Childhood cancer in Bangladesh: a qualitative evaluation.

Abstract

Background: Childhood cancer persists as a prominent public health concern in low- and middle-income countries (LMICs), with only a 20% survival rate. In Bangladesh, 67% of healthcare expenses are out of pocket. Since 2012, World Child Cancer-UK (WCC-UK) has collaborated with Bangabandhu Sheikh Mujib Medical University (BSMMU) to address this issue. This evaluation aimed to assess the project's purpose and impact, delivering insights to donors regarding their contributions, best practices, lessons learned, potential challenges encountered, and recommendations for future project development or refinement.

Methods: This study employed a qualitative method to evaluate the WCC-UK project objectives from May to June 2017. It involved seven document reviews and nine key informant interviews (KIIs) with project leadership, collaborating partners at the Hub and Satellites, management staff, and Twinning Partners. Besides, two in-depth interviews (IDIs) were carried out with certain beneficiaries, particularly parents of children with cancer. Thematic data analysis was performed to emanate the findings.

Results: Despite facing challenges such as an unclear management structure, ambiguous patient eligibility criteria, personnel issues, and communication gaps, the project made strides in several areas. BSMMU provided essential space and leadership, while Satellite Centers supported the project with continuing medical education (CME) and data entry. The project offered subsidies to poor patients and improved cancer awareness among healthcare providers and service seekers. Despite some parents receiving health and nutrition education during their hospital stays, developing a long-lasting system to educate them about long-term cancer care for their children was found to be formidable. The analysis also highlighted staffing shortages, a hierarchical gap between physicians and nurses, and a predominantly male leadership structure.

Conclusions: While the project has made progress toward its goals, there are critical areas that require attention to fully realize its objectives. Specifically, it is recommended that the project clarify its management structure, establish clear patient eligibility criteria, address staffing and communication issues, and work towards a more inclusive leadership. These improvements are essential for the project's long-term success and sustainability.