Complex Care Systems in Developing Countries: Breast Cancer Patient Navigation in Ethiopia

This study traced how 69 breast cancer patients at Ethiopia’s only cancer referral hospital actually made their way through the health system, from first noticing symptoms to reaching specialized treatment. It found that patients typically passed through three or more different care sites, often backtracking or repeating steps along the way, revealing just how inefficient and confusing the path to cancer care can be in a country with limited health infrastructure.

• More than half of patients first sought care at a basic primary clinic, but 16% went to a traditional healer first, and those patients ended up needing the most stops (nearly 4 on average) before reaching proper cancer treatment.
• Nearly a quarter of patients “reverse-navigated,” meaning they left an appropriate level of care and went backward to a lower one, or repeated visits to similar-level clinics, both of which wasted precious time.
• Family members often played a critical role in pushing patients toward care, while fear, disbelief of a diagnosis, and the cost or unavailability of chemotherapy (in one case requiring a family to import it from Egypt) further delayed treatment.
• The study suggests Ethiopia’s central cancer hospital could reduce these bottlenecks by more closely coordinating with local clinics and regional hospitals, so patients are diagnosed and referred correctly the first time instead of ricocheting between facilities.