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Table 3 Factors (barriers and facilitators) classified according to the WHO building blocks

From: Health system factors that influence diagnostic and treatment intervals in women with breast cancer in sub-Saharan Africa: a systematic review

WHO building blocks Factors identified  
  Barriers Facilitators
Service delivery - Delayed test results
- Delayed appointment
- Delayed referral and long primary care interval
- Decreased access to providers and services
- Poor delivery process
- Long wait for surgery/treatment
- One to ≥4 or more healthcare visits between symptom discovery and a breast cancer diagnosis
- Long waiting time in hospital reception
- Difficulty navigating referral system
- Long waiting for imaging/staging investigation
- Long waiting for transfer to health facility offering breast cancer surgery
- Long queue during treatment and drug dispensation
- Lack of cancer service in primary care
- Geographical inaccessibility/long travel distance
- Few diagnostic centres
- Long waiting times for diagnostic confirmation
- Be reffered by an oncologist or surgeon
- Visited a public hospital at the first consultation Short waiting period
Health workforce - Misdiagnosis
- Mismanagement
- Provider misinformation
- Provider’s poor attitude
- Lack of knowledge among providers
- Lack of providers training
- No appropriate physician/unavailability of doctors
- Strike
- Good communication by healthcare providers
Information system - Delayed administrative procedures NA
Health financing - High cost of treatment/investigations
- Lack of insurance
- Limited insurance coverage
- Expensive private insurance
- Discrimination by private insurance
- Financial impact of breast cancer treatment
- Have a healthcare coverage
- availability of free health care
Medication access and technologies - Persistent breakdown of hospital machines/medical Equipment failure
- Shortage of medicine/unavailability of drug
- Lack of screening and diagnostic equipment in local facilities
- Availability of equipment
- Drug availability
Governance/Leadership - Lack of cancer policy
- Low prioritization of NCDs