Modeling Sustainable, National, Regional and Local Healthcare Systems Based on Childhood Cancer Shared-Care Networks in LMICS

Background: World Child Cancer (WCC) has been working in partnership with pediatric oncology programs in low-middle income countries (LMICs) to support improved services for children with cancer. Central to the success of services is the development of effective shared-care networks situated to match population centers. Literature on how to develop shared-care networks in LMICs does not currently exist. Aim: Modeling sustainable national, regional and local health systems based on childhood cancer shared-care networks in LMICs. Methods: The model was developed through learning from a 3 year UK Government (DFID) funded program in Ghana and Bangladesh and lessons shared from WCC-funded programs in Myanmar and the Philippines. A workshop was held focusing on lessons learned from practitioners representing shared-care networks in different stages of development to identify key elements and steps necessary to build a shared-care network. Results: The overarching themes of the model are; good communication, health partnerships (twinning) and funding. A successful shared-care network must have a strong hub hospital at its center which requires a doctor with training and some experience in pediatric oncology, a committed multidisciplinary team, dedicated bed space, provision for training, patient data accurately recorded, essential medicines available and research opportunities accessible. A health partnership with an external developed center is beneficial. A tangible plan, developed treatment guidelines and protocols, measurable outcomes and financial support are needed for development into a center of excellence. Support would ideally be available for patients and families, to include accommodation, treatment costs, food and transport. Each shared-care center needs an interested doctor, a basic multidisciplinary team, some ward space for oncology patients and the support of the hospital administration. Patient data needs to be stored and there must be a close relationship with the hub center. A development plan is outlined and services provided should replicate the hub as well as resources allow. Major challenges include obtaining support from the hospital administration, and even more importantly, government policies and financing for such developments. Collaborative working and good communication are emphasized by using the same treatment protocols, developing two-way referral systems and sharing challenges and successes. The overarching principle of sustainability requires availability of training within the system and funding. Conclusion: This model can be shared to enable others in LMICs to access the information and inform their systems development. While the model is not exhaustive and requires further research, it represents an important first step with lessons learned from practitioners with experience. The inclusion of such practitioners in the process of developing this model is essential for sustainability.