BACKGROUND : Cervical cancer is a major cause of morbidity and mortality among women yet access to treatment
and care remains a huge challenge in Zimbabwe. The objective of this study was to investigate health system
constraints affecting engagement into treatment and care by women with cervical cancer in Harare, Zimbabwe.
METHODS : A sequential explanatory mixed methods design was used for this study. Phase 1 comprised of two
surveys namely: patient and health worker surveys with sample sizes of 134 and 78 participants respectively.
Validated structured questionnaires programmed in Android tablet with SurveytoGo software were used for data
collection during the surveys. Univariate analyses were conducted using STATA® version 14 to generate descriptive
statistics. In phase 2, 16 in-depth interviews, 20 key informant interviews and 6 focus groups were conducted to
explain survey results. Participants were purposively selected and sample sizes were informed by saturation
principle. Participants in phase 1 and 2 were different. English transcripts were manually coded line by line in
Dedoose software using the thematic codes that had been established from the survey data. The final codes were
used to support and explain the survey data at the interpretation stages.
RESULTS : Health system constraints identified in surveys were: limited or lack of training for health workers,
weakness of surveillance system for cervical cancer, limited access to treatment and care, inadequate health
workers, reliance of patients on out-of-pocket funding for treatment services, lack of back-up for major equipment.
Qualitative inquiry revealed the following barriers to treatment and care: high costs of treatment and care, lack of
knowledge about cervical cancer and bad attitudes of health workers, few screening and treating centres located
mostly in urban areas, lack of clear referral system resulting in bureaucratic processes, and limited screening and
treating capacities in health facilities due to lack of resources.
CONCLUSION: The results of this study show that health system and its organization present barriers to access of
cervical cancer treatment and care among women. Strong political will, mobilization of resources both domestically
and from partners in addition to sound policies are imperative to address key health system challenges.
Additional file 1. Validated structured questionnaire for healthy women
and cervical cancer patients [English & Shona].
Additional file 2. Validated structured questionnaire for health workers
Additional file 3. In-depth interview guide [English and Shona].