑尼亚提供癌症服务的五所三级医院中收集有关前列腺服务可用结构投入的信息。使用经过验证的清单收集三级医院前列腺服务可用结构投入的信息。使用半结构化访谈指南对 20 名医疗保健提供者、5 名医院管理人员和 17 名正在接受前列腺癌治疗的患者进行了 42 次深入访谈。对定量数据进行描述性分析，并用 NVivo 14 定性软件对访谈记录进行主题分析。
所有五所评估的三级医院都缺乏提供前列腺癌服务的卫生人力资源。只有一家医院拥有 70%所需的人力资源，而没有一家医院拥有超过 40%的人力资源。在医院内部，各层次的技能组合严重失衡。五个主题出现：基础设施不足、诊断延误、治疗延误、卫生人力资源短缺和前列腺癌服务组织效率低下。
本研究结果强调了提供三级医院前列腺癌服务的主要卫生系统缺陷。随着人口老龄化的增加，强大的卫生系统对于解决老年人的状况至关重要，包括前列腺癌。需要对现有人力资源和基础设施进行优化研究，以改善三级医院前列腺癌的提供，作为临时解决方案，同时需要采取长期措施来提高人力资源的可用性和有利的基础设施。
