Transport stipend to facilitate cancer early detection: experiences of beneficiaries and perspectives of program personnel in Rwanda
Transportation barriers can hinder patients' access to timely cancer diagnosis and treatment, particularly in low- and middle-income countries. In Rwanda, where cervical and breast cancer burdens are high, support through transport stipends can alleviate transportation barriers and improve patient outcomes. This study aims to understand the experiences and perspectives of women beneficiaries and program personnel involved in Rwanda's Bugesera District transport stipend program. Purposive sampling selected seventeen participants for in-depth interviews, including twelve women beneficiaries and five program personnel. Document review and household visits provided context. From September 2021 to May 2023, 204 women attended follow-ups for cervical and breast cancer screening and 75% of them received transport stipends. Five themes emerged from beneficiaries' interviews: financial difficulties in accessing transportation for cancer care, impact of transport stipend on access to cancer services, barriers faced during transportation to cancer services, challenges in the process of receiving transport stipend, and recommendations to overcome stipend provision challenges. Five themes emerged from program personnel's interviews: impact of transportation stipend on access to cancer services, challenges in the process of providing transport stipend, recommendations to overcome stipend provision challenges, recommendations for implementation of transport stipend in other settings, and sustainability. The stipend was found to be impactful, but challenges in the provision process, including communication and delays, were identified. Insufficiency of the stipend was highlighted, with recommendations to expand coverage to other expenses. The study highlights the role of transport stipends in improving cancer early detection and linkage to needed follow-up and recommends strong partnerships and funding for program replication and sustainability. These findings can inform the planning of similar programs in low-income countries of Sub-Saharan Africa.