Using the Pediatric Oncology Facility Integrated Local Evaluation (PrOFILE) Tool to Evaluate and Improve Pediatric Oncology Systems in Cameroon: A Focus on National, Facility, and Financing Contexts

BACKGROUND: Childhood cancers remain a major cause of morbidity and mortality in low- and middle-income countries (LMICs), where nearly 90% of the world's children live. In 2018, the World Health Organization (WHO) and St Jude Children's Research Hospital launched the Global Initiative for Childhood Cancer (GICC) with the goal of increasing global survival to at least 60% by 2030. Achieving this requires a systematic approach to understanding country-level contexts to guide national planning. METHODS: The Pediatric Oncology Facility Integrated Local Evaluation (PrOFILE) tool was implemented in Cameroon in 2021 to evaluate the national context for childhood cancer care, alongside facility and financing assessments. This paper reports how the PrOFILE assessment informed planning and describes the translation of results into an actionable plan. Stakeholders used an impact-effort matrix to prioritize recommendations. A follow-up review was conducted in 2023 to document progress after two years. Diagnosis- and treatment-specific components of the assessment are being reported separately. RESULTS: The assessment and workshops yielded four overarching themes: (1) workforce development and training of physicians, nurses, supportive care staff, and palliative care providers; (2) strengthening diagnosis and treatment capacity including pathology, timeliness of solid tumor diagnosis, chemotherapy safety, and subspecialty access; (3) improving financial and social support systems including local fundraising and family support; and (4) enhancing patient outcomes through reduction of early deaths and upfront integration of palliative care. At two years, measurable progress had been achieved, particularly in workforce training, expansion of psychosocial and financial support, and integration of palliative care, although gaps remain in diagnostic capacity and government financing. CONCLUSION: The PrOFILE tool facilitated a robust, data-driven prioritization process for childhood cancer care in Cameroon. Two years on, early gains are evident, though sustained efforts are required to address persisting diagnostic and financing barriers.