Development of a programme to manage cancer ser-vice delivery in primary health care clinics in Botswana

Abstract

Cancer remains a growing public health concern in Botswana, placing a burden on primary health care systems. Effective management and delivery of cancer services at the primary care level are essential to improve early detection, referral, and treat-ment outcomes. Purpose The purpose of this study was to develop a programme for the management of cancer services and treatment for adults in Botswana primary health care clinics. The study was conducted in primary healthcare clinics situated in Molepolole, Kanye and Ramotswa for nurses. Although patients were seen at local clinics for follow-up care, the researcher, through the guidance of oncology nurses, accessed patients’ records pertaining to cancer treatment received at the main oncology clinic situated in Princess Marina Hospital in Gaborone. Participants were recruited in these areas, re-spectively, followed by data collection. All sites are in the southern part of Botswana. Methods A convergent parallel mixed methods approach guided the study in three phases. Data were collected simultaneously, analysed independently, and the findings were merged at the end and discussed. Phase 1 addressed two objectives of the study using a qualitative approach to explore the perceptions of Registered nurses in Primary health care clinics regarding the management of cancer patients using a purposive sample consisting of 32 registered nurses. Thematic analysis was used to analyse data. A quantitative approach, in line with Objective 2, was utilised to assess cancer patients xii (n = 135), outcomes regarding their quality of life and satisfaction with services re-ceived in primary healthcare clinics, using the EuroQol EQ-5D instrument to collect data and SPSS Version 27 was used to analyse data. Based on a confidence level of 95% and a margin of error of 5%, the sample size for cancer patients was 135 and was recruited at an oncology clinic in a tertiary hospital when they turned up for review, because in primary healthcare clinics they do not keep their records. Phase 2 involved a scoping review to determine and map out the existence of programmes for managing cancer. Phase 3 was the development and validation of a programme to support can-cer care and services in primary health care clinics. Findings In Phase 1 (the qualitative phase), four major themes emerged, which were: Lack of knowledge and skills on cancer care; delays in the diagnosis of cancer; the need to support cancer patients; and a programme to guide cancer care services. The results were consistent with findings from cancer patients (quantitative approach). Out of 135 cancer patients interviewed, most patients (80%) rated services from primary healthcare clinics as unsatisfactory, indicated a lack of support from the local clinics, and rated services as poor. Coclusion The study found that primary healthcare clinics in Botswana are currently not ade-quately equipped to deliver comprehensive cancer care services. There is a need to develop and implement a structured programme that focuses on improving healthcare provider competencies, strengthening early detection and referral systems, and en-hancing psychosocial and clinical support for patients. Recommendations The developed programme is envisioned to improve the quality of care for cancer pa-tients. Findings would inform policymakers to resource primary healthcare clinics, such as availing oncology-trained personnel and upskilling those not trained in oncology. A programme would promote standardisation of care to improve cancer service delivery and may also serve as a model for other countries with similar backgrounds and needs.