African Journal of Surgery | 01 December 2003
Evaluating the Feasibility and Perceived Outcomes of a Pilot Programme for Decentralised Breast Cancer Surgery with Oncoplastic Techniques in Ugandan District Hospitals
M, o, s, e, s, K, a, t, o
Abstract
Breast cancer management in Uganda is centralised, creating significant access barriers. Oncoplastic techniques, which combine tumour excision with breast conservation, are seldom available outside specialised centres. While decentralising such surgery could improve access, its feasibility in resource-limited district hospitals is not established. This study aimed to evaluate the feasibility and perceived outcomes of a pilot programme for decentralised breast cancer surgery using oncoplastic techniques in Ugandan district hospitals, linked to central oncology services. A qualitative, descriptive study was conducted. Semi-structured interviews were held with a purposive sample of surgical providers, hospital administrators, and patients involved in the pilot programme across two district hospitals. Data were analysed using thematic analysis. The programme was perceived as feasible and beneficial. A dominant theme was improved patient access, with reduced travel and financial burdens. Key challenges included intermittent supply of specific surgical materials and the need for ongoing mentorship. Most provider participants reported increased confidence in performing breast-conserving procedures. Patient participants expressed satisfaction with cosmetic outcomes and care continuity. Decentralising oncoplastic breast surgery to district hospitals with central support is feasible and perceived to improve access and patient satisfaction. Successful scale-up requires addressing supply chain issues and sustaining mentorship. Specific recommendations include integrating oncoplastic training into Ugandan surgical residency programmes; developing standardised surgical kits and reliable supply chains for district hospitals; and establishing a formalised telemedicine mentorship network with central units. Breast cancer surgery, oncoplastic surgery, decentralisation, district hospitals, qualitative research, Uganda, global surgery This study provides qualitative evidence on the implementation of decentralised oncoplastic surgery in a sub-Saharan African context, informing health system strategies to improve equitable cancer care access.