Health facility preparedness for early detection of symptomatic cancer in Southern Africa: a multi-centre cross-sectional study

BackgroundFor early detection and diagnosis of cancer to become a reality in African contexts, health services should identify people with symptoms suggestive of cancer, refer timeously, and implement diagnostic processes efficiently. This requires health facilities to have the necessary resources and infrastructure to provide these services. This study, the first in Southern Africa, reports on the availability of these services across referral pathways in four provinces of two Southern African countries, South Africa (SA) and Zimbabwe. MethodsAs part of the African Awareness of Cancer and Early Diagnosis (AWACAN-ED) programme, we conducted a quantitative cross-sectional study, from February to September 2023 at primary, secondary and tertiary level public sector health facilities. Data were collected on the availability of staff, infrastructure, diagnostic services, referral pathways and community engagement, and analysed descriptively. ResultsA total of thirty-four (N=34) facilities were included. Of these, twenty-two were primary care facilities, serving an estimated population of 1,068,177, with a nurse-to-people ratio of 0.46 per 1000 people, and doctor-to-people ratio of 0.04 per 1000 people. Twelve (n=12) secondary/tertiary (ST) facilities were included, serving a population of 18,750,387, with a nurse-to-people ratio of 0.3 per 1000 people, and doctor-to-people ratio of to 0.06 per 1000 people. There were differences between primary care versus secondary/tertiary facilities in availability of adequate communication infrastructure (29% vs 42%); patient transport systems (50% vs 100%); cervical smears/visual inspection (77% vs 100%) and colorectal clinical assessment (9% vs 58%). Mammography was not available at any Zimbabwean facilities. There was low availability of clinical protocols in primary care for cervical (30%) and breast (9%) cancer, and none for colorectal cancer. Community engagement activities focused on breast and cervical cancer. ConclusionThis study identifies areas for improving early cancer diagnosis and provides a baseline for quality improvement interventions in facility infrastructure and referral pathways.