{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T19:17:36Z","timestamp":1770923856357,"version":"3.50.1"},"reference-count":57,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T00:00:00Z","timestamp":1770854400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Tanzania Comprehensive Cancer Project","award":["TCCP\/BCRI\/2022\/10"],"award-info":[{"award-number":["TCCP\/BCRI\/2022\/10"]}]},{"name":"Tanzania Comprehensive Cancer Project","award":["TCCP\/BCRI\/2022\/10"],"award-info":[{"award-number":["TCCP\/BCRI\/2022\/10"]}]},{"name":"Tanzania Comprehensive Cancer Project","award":["TCCP\/BCRI\/2022\/10"],"award-info":[{"award-number":["TCCP\/BCRI\/2022\/10"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The rising burden of chronic illnesses due to Communicable Diseases and Non-communicable Diseases has heightened the need for palliative care services globally. The World Health Organisation (WHO) advocates for palliative care integration from the lower levels of the healthcare system. However, health systems in many low\u2014and middle-income countries suffer from a lack of palliative care services at the lower level.<\/jats:p>\n                    <jats:p>This study aimed to explore the perceptions of the hospital in charge (the managers from 15 Health Centre facilities) on available healthcare services that can facilitate the integration of palliative care services at primary care facilities in Dar es Salaam, Tanzania.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods and findings<\/jats:title>\n                    <jats:p>An exploratory qualitative case study on the perceptions of purposefully selected health facilities in charge of the available healthcare services, which can be used to facilitate the integration of palliative care services in primary care facilities. A semi-structured interview guide was used to conduct in-depth interviews with the selected informants. Data was analysed using a content analysis approach. Two categories emerged from the in-depth interviews: the availability of physical support services to manage pain and symptoms and multiple support systems to facilitate care for patients with chronic illnesses. Health facilities in charge consider the availability of various healthcare services at primary healthcare facilities essential for integrating palliative care services at this level. However, these services do not work in the context of palliative care and lack the philosophy behind it.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The availability of these services is a starting point for developing palliative care philosophy and, thus, its integration. Capacity building on palliative care services at the Primary health care facilities is recommended.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0342485","type":"journal-article","created":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T18:27:00Z","timestamp":1770920820000},"page":"e0342485","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Struggles for provision of palliative care services at the primary healthcare setting in Tanzania; Experiences from health facility in-charges in Dar es Salaam; A qualitative study"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7567-1437","authenticated-orcid":true,"given":"Christina Vallen","family":"Malichewe","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Furahini","family":"Yoram","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juda","family":"Lyamai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Veronica","family":"Mkusa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George","family":"Kiwango","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Obadia","family":"Nyongole","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5205-624X","authenticated-orcid":true,"given":"Nathanael","family":"Sirili","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,2,12]]},"reference":[{"issue":"1","key":"pone.0342485.ref001","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1136\/bmjspcare-2012-000215","article-title":"How to design and implement palliative care public health programmes: foundation measures. An operational paper by the WHO Collaborating Centre for Public Health Palliative Care Programmes at the Catalan Institute of Oncology","volume":"3","author":"X G\u00f3mez-Batiste","year":"2013","journal-title":"BMJ Support Palliat