title: Complex care systems in developing countries: breast cancer patient navigation in Ethiopia.
abstract: BACKGROUND
  As the global visibility and importance of breast cancer increases, especially in developing countries, ensuring that countries strengthen and develop health systems that support prevention, diagnosis, and treatment of a complex chronic disease is a priority. Understanding how breast cancer patients navigate health systems to reach appropriate levels of care is critical in assessing and improving the health system response in countries to an increasing breast cancer burden in their populations. Ethiopia has accelerated attention to breast cancer, expanding clinical and public health efforts at diagnosing and treating breast cancer earlier and more efficiently.
  
  
  METHODS
  This project used a mixed-method approach to assessing patient navigation of the healthcare system that resulted in care at the cancer referral hospital for Ethiopia (Tikur Anbessa Hospital [TAH]). In total, 69 patients representative of the entire breast cancer clinical population at TAH were interviewed.
  
  
  RESULTS
  Navigation chains are widely divergent and typically involve 3 or more care nodes until they reach the referral hospital. Patients who consult traditional healers have significantly more care nodes to reach the referral hospital than others, and patients who have direct access to local and regional hospitals have the smallest number of care nodes. Patients report moving laterally from 1 health institution to another or regressing to lower levels of care, sometimes complicated by reinvolving traditional healers.
  
  
  CONCLUSIONS
  The care system can be streamlined for breast cancer patients in Ethiopia to facilitate patient access to available and clinically effective diagnostic and treatment services in the country, largely through improving local primary care and hospital capacity to provide basic breast cancer services and improve detection and referral.
authors.affiliation: Axios International, Paris, France. dyet@upstate.edu
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Dye
authors.forename: Solomon
authors.initials: S
authors.lastname: Bogale
authors.forename: Claire
authors.initials: C
authors.lastname: Hobden
authors.forename: Yared
authors.initials: Y
authors.lastname: Tilahun
authors.forename: Vanessa
authors.initials: V
authors.lastname: Hechter
authors.forename: Teshome
authors.initials: T
authors.lastname: Deressa
authors.forename: Marion
authors.initials: M
authors.lastname: Bizé
authors.forename: Anne
authors.initials: A
authors.lastname: Reeler
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000628:therapy; D003695:Delivery of Health Care; D003906:Developing Countries; D005002:Ethiopia; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D012017:Referral and Consultation; D013997:Time Factors