Equitable access to essential medicines is a critical component of childhood cancer care and vital to improved global outcomes for children with cancer. Little rigorous data exists on the nature and determinants of access to childhood cancer medicines in African health system contexts. This session will review new data from a multi-centre prospective mixed-methods study of access to essential cancer medicines for children in five East African countries, to inform discussion about challenges in achieving sustained access to vital childhood cancer treatments in the region and opportunities to address them through evidence-informed policies.

Information on context-specific challenges with regards to access to essential medicines for children with cancer is important as this would determine strategies to improve outcomes for children with cancer in low and low-middle income countries such as Ghana.
A mixed methods study with quantitative assessment of drug availability and qualitative interviews to document health system and sociopolitical determinants of access was undertaken in Accra, Ghana. Forty-one cancer and supportive care drugs from the WHO Essential Medicines list were analyzed for price and stock data from both private and public institutions. Policy documents were assessed and 21 interviews conducted with key health system stakeholders.
Only 47% of essential childhood cancer drugs were included in the National Essential Medicines List. Stock-outs were recorded for 88% of the drugs with a median stock-out duration of 70 days. Median price ratios for 32% of the drugs were above internationally-accepted efficiency limits. Determinants of access included a lack of sociopolitical priority for childhood cancer and the effects of policy and regulatory environment on availability, affordability and quality of the drugs.
The setting up of a National Cancer Registry, a nationally coordinated procurement strategy for childhood cancer drugs, public financing for childhood cancer services and policies to control drug pricing are of paramount importance. An understanding of system level impediments in-country is critical to inform strategies that will improve drug access.

Franco-African Group for Pediatric Oncology (GFAOP) was founded in 2000. It federates Pediatric Oncology Units (UOP) in order to treat and cure African Children with cancer in African by trained African teams. GFAOP actions are based on formation, expertise exchanges and, since 2005, donation of essential drugs, mainly cancer drugs. These shipping from France are organized and based on African team’s needs. Nevertheless, UOP are more and more numerous since years (from 14 in 2005 to 24 in 2021), and, nowadays, GFAOP fails to send enough drugs. Moreover, discrepancies between needs and shipping were increased during COVID pandemia (supply chain broken, delays, etc). Then, in it Strategic Plan 2021 -2030, GFAOP planned to develop local supplying of cancer drugs, with local pharmacists involved in order to secure drug circuit (ordering, handling, etc…) and finally to stop inefficient drug donations from France. To achieve this goal, a strategic group was created. First actions were to develop a pharmacists committee (Senegal, Côte d’Ivoire, Democratic Republic of Congo, France) to share experiences and to develop pharmacist’s knowledge in paediatric oncology. As results, for instance, the Ivoirian Society for Oncology Pharmacy (SIPO) was created in Côte d’Ivoire, with GFAOP members as honorary members. It cooperates with French Society for Oncology Pharmacy (SFPO) to upgrade African pharmacist’s competency in paediatric oncology. These actions are developed in alignment with WHO GICC.

Low- and middle-income countries find it difficult to prioritize childhood cancer treatment programs due to high costs and resource intensity perceptions. There is little information available about how much these programs really cost. To improve outcomes for children with Burkitt lymphoma (BL)--the most common childhood cancer in Africa--, the Uganda Cancer Institute implemented a comprehensive BL treatment program in 2012. We conducted an economic evaluation of the program to determine how cost-effective BL therapy was in the circumstances of a low-income setting. Based on 122 patients treated from 2012 to 2014, we compared BL treatment to usual care (variable, fixed, and family costs). Our primary measure of effectiveness was overall survival (OS). Patient outcomes were determined through prospective capture and retrospective chart abstraction. The cost per disability-adjusted life-year (DALY) averted was calculated using the World Health Organization’s Choosing Interventions That Are Cost-Effective (WHO-CHOICE) methodology. Among the 122 patients with BL, 55% (95% CI, 45% to 64%) were alive at two years from diagnosis. Patients with low-risk disease had a statistically significantly higher 2-year OS (66%; 95% CI, 51% to 77%) compared with high-risk disease (45%; 95% CI, 31% to 58%), (P = .03). We found the cost per DALY averted in the treatment group was US$97 (Int$301). The cumulative estimate of national DALYs averted through treatment was 8607 years, and the total national annual cost of treatment was US$834,879 (Int$2,590,845). The cost of BL treatment fell well within WHO-CHOICE cost-effectiveness thresholds. DALYs were averted at the cost of 0.14 per capita gross domestic product, reflecting a very cost-effective intervention. By international standards, this study proves that treating BL with locally tailored protocols is very cost-effective. Such studies provide crucial evidence to help policymakers allocate resources to childhood cancer in LMICs.