Care"},{"issue":"8","key":"pone.0342485.ref002","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1089\/jpm.2019.0696","article-title":"Palliative Care Advocacy: Why Does It Matter?","volume":"23","author":"KI Pettus","year":"2020","journal-title":"J Palliat Med"},{"key":"pone.0342485.ref003","article-title":"Primary health care performance: a scoping review of the current state of measurement in Africa","volume":"4","author":"B Graham","year":"2019","journal-title":"BMJ Global Health"},{"key":"pone.0342485.ref004","author":"WHO","year":"2020"},{"issue":"1","key":"pone.0342485.ref005","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1186\/s12913-021-06278-7","article-title":"Health care providers\u2019 experiences of pain management and attitudes towards digitally supported self-management interventions for chronic pain: a qualitative study","volume":"21","author":"C Varsi","year":"2021","journal-title":"BMC Health Serv Res"},{"issue":"9","key":"pone.0342485.ref006","doi-asserted-by":"crossref","first-page":"1743","DOI":"10.1185\/03007995.2015.1072088","article-title":"A holistic approach to chronic pain management that involves all stakeholders: change is needed","volume":"31","author":"H-G Kress","year":"2015","journal-title":"Curr Med Res Opin"},{"issue":"7","key":"pone.0342485.ref007","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1016\/j.mayocp.2016.04.029","article-title":"Chronic Pain and Mental Health Disorders: Shared Neural Mechanisms, Epidemiology, and Treatment","volume":"91","author":"WM Hooten","year":"2016","journal-title":"Mayo Clin Proc"},{"key":"pone.0342485.ref008","doi-asserted-by":"crossref","DOI":"10.1089\/jpm.2017.0392","article-title":"A Review of the Essential Components of Quality Palliative Care in the Home","volume":"21","author":"H Seow","year":"2018","journal-title":"J Palliat Med"},{"issue":"1","key":"pone.0342485.ref009","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1186\/s12904-020-00558-5","article-title":"Challenges on the provision of palliative care for patients with cancer in low- and middle-income countries: a systematic review of reviews","volume":"19","author":"H Abu-Odah","year":"2020","journal-title":"BMC Palliat Care"},{"issue":"1","key":"pone.0342485.ref010","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1177\/0269216320956825","article-title":"Prevalence of burnout in healthcare professionals providing palliative care and the effect of interventions to reduce symptoms: A systematic literature review","volume":"35","author":"A-FQ Dijxhoorn","year":"2021","journal-title":"Palliat Med"},{"issue":"3","key":"pone.0342485.ref011","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1007\/s11606-014-3100-x","article-title":"Challenges in referral communication between VHA primary care and specialty care","volume":"30","author":"JL Zuchowski","year":"2015","journal-title":"J Gen Intern Med"},{"issue":"1","key":"pone.0342485.ref012","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1186\/s12889-021-10630-1","article-title":"The impacts of collaboration between local health care and non-health care organizations and factors shaping how they work: a systematic review of reviews","volume":"21","author":"H Alderwick","year":"2021","journal-title":"BMC Public Health"},{"issue":"10","key":"pone.0342485.ref013","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2024-085746","article-title":"Challenges and opportunities for strengthening palliative care services in primary healthcare facilities: perspectives of health facilities in-charges in Dar es Salaam, Tanzania","volume":"14","author":"N Sirili","year":"2024","journal-title":"BMJ Open"},{"key":"pone.0342485.ref014","volume-title":"Primary health care systems (PRIMASYS): comprehensive case study from United Republic of Tanzania","author":"PRIMASYS","year":"2017"},{"issue":"2","key":"pone.0342485.ref015","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"V Braun","year":"2006","journal-title":"Qualitative Research in Psychology"},{"issue":"5","key":"pone.0342485.ref016","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0232076","article-title":"A simple method to assess and report thematic saturation in qualitative research","volume":"15","author":"G Guest","year":"2020","journal-title":"PLoS One"},{"issue":"2","key":"pone.0342485.ref017","doi-asserted-by":"crossref","first-page":"65","DOI":"10.34172\/jqr.2024.10","article-title":"Culture