Table 1 Barriers and opportunities to access oncology care in Mali for women with breast cancer
From: Access to oncology care in Mali: a qualitative study on breast cancer
DEMAND | Ability to perceive | Ability to seek | Ability to reach | Ability to pay | Ability to engage |
Opportunities | Confidence in doctors | Social support and association of patients | |||
Barriers | Lack of information about cancer Representations and beliefs about breast and cancer Confusion surrounding the disease during pregnancy and breastfeeding | Therapeutic wandering Plans and influences of family members to seek treatment abroad Refusal to be amputated | Wandering from one hospital to another Cost of travel and staying in Bamako Cost of back and forth between hospitals The importance of the social network in reaching the top of the health pyramid | Very high cost of examinations and treatment in relation to average salaries | Lack of information about breast reconstruction Redhibitory cost of reconstruction |
SUPPLY | Approachability | Acceptability | Availability and accommodation | Affordability | Appropriateness |
Opportunities | DUa in oncology since 2021 | State funding for chemotherapy drugs and radiotherapy MSFb funding for palliative care and treatment for localised breast cancer | Postmastectomy surgical reconstruction available | ||
Barriers | Limited access to health care facilities in insecure areas Limited screening campaigns Limited number of mammography machines in public hospitals | Lack of communication between carers and patients about diagnosis and treatment Discrimination in access to information based on social class | Few specialised doctors Repeated strikes in public hospitals Technical platform centralised in Bamako and spread over different establishments Dilapidated state of operating theatres and lack of available equipment Only one radiotherapy machine with many breakdowns Frequent chemotherapy drugs stock-outs Targeted therapy (trastuzumab) not available | Incomplete free health care | Misdiagnosis and inappropriate prescriptions received before reaching specialists Lack of breast implant for reconstruction |