National Paediatric Oncology Policy

Objectives

Build a sustainable, evidence-based paediatric oncology service within Fiji’s health system so that children and adolescents receive timely, equitable and comprehensive cancer care that improves survival and quality of life for patients and families.[1]The overarching vision is that no child should die from cancer.[1]Paediatric oncology is to be recognised, governed and resourced as a distinct clinical service rather than being subsumed within adult oncology or general paediatric provision.[1][2][3]

• Provide an integrated continuum of early detection, diagnosis, treatment, rehabilitation, supportive care and palliative care for children and adolescents with cancer.[1][4]
• Accept oncology patients up to 18 years within paediatric services unless adult treatment is clinically more appropriate.[1]
• Deliver active total care for children and family-centred support, including good-quality palliative care where treatment is declined or is no longer appropriate.[2][5]
• Coordinate child cancer services under the National Paediatric Oncology Committee, with dedicated leadership, reporting arrangements and national coordination across clinical and supportive care.[2]
• Establish dedicated staffing, suitable medicines, supplies and technologies, clinical space, a national child cancer information system and coordinated national service delivery.[3][5]
• Align chemotherapy treatment as closely as possible with the Pacific Island Protocols while enabling clinically justified individualisation through local teams and twinning partners.[4]
• Expand and sustain services through strategic planning, community outreach, research, international partnerships and strengthened local capacity for diagnostic work-up and treatment planning.[6][7]

Implementation

Implement the service through dedicated governance, a hub-and-shared-care delivery model, multidisciplinary clinical practice, strengthened information systems, workforce development and formal partnerships.[2][3][5]The Ministry of Health and Medical Services is expected to resource paediatric oncology independently through separate budgets, staff, premises, training and data-management capacity.[1]The source does not specify quantified performance indicators, targets, a formal independent evaluation process, or monetary budget allocations.[1][6][3]

• Establish the National Paediatric Oncology Committee as a special committee of the National Oncology Committee and the leading paediatric oncology body, reporting separately to the Permanent Secretary for Health and Medical Services.[1][2]
• Establish Divisional Paediatric Oncology Committees to report to the National Paediatric Oncology Committee, implement approved strategic and action plans, develop standard operating procedures and report implementation successes and challenges.[2][7]
• Develop Colonial War Memorial Hospital as the long-term lead clinical site, with Labasa and Lautoka divisional hospitals delivering shared care and referring new cases for investigation and initial treatment.[5]
• Deploy a consultant paediatrician to oversee the service, rotate paediatric registrars through oncology units every six months, and use multidisciplinary teams involving pathology, radiology, paediatric surgery, paediatric oncology, nursing and pharmacy.[5]
• Apply evidence-based clinical protocols and cost-effective choices of supplies and technologies, while safeguarding children at risk of harm and maintaining constructive relationships with families.[1][3]
• Manage palliative care through paediatric oncology units using individual assessment care plans and regular reviews, consistent with World Health Organization guidance on persistent pain in children.[5][7]
• Use weekly teleconferences with twinning partners for advanced cases and consider overseas referral where clinically recommended and funding is available.[7]Financial assistance for eligible overseas treatment is to follow the 2008 government guidelines for Fiji citizens requiring medical treatment overseas.[4]
• Formalise international twinning arrangements through terms of reference and memoranda of understanding defining minimum roles and responsibilities, including the established partnership with the New Zealand National Child Cancer Network and the Children’s Haematology Oncology Centre in Christchurch.[1][6][7]
• Provide regular refresher training for paediatric oncology doctors and nurses at Ministry of Health and Medical Services expense, organised through national and divisional committees and twinning partners.[3]
• Follow the Ministry of Finance Procurement Regulations 2010 and establish an emergency procurement process 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]
• Establish a Fijian National Child Cancer Registry and reporting form that separate paediatric oncology information from adult oncology data, with divisional data collection supported by the Health Information, Research and Analysis Unit.[3]
• Require divisional committees to submit reports to the Health Information, Research and Analysis Unit and National Paediatric Oncology Committee, and formally record and report voted committee decisions through the specified governance arrangements.[2][3]
• Develop community outreach nursing, upskill existing personnel and provide dedicated transport through the Ministry of Health and Medical Services and partners to link families with divisional oncology teams.[7]
• Coordinate accommodation and other supportive services with non-governmental and civil society organisations, including WOWS Kids and the Fiji Cancer Society.[4][7]
• Submit paediatric oncology research for ethical review through the Fiji National Research and Ethics Review Committee or the relevant Fiji National University ethics committee.[7]
• Maintain a separate paediatric oncology budget from Wellness Oncology, general oncology, paediatric and other clinical allocations, with National Paediatric Oncology Committee submissions aligned to the Ministry budget cycle.[2]
• Review the policy every five years, or sooner where 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 centre on a national child cancer information system, registry-based data collection, divisional reporting and National Paediatric Oncology Committee oversight; however, the policy provides no quantitative indicator framework or independent evaluation approach.[2][3][7]

• Establish a Fijian National Child Cancer Registry and reporting form, keeping paediatric oncology information separate from adult oncology data and coordinating collection through Divisional Paediatric Oncology Committees with advice from the Health Information, Research and Analysis Unit.[3]
• Require Divisional Paediatric Oncology Committees to report to the Health Information, Research and Analysis Unit and the National Paediatric Oncology Committee.[2][3]
• Record and formally report National Paediatric Oncology Committee decisions that are voted and minuted through the specified governance arrangements.[2]
• Report implementation successes and challenges from Divisional Paediatric Oncology Committees to the National Paediatric Oncology Committee, which oversees timely delivery of strategic plans and develops supporting guidelines.[7]
• Report progress in advanced-case clinical management regularly to Divisional Paediatric Oncology Committees.[7]
• Review the policy every five years, or earlier where 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]
• Resource independent data management for paediatric oncology and deliver care using established evidence-based clinical protocols.[1]
• Specify no quantitative indicators, target values, evaluation methodology, audit process, reporting interval, reporting template, surveillance arrangement beyond the registry, or independent evaluation mechanism.[1][6][3][8]

Costing & Financing

Financing policy requires paediatric oncology to receive distinct, adequate resourcing through the Ministry of Health and Medical Services, while recognising reliance on adult oncology resources and seeking complementary support for training, overseas care, transport and family services.[1][6][2][4][7]

• Maintain a dedicated paediatric oncology budget separate from Wellness Oncology, general oncology, paediatric and other clinical allocations, with National Paediatric Oncology Committee submissions aligned to the Ministry of Health and Medical Services budget cycle.[2]
• Allocate independent resources for paediatric oncology budgets, staff, premises, training and data management.[1]
• Advocate for an adequate budget to sustain quality paediatric oncology services.[2]
• Fund regular refresher training for paediatric oncology doctors and nurses through the Ministry of Health and Medical Services.[3]
• Provide financial assistance for eligible overseas treatment under the 2008 government guidelines for Fiji citizens requiring medical treatment overseas, and consider available funding sources when selecting treatment options with twinning partners.[4][7]
• Mobilise support from non-governmental and civil society organisations for accommodation and supportive care, including collaboration on community outreach transport.[4][7]
• Address the risk of paediatric services being marginalised because they rely on a portion of adult oncology resources.[6]
• Specify no monetary allocation, total programme cost, unit cost, quantified funding gap, funding target, economic assumption or cost-effectiveness threshold.[1][6][2][3][7]