Abstract: Timely and appropriate care reduces the risk of mortality and disability after stroke. Despite high stroke incidence, little is known about the specific barriers to accessing stroke care in Zanzibar, East Africa. The aim of this study was to investigate healthcare providers’ perspectives regarding the barriers to stroke care at the main referral hospital in Zanzibar. We used a phenomenological approach and conducted 14 individual semi-structured interviews with healthcare providers at Mnazi Mmoja Referral Hospital in Zanzibar. The interviews took place from April through September 2022. Thematic network analysis was applied to analyse and interpret the data. Three broad themes and eleven sub-themes were identified, relevant at specific stages in the patient’s care pathway from deciding to seek care over receiving acute stroke care in hospital to accessing post-stroke care. These themes include health system barriers (medical supplies and equipment; staff shortages; attitudes and teamwork; organization of services; health education); patient-level factors (health literacy; relational factors; worries and feeling hopeless; financial constraints); and cultural context (stroke as a spiritual malady; trust, mistrust and power). Some of the sub-themes of barriers were similar to findings from other studies in both high and low-resource settings, such as shortages of medical supplies, equipment and staff, and sub-optimal organization of care. Other sub-themes were unique findings to low-resource settings, such as Zanzibar, and included relational factors and patients’ perception of stroke as a spiritual malady. Interventions to improve stroke care should be informed by all these findings. Otherwise, focus only on removing barriers related to availability of stroke treatment in hospital may divert attention from significant cultural factors that affect health care seeking behaviour.
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