of Nursing Care in Iranian Nursing Homes: An Ethnographic Study","volume":"13","author":"B Pouraboli","year":"2024","journal-title":"J Qual Res Health Sci"},{"issue":"3","key":"pone.0342485.ref018","doi-asserted-by":"crossref","first-page":"23","DOI":"10.29333\/ajqr\/14887","article-title":"Inter-Coder Agreement in Qualitative Coding: Considerations for its Use","volume":"8","author":"SN Halpin","year":"2024","journal-title":"Am J Qualitative Res"},{"key":"pone.0342485.ref019","first-page":"426","article-title":"Reflexivity in Qualitative Research: A Journey of Learning","volume":"22","author":"E Palaganas","year":"2017","journal-title":"The Qualitative Report"},{"key":"pone.0342485.ref020","volume-title":"Integrating palliative care and symptom relief into primary health care: a WHO guide for planners, implementers and managers","author":"WHO","year":"2018"},{"issue":"1","key":"pone.0342485.ref021","first-page":"87","article-title":"Health education as a tool for effective primary health care services","volume":"3","author":"SK Brar","year":"2018","journal-title":"International Journal of Yogic, Human Movement and Sports Sciences"},{"issue":"5","key":"pone.0342485.ref022","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0125004","article-title":"Primary care patients\u2019 perspectives of barriers and enablers of primary prevention and health promotion-a meta-ethnographic synthesis","volume":"10","author":"P Moreno-Peral","year":"2015","journal-title":"PLoS One"},{"issue":"2","key":"pone.0342485.ref023","doi-asserted-by":"crossref","first-page":"2248","DOI":"10.4081\/jphia.2023.2248","article-title":"Assessment of the implementation of health education in primary health care facilities, Kavango, East Region, Namibia","volume":"14","author":"F N Nakakuwa","year":"2023","journal-title":"J Public Health Afr"},{"key":"pone.0342485.ref024","doi-asserted-by":"crossref","unstructured":"Swathi M, Manjusha S, Vadakkiniath IJ, A G. Prevalence and correlates of stress, anxiety, and depression in patients with chronic diseases: a cross-sectional study. Middle East Current Psychiatry. 2023;30(1):66.","DOI":"10.1186\/s43045-023-00340-2"},{"issue":"4","key":"pone.0342485.ref025","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1016\/j.jpainsymman.2020.04.027","article-title":"Redefining Palliative Care-A New Consensus-Based Definition","volume":"60","author":"L Radbruch","year":"2020","journal-title":"J Pain Symptom Manage"},{"issue":"1","key":"pone.0342485.ref026","doi-asserted-by":"crossref","DOI":"10.4102\/phcfm.v14i1.3657","article-title":"The role of community health workers in palliative care in a rural subdistrict in South Africa","volume":"14","author":"EM Van Heerden","year":"2022","journal-title":"Afr J Prim Health Care Fam Med"},{"issue":"5","key":"pone.0342485.ref027","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2020-002368","article-title":"Community health workers in palliative care provision in low-income and middle-income countries: a systematic scoping review of the literature","volume":"5","author":"MC MacRae","year":"2020","journal-title":"BMJ Glob Health"},{"key":"pone.0342485.ref028","doi-asserted-by":"crossref","first-page":"733","DOI":"10.12688\/f1000research.111644.1","article-title":"Improving symptom assessment and management in the community through capacity building of primary palliative care: A study protocol of exploratory research","volume":"11","author":"MG Nayak","year":"2022","journal-title":"F1000Res"},{"issue":"3","key":"pone.0342485.ref029","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1111\/j.1365-2524.2012.01092.x","article-title":"The role of healthcare support workers in providing palliative and end-of-life care in the community: a systematic literature review","volume":"21","author":"OR Herber","year":"2013","journal-title":"Health Soc Care Community"},{"issue":"3","key":"pone.0342485.ref030","doi-asserted-by":"crossref","first-page":"99","DOI":"10.2344\/0003-3006-61.3.99","article-title":"OFIRMEV: an old drug becomes new again","volume":"61","author":"RN Nishimoto","year":"2014","journal-title":"Anesth Prog"},{"issue":"1","key":"pone.0342485.ref031","doi-asserted-by":"crossref","first-page":"50","DOI":"10.4103\/1117-1936.163367","article-title":"A Comparative Study of a Combination of Paracetamol Infusion (Perfalgan) and Intramuscular Diclofenac versus Intravenous