Discussion
The PrOFILE tool provided a baseline assessment of childhood cancer services in Kenya which was the first of its kind in the country. It allowed multidisciplinary teams from various locations in Kenya to work collaboratively. The workshop participants assumed an active role in identifying barriers and opportunities to achieve the common goal of improving the cure rate of children with cancer in Kenya. They were able to identify goals and develop actionable objectives that they can take ownership of accomplishing. Kenya was the first country to conduct this workshop in hybrid format, which was successfully completed, with demonstrated benefits and challenges.
The hybrid setting allowed participation of global collaborators and Kenyan teams from different regions with diverse access to resources, some of whom were not able to travel. To facilitate participation of on-line participants in this hybrid setting, an on-line presentation about concept definitions related to the respective activity and instructions was incorporated prior to each of the 4 PrOFILE activities. However, one limitation of the hybrid setting includes virtual participants having limited interactions with in-person participants. The potential for less effective exchange of ideas and experiences when discussed virtually also exists. The focus of plans for the upcoming years was based on results from small group sessions, which were predominantly attended by in-person participants due to the availability and time differences of virtual attendees, especially the international collaborators.
The initiative and hybrid format were felt to be highly valuable by participants, with results able to encompass all the health systems that are needed to improve the survival of children with cancer in the country. The various members at the workshop were voluntarily assigned to each of the working groups after the conclusion of the workshop, with a team leader appointed for each; the National Context, Diagnostic, Workforce, Therapeutic and Patient Outcomes working groups. The working groups agreed to meet individually to accomplish their group objectives and monitor the milestones of their objectives at key time points to ensure that they are achieved before the 2-year period. The team leaders of each working group agreed to meet every 3 months to coordinate their activities.
Subsequent to this workshop, the Kenyan NCI developed a Multi-disciplinary Advisory Committee with 5 subcommittees, including 1) Awareness and Diagnosis, 2) Treatment, 3) Palliative Care, survivorship and rehabilitation, 4) Training, and 5) Commodities and oncology drugs. The plan is to incorporate the working group members who volunteered at the Profile workshop and then meet monthly initially to work toward the identified goals. A follow-up PrOFILE assessment 2 years after the action points will be conducted to evaluate childhood cancer services after the interventions made by the working groups.
Changing the outcomes of children with cancer in LMICs requires a stepwise approach that focuses on tackling specific problems over time. A formal way of evaluating the major challenges in each work environment is necessary to address the threats that effect each facility, but also on a national context, enabling them to foster collaborations that leverage on the strengths of each hospital. It is therefore our hope that in the 2-year period, the working groups will be collaborating and developing practical solutions to the major challenges impacting childhood cancer services.