Implementation of Transport Stipend in Cervical and Breast Cancer Services: The Expiriences of Women Beneficiaries and Perspectives of Program Personnel In Bugesera District, Rwanda

Background:
Barriers preventing timely transportation to health facilities may impact patients’
adherence to accessing cancer diagnostic, treatment, and management services. In Rwanda where
the burden of cervical and breast cancer is high with 13.9% and 14.0% incidence and 13.7% and
10.5% mortality rate respectively, economic support through transport stipend provision can help
alleviate financial burdens, increase follow-up, and improve patient health outcomes (IARC,
2020b). According to Habinshuti et al. (2020) and O’Neil et al. (2019), they also found the lossto-
follow-up rate of cervical and breast cancer patients in their sample population in Rwanda to
be 40.1% and 14.0% respectively. The study aims to understand the respective experiences and
perspectives of women beneficiaries and program personnel involved in the transport stipend
provision program of Rwanda’s Bugesera District.

Methods:
This descriptive qualitative study used purposive sampling to select seventeen
participants for in-depth interviews. Twelve women beneficiaries who received the transport
stipend as part of the BIO Ventures (BVGH) for Global Health Educate, Screen, and Treat (EST)
program were selected using maximum variation based on their age, distance to the health
facility, number of referrals, and insurance category. Five program personnel involved in
program planning and stipend provision of the same program were selected based on their period
of participation. Document review of financial reports and transport database provided by BVGH
were used to provide an overview of the program’s stipend eligibility criteria, distribution
process, amount, reach, and cost. To enhance contextual understanding of the women
beneficiaries’ experiences, two household visits were carried out, offering valuable insights into
their journeys to healthcare facilities.

Results:
From the document review, 6730 women were screened for cervical and breast cancer
between September 2021 and May 2023. An overall 7,672 $USD was allocated to the provision
of transport stipend during this period with 2,762 $USD utilized as of the end of data collection
period. The stipend reached 75% of the 204 women who attended follow-ups. The amount of
transport stipend provided to each beneficiary varied based on their distance to the hospital. Five
themes emerged from women beneficiaries’ interviews: (1) financial difficulties in accessing
transportation for cancer care, (2) impact of transport stipend on access to cancer services, (3)
barriers faced during transportation to cancer services, (4) challenges in the process of receiving
transport stipend, and (5) recommendations to overcome transport stipend provision
challenges. Five themes emerged from program personnel’s interviews: (1) impact of
transportation stipend on access to cancer services, (2) challenges in the process of providing
transport stipend, (3) recommendations to overcome transport stipend provision challenges, (4)
recommendations for implementation of transport stipend in other settings, and (5)
sustainability. Both women beneficiaries and program personnel found the transport stipend to
be impactful. However, challenges remain within the provision process related to
communications and delays. Insufficiency of the stipend was highlighted with recommendations
to provide the same amount for all regardless of insurance and distance as well as to increase
coverage to other expenses such as food, accommodation, and travel companions.