Exploring Access to Care in Zimbabwe Using the 3-Delay Model

Objective(s)

We aim to identify the diversity of barriers to care for otolaryngology-head and neck surgery patients in Harare, Zimbabwe.

Methods

Interviews were conducted at four general otolaryngology clinics in Harare in October 2022.

The patient population included children and adults presenting to either government or private clinics. Via interpreter, six standardized questions were discussed with each patient. Survey responses were used to categorize patients into one or more of three types of delays: (1) deciding to seek care, (2) reaching the appropriate healthcare facility, and (3) receiving adequate care after reaching that facility.

Results

Forty-six patients participated in this survey. The average time from problem presentation to treatment in this population was 16.3 months. Twenty-six percent of patients experienced more than one type of delay. The most common type of delay was Type 3 (67%). Many of these patients reached appropriate facilities but could not receive timely treatment due to lengthy wait times. Type 1 delays affected 35% of patients. Notable causes were fear of doctors, preference for traditional healing, or ignorance to a treatable problem. Type 2 delays were also reported in 37%, commonly due to long distance and time to travel and insufficient finances for these journeys.

Conclusions

ENT patients in Zimbabwe experience a myriad of delays to receiving appropriate care. Systemic issues, including backlogged surgical lists, convoluted referral patterns, and poor transportation infrastructure, are significant contributors to patient delays. The 3-delay model is useful for identifying barriers to care for future efforts to improve patient access to safe and affordable surgical care.

Level of Evidence

Level VI.