Pethidine, in the Management of Post Caesarean Pain","volume":"22","author":"HO Idehen","year":"2015","journal-title":"Niger Postgrad Med J"},{"issue":"4","key":"pone.0342485.ref032","doi-asserted-by":"crossref","first-page":"983","DOI":"10.18203\/2320-1770.ijrcog20240799","article-title":"Comparative study of diclofenac, paracetamol infusion, or a combination in post-caesarean patients for pain management","volume":"13","author":"AS Choudhary","year":"2024","journal-title":"Int J Reprod Contracept Obstet Gynecol"},{"issue":"2","key":"pone.0342485.ref033","doi-asserted-by":"crossref","DOI":"10.1016\/j.bja.2019.02.028","article-title":"Nonsteroidal anti-inflammatory drugs and pain in cancer patients: a systematic review and reappraisal of the evidence","volume":"123","author":"DJ Magee","year":"2019","journal-title":"Br J Anaesth"},{"issue":"6","key":"pone.0342485.ref034","doi-asserted-by":"crossref","first-page":"764","DOI":"10.1093\/bja\/aer107","article-title":"Single-dose intravenous paracetamol or propacetamol for prevention or treatment of postoperative pain: a systematic review and meta-analysis","volume":"106","author":"ED McNicol","year":"2011","journal-title":"Br J Anaesth"},{"issue":"3","key":"pone.0342485.ref035","doi-asserted-by":"crossref","first-page":"159","DOI":"10.4314\/thrb.v10i3.14356","article-title":"The status of occupational safety among health service providers in hospitals in Tanzania","volume":"10","author":"SV Manyele","year":"2008","journal-title":"Tanzan J Health Res"},{"issue":"10","key":"pone.0342485.ref036","first-page":"787","article-title":"Injection safety: a global challenge","volume":"77","author":"YJ Hutin","year":"1999","journal-title":"Bull World Health Organ"},{"issue":"9","key":"pone.0342485.ref037","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0002401","article-title":"Views and experiences of opioid access amongst palliative care providers and public representatives in a low-resource setting: A qualitative interview study","volume":"3","author":"J Clark","year":"2023","journal-title":"PLOS Glob Public Health"},{"issue":"2","key":"pone.0342485.ref038","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1016\/j.jfma.2020.09.011","article-title":"Increasing tramadol utilisation under strict regulatory control of opioid prescribing - A cross-sectional study in Taiwan from 2002 through 2016","volume":"120","author":"T-C Chen","year":"2021","journal-title":"J Formos Med Assoc"},{"key":"pone.0342485.ref039","volume-title":"Cancer pain management in Tanzania: using scenarios to explore critical interrelationships and potential interventions","author":"I Steenmans","year":"2021"},{"key":"pone.0342485.ref040","volume-title":"Barriers to morphine use in primary care in the Cape Town metropole","author":"G Hofmeyr","year":"2023"},{"key":"pone.0342485.ref041","volume-title":"An analysis of Oral Morphine use at Primary Healthcare facilities in the Cape Town Metro Health District","author":"G Hofmeyr","year":"2022"},{"key":"pone.0342485.ref042","first-page":"265","article-title":"Innovation and Policy in Cancer Pain Management: Systemic Interactions in Tanzania.","volume-title":"Cancer Care in Pandemic Times: Building Inclusive Local Health Security in Africa and India","author":"C Daniels","year":"2024"},{"key":"pone.0342485.ref043","doi-asserted-by":"crossref","first-page":"1829","DOI":"10.2147\/JPR.S410944","article-title":"Challenges of Access to Oral Morphine Medicine: Palliative Care at a Crossroads for Cancer Patients in Ethiopia","volume":"16","author":"AM Fentie","year":"2023","journal-title":"J Pain Res"},{"issue":"7","key":"pone.0342485.ref044","doi-asserted-by":"crossref","first-page":"1323","DOI":"10.1177\/02692163211013248","article-title":"Emotional disclosure in palliative care: A scoping review of intervention characteristics and implementation factors","volume":"35","author":"D McInnerney","year":"2021","journal-title":"Palliat Med"},{"issue":"1","key":"pone.0342485.ref045","first-page":"64","article-title":"Addressing spiritual needs in palliative care: proposal for a narrative and interfaith spiritual care intervention for chaplaincy","volume":"29","author":"IR Wierstra","year":"2023","journal-title":"J Health Care Chaplain"},{"issue":"4","key":"pone.0342485.ref046","doi-asserted-by":"crossref","first-page":"1087","DOI":"10.3390\/rel5041087","article-title":"Spiritual Distress