Background/AimsWorld Child Cancer has created twinning partnerships with developing oncology services in low-middle income countries (LMICs) to support improvement of services for children with cancer. Central to success for these is the creation of effective shared-care networks not just single centre support.There is a dearth of good literature on network development. Our aim was to create an ideal model.MethodsThe model was developed through learning from a 3 year UK Government(DFID) funded programme in Ghana and Bangladesh in which new shared care units were created and from lessons shared from other WCC-funded programmes in Myanmar and the Philippines. A 2 dayworkshop was held,focussing on lessons learnt from paediatricians representing networks in different stages of development to identify key elements and steps necessary to optimise planning.ResultsThe over-arching proposed themes for the model were need for; excellent,regular communication between the centres;twinning partnerships and funding.A succesful shared- care network must have a strong hub hospital at its centre with at least one fully trained paediatric oncologist and a committed multi-disciplinary team. The hub (referral) centre must have dedicated space/beds,develop treatment guidelines and protocols and provide training for the staff populating the satellite units.Shared- care centres must, be strategically chosen based on population demography and accessibility, create development plans and service provision to replicate the hub centre as close as resources allow… Collaborative working and good communication, using the same treatment protocols, developing two-way referral systems and sharing successes and any failures are essential. Sustainable development is ensured through a step -by step process, funding support, and ongoing opportunities within the network.ConclusionWe hope that this model can be shared to enable others to access it and help iinform their systems development. Whilst the model is not exhaustive and requires further research,it represents a first step,with lessons learnt from paediatricians with actual experience of creating such networks. Hub and spoke service provision better meets the needs of all children no matter where they live in the world.
BackgroundThere is increasing anxiety worldwide that the World Health Organisation recommended Essential Medicines may not be universally available,accessible,affordable and of good quality.Aims/methodsWe wished to seek the perceptions of 10 lead paediatricians treating children with cancer in 9 low-middle income countries. We used a 17 point semi-structured questionnaire to gather the information. this study involved doctors in Cameroon,Ghana, Malawi,Tanzania,Zambia, Bangladesh,Myanmar, The Philippines,and Colombia. Collectively the centres were seeing overr 2000 new patients annually of whom a median of 65% (range 5%–90%) received ‘curative intent’ therapy.ResultsOnly Bangladesh produced any but not all the required cytotoxics. All countries were required to import some or all the medicines.In only 3 countries did the Ministry of Health directly oversee procurement/importation of drugs.In 5 delegated pharmacies or a single hospital was responsible. in Bangladesh there was a free market approach for procurement and importation. Inconsistent supplies were cited by all respondents especially of critical drugs including antibiotics,morphine,6-mercaptopurine, methotrexate,cytosine, asparaginase, and vincristine. Reasons cited for no-importation were non/or late renewal of licences to import, reluctance to procure low profit or low volume drugs and anxieties regarding importation of opiates. Medicines were imported from a range of countries most commomly from India (7/9) and China (often via India), argentina,Brazil, South Kores, Cyprus and Malaysia. All respondents expressed anxiety about drug quality imported with no International Quality Certification. High rates of treatment refusal/abandonment (20% median range <5%–50%) were most often attributedto non-affordability by parents unless some subsidies were available.ConclusionsFrom these perceptions there are major obstacles to be overcome to ensure that all children can receive the medicines they need for any chance of cure certainly those living in low-middle income countries. There are challenges at each stage from production to the bedside and only a truly global effort by all interested parties including the WHO and the Pharmaceutical Industry can resolve these issues.
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