PloS one · 2026
Perspectives of stroke survivors, caregivers and healthcare providers on improving access to stroke care services in Tanzania: A qualitative study.
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Michael Nyagwaswa Athanas, Mselle Lilian Teddy, Bureta Costansia Anselim, Cao Yingjuan
Аннотация
BACKGROUND: Stroke is a leading cause of death and disability worldwide, with the greatest burden occurring in in low- and middle-income countries. In Tanzania, delayed hospital presentation, weak referral systems, high out-of-pocket costs, shortages of stroke-ready facilities, and limited rehabilitation services contribute to preventable deaths and long-term disability. Although previous qualitative studies have described barriers to accessing stroke care services, there remains limited evidence on strategies for improving access across the continuum of stroke care. Therefore, this study explored strategies to ensure equitable access to stroke care services in Tanzania, focusing on the perspectives of healthcare providers, stroke survivors, and family caregivers.
MATERIALS AND METHODS: A descriptive qualitative study was conducted at Muhimbili National Hospital- Mloganzila, a national tertiary referral hospital and designated stroke center in Tanzania. A purposive sample of 45 participants was recruited, including 15 healthcare providers, 15 stroke survivors, and 15 caregivers. In-depth semi-structured interviews were conducted between June and September 2024. Interviews were transcribed verbatim and analyzed using thematic analysis guided by the WHO health system building blocks framework.
RESULTS: Thematic analysis identified six themes aligned with the WHO health system building blocks. These include: (1) raise public awareness on stroke risks, prevention and treatment; (2) strengthen stroke care resources and infrastructures at primary care facilities; (3) increase healthcare financing and stroke services insurance coverage; (4) integrate health information systems in stroke care; (5) train multidisciplinary teams in stroke care and effective communication; and (6) improve stroke care services delivery across care continuum.
CONCLUSION: Improving access to stroke care requires both patient-centered and health system-level interventions across the continuum of care. Strengthening public awareness, healthcare infrastructures, referral pathways, service delivery, rehabilitation access, workforce capacity, and health insurance coverage may reduce inequities in accessing stroke care services in Tanzania.
MATERIALS AND METHODS: A descriptive qualitative study was conducted at Muhimbili National Hospital- Mloganzila, a national tertiary referral hospital and designated stroke center in Tanzania. A purposive sample of 45 participants was recruited, including 15 healthcare providers, 15 stroke survivors, and 15 caregivers. In-depth semi-structured interviews were conducted between June and September 2024. Interviews were transcribed verbatim and analyzed using thematic analysis guided by the WHO health system building blocks framework.
RESULTS: Thematic analysis identified six themes aligned with the WHO health system building blocks. These include: (1) raise public awareness on stroke risks, prevention and treatment; (2) strengthen stroke care resources and infrastructures at primary care facilities; (3) increase healthcare financing and stroke services insurance coverage; (4) integrate health information systems in stroke care; (5) train multidisciplinary teams in stroke care and effective communication; and (6) improve stroke care services delivery across care continuum.
CONCLUSION: Improving access to stroke care requires both patient-centered and health system-level interventions across the continuum of care. Strengthening public awareness, healthcare infrastructures, referral pathways, service delivery, rehabilitation access, workforce capacity, and health insurance coverage may reduce inequities in accessing stroke care services in Tanzania.