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Paediatric oncology in the Eastern Mediterranean region (EMR): the current state and challenges
Arsalan Kabir Siddiqui1, Asim Fakhruddin Belgaumi1,2
1All authors have contributed to this manuscript and take responsibility for its contents.
Insights
Childhood cancer care varies greatly across the WHO Eastern Mediterranean Region due to economic diversity. Regional collaboration and initiatives show promise for improving equitable access to quality pediatric oncology services.
Area of Science:
- Global Health
- Pediatric Oncology
- Health Systems Research
Background:
- The WHO Eastern Mediterranean Region (EMR) exhibits significant economic diversity, impacting healthcare system development and childhood cancer care provision.
- Paediatric oncology care ranges from highly sophisticated services in some nations to non-existent provision in others within the EMR.
- The reported age-standardised incidence rate of childhood cancer (10.1 per 100,000) may be underestimated due to potential under-registration.
Purpose of the Study:
- To assess the current state of childhood cancer care in the WHO Eastern Mediterranean Region.
- To identify challenges and opportunities for improving paediatric oncology services and equitable access.
- To highlight the potential for regional collaboration and existing initiatives in enhancing cancer care capacity.
Main Methods:
- A review of healthcare systems and childhood cancer care provision across diverse economic settings in the EMR.
- Analysis of factors influencing care capacity, including provider training, infrastructure, and financial accessibility.
- Examination of the impact of geopolitical instability and natural disasters on healthcare services.
Main Results:
- Significant disparities in paediatric oncology care capacity and access exist across the EMR, influenced by country income levels.
- Shortages of trained healthcare providers are prevalent, particularly in low and lower-middle-income countries, though training programs are emerging.
- High out-of-pocket expenditures (up to 75%) burden families in lower-income nations, with charitable foundations and public hospitals providing some support.
- Geopolitical turmoil and natural disasters have adversely affected healthcare capacity in several regional countries.
Conclusions:
- Substantial inequities in childhood cancer care persist within the EMR, necessitating targeted interventions.
- Regional collaboration, educational support, and twinning programs offer a viable strategy for capacity building and infrastructure improvement.
- Despite challenges, positive change is evident, driven by initiatives like the WHO Global Initiative for Childhood Cancer, indicating an upward trajectory for care improvement.
Abstract:
The WHO Eastern Mediterranean region (EMR) is characterised by highly economically diverse countries, with healthcare systems in various phases of development. Childhood cancer care provision also ranges from that provided in centres able to deliver sophisticated therapy resulting in outcomes comparable to those seen in highly developed nations, to countries with no provision for care of children with cancer. At 10·1 per 100,000 children at risk, the age standardised incidence-rate for cancer in children below 14 years of age is relatively low but may be consequent to poor registration. Shortages in trained care providers were identified in many regional countries, particularly in low and lower-middle income countries, however, implementation of training programs are beginning to counter this deficit. Significant diversity in patient care capacity exists in the region, leading to inequitable access to quality paediatric oncology care. There is strong potential for regional collaboration towards infrastructure and capacity improvement, with facilities available within the EMR for twinning and educational support to those centres and countries that need them. While cancer care coverage is available to citizens of high-income countries, in the lower-income countries out-of-pocket health expenditure can reach 75%. Some relief is achieved through the contribution of multiple charitable foundations working to support childhood cancer care in the region, as well as the provision of care in, often overburdened, public sector hospitals. War and other geo-political turmoil, as well as natural disasters, have negatively impacted healthcare capacity, including childhood cancer care, in several regional countries. Despite all this, the trajectory for change is upward and initiatives such as the WHO Global Initiative for Childhood Cancer are igniting positive change.
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