Department of Development Studies, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of.
Department of Clinical Oncology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
BMJ Open. 2024 Oct 23;14(10):e085746. doi: 10.1136/bmjopen-2024-085746.
With the rise of non-communicable diseases in Tanzania, palliative care (PC) is increasingly needed to improve the quality of life for these patients through pain and symptom management and providing psychological care, social and spiritual support. Despite a larger portion of the population having access to healthcare services at primary healthcare (PHC) facilities in Tanzania, PC services are limited and less organised at this level. This study explored the challenges facing the provision of PC and the opportunities for strengthening PC services at PHC facilities in Tanzania.
We adopted an exploratory qualitative case study to conduct in-depth interviews with 15 health facilities in charge from 15 purposefully selected PHC facilities in Dar es Salaam City, Tanzania, in August 2023. We analysed the gathered information using qualitative content analysis.
Two categories emerged from the analysis of the gathered information. These are (1) challenges facing the provision of PC services at PHC facilities and (2) opportunities for strengthening PC services at PHC facilities. The challenges are grouped as provider-level, facility-level and patient-level challenges. The opportunities are organised into three subcategories. These are the increasing demand for PC services, the availability of multiple supporting systems and a functional referral system.
This study underscores the challenges and opportunities for providing PC services at PHC facilities. These findings call for a collaborative effort from health system players to strengthen the available PC services. The efforts should include expanding the coverage of PC services at the PHC facilities and healthcare providers' training. Expansion of PC services should include introducing them in places where they are unavailable and improving them where they are not available. PC training should consider preservice training in the health training institutions' curricula and continued medical education to the existing staff. Furthermore, we recommend community health education to raise awareness of PC services.
随着坦桑尼亚非传染性疾病的增加，姑息治疗（PC）越来越需要通过疼痛和症状管理以及提供心理关怀、社会和精神支持来提高这些患者的生活质量。尽管坦桑尼亚的大部分人口都能在初级保健（PHC）设施获得医疗保健服务，但 PC 服务在这一层次上受到限制且组织不够完善。本研究探讨了在坦桑尼亚 PHC 设施提供 PC 所面临的挑战以及加强 PC 服务的机会。
我们采用探索性定性案例研究方法，于 2023 年 8 月在坦桑尼亚达累斯萨拉姆市 15 个精心挑选的 PHC 设施中对 15 名负责的卫生设施负责人进行了深入访谈。我们使用定性内容分析对收集到的信息进行了分析。
从对收集到的信息的分析中得出了两个类别。这些是（1）在 PHC 设施提供 PC 服务面临的挑战和（2）在 PHC 设施加强 PC 服务的机会。这些挑战分为提供者层面、设施层面和患者层面的挑战。机会分为三个亚类。这些是对 PC 服务的需求不断增加、多个支持系统的可用性以及功能转诊系统。
本研究强调了在 PHC 设施提供 PC 服务所面临的挑战和机遇。这些发现呼吁卫生系统参与者共同努力加强现有的 PC 服务。这些努力应包括扩大 PHC 设施的 PC 服务覆盖范围并培训医疗保健提供者。扩大 PC 服务应包括在没有提供的地方引入它们，并在没有提供的地方改进它们。PC 培训应考虑在卫生培训机构的课程中纳入岗前培训和继续教育给现有员工。此外，我们建议进行社区健康教育，提高对 PC 服务的认识。