in Bereavement: Evolution of a Research Program","volume":"5","author":"L Burke","year":"2014","journal-title":"Religions"},{"issue":"1","key":"pone.0342485.ref047","first-page":"20","article-title":"Effectiveness of exemption measure in providing health care services among old people in Tanzania: The case of Kasulu District","volume":"28","author":"M Ntahosanzwe","year":"2021","journal-title":"Huria Journal"},{"key":"pone.0342485.ref048","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1186\/1472-6963-13-298","article-title":"Feasibility of introducing compulsory community health fund in low resource countries: views from the communities in Liwale district of Tanzania","volume":"13","author":"B Marwa","year":"2013","journal-title":"BMC Health Serv Res"},{"issue":"24","key":"pone.0342485.ref049","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1016\/S0968-8080(04)24135-0","article-title":"Poor people\u2019s experiences of health services in Tanzania: a literature review","volume":"12","author":"M Mamdani","year":"2004","journal-title":"Reprod Health Matters"},{"issue":"1","key":"pone.0342485.ref050","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1258\/095148406775322061","article-title":"User charges in public health facilities in Tanzania: effect on revenues, quality of services and people\u2019s health-seeking behaviour for malaria illnesses in Korogwe district","volume":"19","author":"G Mubyazi","year":"2006","journal-title":"Health Serv Manage Res"},{"issue":"1","key":"pone.0342485.ref051","first-page":"1","article-title":"The Tanzanian policy on health-care fee waivers and exemptions in practice as compared with other developing countries: Evidence from recent local studies and international literature","volume":"1","author":"G Mubyazi","year":"2004","journal-title":"East African Journal of Public Health"},{"issue":"1","key":"pone.0342485.ref052","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1177\/20534345221122952","article-title":"Social workers coordination in primary healthcare for patients with complex needs: A scoping review","volume":"26","author":"Y Couturier","year":"2022","journal-title":"International Journal of Care Coordination"},{"issue":"8","key":"pone.0342485.ref053","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1177\/02692163241248324","article-title":"Primary palliative care in low- and middle-income countries: A systematic review and thematic synthesis of the evidence for models and outcomes","volume":"38","author":"A Peeler","year":"2024","journal-title":"Palliative Medicine"},{"issue":"5","key":"pone.0342485.ref054","doi-asserted-by":"crossref","first-page":"976","DOI":"10.1007\/s10900-013-9681-1","article-title":"Traveling towards disease: transportation barriers to health care access","volume":"38","author":"ST Syed","year":"2013","journal-title":"J Community Health"},{"issue":"2","key":"pone.0342485.ref055","doi-asserted-by":"crossref","DOI":"10.1002\/hsr2.1881","article-title":"Factors disrupting the continuity of care for patients with chronic disease during the pandemics: A systematic review","volume":"7","author":"M Ghanbari-Jahromi","year":"2024","journal-title":"Health Sci Rep"},{"issue":"1","key":"pone.0342485.ref056","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1186\/s12875-025-02831-z","article-title":"The effect of community-based palliative supportive care integrated with primary health care (PHC) on the outcomes of terminally ill cancer patients","volume":"26","author":"H Hosseini","year":"2025","journal-title":"BMC Prim Care"},{"issue":"9","key":"pone.0342485.ref057","doi-asserted-by":"crossref","DOI":"10.1093\/ageing\/afad175","article-title":"The effectiveness of community-based palliative care programme components: a systematic review","volume":"52","author":"MC Hughes","year":"2023","journal-title":"Age Ageing"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0342485","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T18:27:11Z","timestamp":1770920831000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0342485"}},"subtitle":[],"editor":[{"given":"Martin","family":"Schneider","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,2,12]]},"references-count":57,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2,12]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0342485","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,12]]}}}