National Paediatric Oncology Policy

Objectives

Establish a sustainable, child-centred paediatric oncology service within Fiji’s health system so that children and adolescents receive timely, equitable access to early detection, diagnosis, treatment, rehabilitation, supportive care and palliative care. The overarching vision is that no child should die from cancer, with improved survival and quality of life for children, adolescents and their families as central aims.[1]Paediatric oncology is to operate as a distinct clinical service from adult oncology, with dedicated leadership, financing, workforce, premises, information systems and clinical delivery arrangements.[1][2]

• Provide coordinated national clinical and supportive care, maintaining quality services and improving access to trained personnel, essential medicines, technologies and specialist treatment.[2][3]
• Deliver care for patients up to 18 years of age through paediatric oncology services, unless individual clinical circumstances make adult treatment more appropriate.[1]
• Develop Colonial War Memorial Hospital as the longer-term lead clinical site, with Labasa and Lautoka divisional hospitals providing shared care, investigating and initiating treatment for new cases, and referring as required.[4]
• Ensure palliative and supportive care is available equitably, including for children whose treatment is refused or discontinued, with support for both the child and family or guardian.[4][5]
• Apply the World Health Organization guidance on pharmacological treatment of persistent pain in children as the cornerstone of paediatric palliative care.[5]
• Strengthen community nursing, home-based treatment and palliation, accommodation and other support for children and families at divisional hospitals.[5]
• Align chemotherapy regimens as closely as possible with Pacific Island Protocols while permitting clinically justified individualisation by local teams and twinning partners.[5]
• Coordinate strategic planning with the Family Health Unit’s Child Health Strategic Plan, supporting longer-term policy development, service expansion, independence and sustainability.[6]
• Apply professional clinical judgement and the ethical principles of non-maleficence, beneficence and justice in care decisions.[5]

Implementation

Implement the service through separate resourcing, national and divisional governance, multidisciplinary clinical practice, data systems, workforce development and formal international partnerships. Paediatric oncology is to receive resources independently from adult oncology and other disciplines, covering budget, staff, premises, training and data management.[1]The National Paediatric Oncology Committee is the leading paediatric oncology body in Fiji, recognised as a special committee of the National Oncology Committee and reporting separately to the Paediatric Clinical Services Network.[1][2]

• Establish Divisional Paediatric Oncology Committees at divisional hospitals to report to the National Paediatric Oncology Committee, coordinate data collection and management, implement strategic and action plans, and develop approved clinic standard operating procedures.[2][3][6]
• Require the National Paediatric Oncology Committee to make voted and minuted decisions, report to the Paediatric Clinical Services Network, oversee strategic-plan fulfilment and submit budget proposals through the Ministry of Health and Medical Services budget cycle.[2][6]
• Establish paediatric oncology as a separate unit with dedicated medical, nursing and supportive staff; fund regular refresher training for doctors and nurses through the Ministry of Health and Medical Services, committees and partners.[3]
• Appoint a consultant paediatrician with an oncology interest to oversee operations, rotate paediatric registrars through oncology units every six months, and assess cases through multidisciplinary teams including pathology, radiology, paediatric surgery, paediatric oncology, nursing and pharmacy.[4]
• Provide dedicated clinical space at divisional hospitals, procure supplies under Ministry of Finance regulations, and establish emergency procurement arrangements for Essential Medicine List items through collaboration between the Paediatric Clinical Service Network, National Paediatric Oncology Committee and Fiji Pharmaceutical and Biomedical Services Centre.[3]
• Select supplies and technologies using best practice, evidence, quality-of-life outcomes and reasonable cost-effectiveness.[3]
• Formalise twinning partnerships through terms of reference and memoranda of understanding, using established evidence-based protocols and consultation with an established paediatric oncology centre to support clinical treatment and service development.[1][4]The approach builds on the relationship with the Children’s Haematology Oncology Centre in Christchurch and Pacific cancer treatment protocols.[7]
• Review advanced cases through multidisciplinary teams and weekly teleconferences with twinning partners, recommend treatment, consider overseas treatment where appropriate, and inform families before travel that further overseas treatment may be needed after diagnostic testing or surgery.[6]Financial assistance for overseas treatment follows the 2008 government guidelines governing appropriated funds for Fiji citizens requiring overseas medical treatment.[5]
• Manage palliative care through individual assessment care plans, review these plans through paediatric oncology units, and report advanced-case progress to Divisional Paediatric Oncology Committees.[6]
• Develop community outreach nursing, including up-skilling existing personnel such as Community Health Workers, and provide dedicated outreach transport through the Ministry of Health and Medical Services and partners.[6]
• Establish a Fijian National Child Cancer Registry and reporting form through the Health Information, Research and Analysis Unit, a National Paediatric Oncology Committee working group and the New Zealand National Child Cancer Network, keeping paediatric oncology data separate from adult oncology information.[3]
• Protect children where harm or neglect is suspected, address treatment refusal case by case with the child’s welfare paramount, and maintain supportive and conciliatory relationships with patients and families.[4]
• Coordinate with charitable and civil-society organisations, including WOWS Kids and Fiji Cancer Society, for supportive care and resource mobilisation.[6]
• Route research through the Fiji National Research and Ethics Review Committee or the College Health Research Ethics Review Committee under applicable protocols.[8]
• Review the policy every five years or when considered necessary by the National Paediatric Oncology Committee and Ministry of Health and Medical Services; the stated next review date was April 2020.[8]

