Technical Capacity Reinforcement of the Oncology Unit at Nelson Mandela Academic Hospital: Impact on Access and Quality of Cancer Care

Abstract

Background: Rural and remote areas suffer from inadequate resources for healthcare, including cancer care. In the bid to improve access to and quality of cancer care, the South African government initiated a policy of decentralising cancer care services. This study aimed to appraise the impact of technical capacity reinforcement on access to and quality of cancer care services provided at Nelson Mandela Academic Hospital (NMAH) in South Africa’s Eastern Cape (EC) province. Methodology: A concurrent mixed-methods study design through which a descriptive, quantitative cross-sectional design and in-depth, semi-structured interviews were adopted. The cross-sectional design served to describe cancer prevalence among patients attending NMAH, while the in-depth interviews explored patients’ experiences with access and care quality before and after decentralisation. The statistical software analysis package Epi Info version 7.2.5.0 and the Advance Excel statistical analysis package version 2306 were used for the statistical analysis of quantitative data. While analysis of qualitative data was performed using the Robert codebook interpretation framework. Results: Of the 120 randomly sampled participants for the quantitative study, 122 types of cancer were recorded. A total of 80.8% (n = 97/120) participants were female, and 94.2% (n = 113/120) were unemployed. Patients’ ages ranged from 10 to 93 years, with a median age of 52 years (25th percentile: 42 years, 75th percentile: 67 years). Cervical and breast cancers were prevalent in 25.4% (n = 31/122; 95% Confidence Interval (95%CI): 0.2-0.3) and 23.0% (n = 28/122; with 95%CI: 0.2-0.4) of sampled records, respectively. The qualitative investigation enabled exploration of five main themes: cancer care context in the province, cancer care continuum at primary care services, cancer's emotional toll and social experiences, unequal paths to healing: services before decentralisation, decentralization: perceptions of accessibility and quality in care and twelve sub-themes. Of the twenty interviewed participants, fourteen had cervical cancer. Participants reported that the change to NMAH as the point of care for chemotherapy, had improved access with significant financial relief for patients while maintaining a high standard of care. Conclusion: Despite the current gap in cancer care services, available decentralise services provided at NMAH in the EC province are of high standard. Notwithstanding the improved accessibility, the provision to include radiotherapy will enhance services offered at this health facility.