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.