Monitoring & Evaluation

Monitoring and accountability combine clinical review, patient-level care planning, registry development, committee reporting and periodic policy review. A proposed national child cancer registry is intended to separate paediatric oncology information from adult oncology data, while formal committee structures oversee implementation and strategic delivery.[2][3]

• Establish a Fijian National Child Cancer Registry and reporting form through the Health Information, Research and Analysis Unit, a National Paediatric Oncology Committee working group and the New Zealand National Child Cancer Network.[3]
• Maintain paediatric oncology data separately from general adult oncology information.[3]
• Coordinate data collection and management through Divisional Paediatric Oncology Committees, with technical advice from the Health Information, Research and Analysis Unit, and submit reports to that unit and the National Paediatric Oncology Committee.[3]
• Use close clinical supervision and monitoring because paediatric oncology requires detailed evaluation, patient stratification and more intensive treatment protocols than adult oncology.[7]
• Prepare individual assessment care plans for all patients receiving palliative care and conduct subsequent reviews through paediatric oncology units.[6]
• Review advanced cases through multidisciplinary teams and weekly teleconferences with twinning partners, then report case progress regularly to Divisional Paediatric Oncology Committees.[6]
• Require Divisional Paediatric Oncology Committees to report implementation successes and challenges to the National Paediatric Oncology Committee.[6]
• Record National Paediatric Oncology Committee decisions through voting and minutes, report separately to the Paediatric Clinical Services Network, and submit budget proposals within the Ministry of Health and Medical Services budget cycle.[2]
• Assign the National Paediatric Oncology Committee ultimate responsibility for timely fulfilment of strategic plans, with Divisional Paediatric Oncology Committees accountable for implementing strategic and action plans.[6]
• Route paediatric oncology research through the Fiji National Research and Ethics Review Committee or the College Health Research Ethics Review Committee, in accordance with applicable research protocols.[8]
• Review the policy every five years, or earlier if considered necessary by the National Paediatric Oncology Committee and the Ministry of Health and Medical Services; the stated next review date was April 2020.[8]

No formal quantitative indicator set, performance targets, audit measures, evaluation methodology or reporting timetable is specified. The extract notes that estimated annual case burden and presentation rates are difficult to measure without dedicated information collection.[7][3][6][8]

Costing & Financing

Financing policy centres on separately resourcing paediatric oncology, advocating through Ministry of Health and Medical Services budget processes, and drawing on government, partner and supportive-care organisation support where relevant. No monetary allocation, quantified funding gap, programme cost, expenditure estimate or economic assumption is provided.[1][2][3][5][6]

• Maintain paediatric oncology resources independently from adult oncology and other clinical disciplines, covering dedicated budgets, staffing, premises, training and data management.[1]
• Maintain a separate paediatric oncology budget distinct from Wellness Oncology, general oncology and paediatric financing lines, with submissions made through the Ministry of Health and Medical Services budget cycle.[2]
• Advocate for an adequate budget to maintain quality paediatric oncology services through the National Paediatric Oncology Committee.[2]
• Fund regular refresher training for paediatric oncology doctors and nurses through the Ministry of Health and Medical Services.[3]
• Procure supplies under Ministry of Finance regulations and establish an emergency procurement process for Essential Medicine List items through collaboration among the Paediatric Clinical Service Network, National Paediatric Oncology Committee and Fiji Pharmaceutical and Biomedical Services Centre.[3]
• Base supply and technology choices on best practice, evidence, quality-of-life outcomes and reasonable cost-effectiveness.[3]
• Address resource constraints including reliance on adult oncology allocations, overseas treatment, availability of anticancer agents and palliative-care provision.[7]
• Apply the 2008 government guidelines on use of appropriated funds for Fiji citizens requiring medical treatment overseas when providing financial assistance for overseas care.[5]
• Consider available funding sources when clinicians liaise with twinning partners about treatment options.[6]
• Mobilise support through collaboration with charitable, non-governmental and civil-society supportive-care organisations, and seek Ministry and partner support for dedicated transport for community outreach nursing.[5][6]

The source identifies the need for dedicated service inputs and partner support but does not specify the scale, source distribution or duration of financing beyond Ministry funding, overseas-treatment assistance arrangements and potential support from partner organisations.[1][3][5][6]