Satellite clinics to bring pediatric cancer care closer to patients in Ethiopia: Perceived relevance, opportunities and anticipated challenges

Abstract

Background Ethiopia faces significant gaps in paediatric cancer care, with limited treatment centers and a shortage of trained professionals, leading to delayed diagnoses, high treatment abandonment, and mortality. Establishing Paediatric Cancer Satellite Clinics (PCSCs) in underserved regions offers a potential solution. Objective This study explores the needs, relevance, and feasibility of the Paediatric Cancer Satellite Clinic (PCSC) model in Ethiopia, identifying resources, opportunities, and barriers to guide its development and implementation. Methods This formative study was conducted from August to October 2023 in eight hospitals across Ethiopia, selected for establishing PCSCs. Data were collected through 19 focus group discussions (FGDs) with hospital and health system leaderships and purposively selected health professionals including physician, nurses, pharmacists and other categories. Data were analyzed using ATLAS.ti, with themes developed through iterative coding and categorization. Results Participants consistently identified pediatric cancer as a significant community health issue, worsened by limited diagnostic and treatment facilities, leading to under diagnosis. The study revealed a strong unmet need for pediatric cancer care, with widespread support for establishing PCSCs to improve access. Participants expressed confidence in the feasibility and effectiveness of PCSCs, citing enablers such as existing adult oncology programs, patient demand, adequate staff, leadership interest, stakeholder support, and alignment with government plans. Opportunities included leadership backing, resource availability, partnerships with private labs, and community-based health insurance. However, challenges like inconsistent lab services and medical supplies, staff demotivation due to lack of risk allowances, role confusion, inadequate personal protective equipment (PPE), poor infection control, and insufficient psychosocial support were identified as potential barriers. Conclusions This study underscored the urgent need for pediatric cancer care and strong support for PCSCs as a feasible and appropriate solution. Although challenges like supply chain disruptions, staff demotivation, unclear role delineation, diagnostic limitations, safety concerns, and gaps in psychosocial support-, the strong commitment of healthcare providers offer a solid foundation for success. To ensure the long-term effectiveness and sustainability of PCSCs, these obstacles must be addressed through targeted improvements in diagnostics, enhanced staff support, strengthened safety protocols, and integrated psychosocial care.