Owusu Richmond, Heupink Lieke Fleur, Gulbi Godwin, Asare Brian, Amankwah Ivy, Abassah-Konadu Emmanuella, Otoo Desmond Dzidzornu, Azeez Joycelyn, Gyansa-Lutterodt Martha, Dsane-Selby Lydia, Mensah Ruby Aileen, Yevutsey Saviour, Omane-Adjekum William, Ruiz Francis, Gad Mohamed, Nonvignon Justice, Chola Lumbwe
Department of Health Policy, Planning, and Management, University of Ghana School of Public Health, Accra, Ghana.
Norwegian Institute of Public Health, Oslo, Norway.
PLOS Glob Public Health. 2025 Jul 21;5(7):e0004871. doi: 10.1371/journal.pgph.0004871. eCollection 2025.
Childhood cancers present a significant health problem and contribute to global child mortality. Low- and middle-income countries experience higher rates of childhood cancers with survival rates between 10% and 50%. In Ghana, about 2,500 children are diagnosed with cancer annually. Despite availability of effective management strategies, childhood cancers are not fully integrated into the NHIS, leaving patients and caregivers to make out-of-pocket payments leading to delayed diagnosis and treatment abandonment. Although stakeholders have made efforts to address the issue, the various stakeholders in childhood cancer management and their roles are still unclear. The study sought to identify and analyze stakeholders involved and challenges in childhood cancer management and financing in Ghana. A stakeholder analysis was conducted which included a rapid review of policy documents and a stakeholder engagement workshop. 21 stakeholders were purposively selected and focus group discussions were held with an interview guide at a one-day stakeholder engagement meeting. Stakeholders were categorized using Mendelow's power-interest grid, and their roles, interests, and influence on childhood cancer policies were assessed. Key stakeholders identified included the Ministry of Health, NHIA, healthcare providers, NGOs, WHO, and patient advocacy groups. The Ministry of Health, NHIA, and healthcare providers were primary drivers with high interest and influence. The burden of Burkitt's Lymphoma constituted 30-35% of all childhood cancer cases. Ghana has adapted treatment protocols with some inclusion on the NHIS. However, NHIS tariffs remain low. Challenges in managing Burkitt's Lymphoma included inadequate reimbursement rates, high treatment costs, treatment abandonment, limited access to paediatric oncology specialists and indirect costs such as transportation and accommodation. Achieving universal health coverage through management and financing of childhood cancers in Ghana requires comprehensive policies, equitable financial coverage under the NHIS, enhanced stakeholder collaboration and increased investments in building capacity of paediatric oncologists in Ghana.
儿童癌症是一个重大的健康问题，也是全球儿童死亡的一个原因。低收入和中等收入国家的儿童癌症发病率较高，生存率在10%至50%之间。在加纳，每年约有2500名儿童被诊断患有癌症。尽管有有效的管理策略，但儿童癌症并未完全纳入国家健康保险计划（NHIS），这使得患者和护理人员需要自掏腰包支付费用，从而导致诊断延迟和治疗中断。尽管利益相关者已努力解决这一问题，但儿童癌症管理中的各个利益相关者及其角色仍不明确。该研究旨在确定和分析加纳儿童癌症管理和融资方面的利益相关者及挑战。进行了一项利益相关者分析，其中包括对政策文件的快速审查和一次利益相关者参与研讨会。有目的地选择了21名利益相关者，并在为期一天的利益相关者参与会议上，根据访谈指南进行了焦点小组讨论。使用门德洛的权力 - 利益矩阵对利益相关者进行分类，并评估了他们对儿童癌症政策的角色、利益和影响。确定的关键利益相关者包括卫生部、国家健康保险管理局（NHIA）、医疗服务提供者、非政府组织、世界卫生组织（WHO）和患者倡导团体。卫生部、NHIA和医疗服务提供者是具有高利益和影响力的主要推动者。伯基特淋巴瘤的负担占所有儿童癌症病例的30% - 35%。加纳已经调整了治疗方案，其中一些被纳入了NHIS。然而，NHIS的费率仍然很低。管理伯基特淋巴瘤的挑战包括报销率不足、治疗成本高、治疗中断、获得儿科肿瘤专家的机会有限以及交通和住宿等间接成本。通过对加纳儿童癌症的管理和融资实现全民健康覆盖，需要全面的政策、NHIS下公平的财务覆盖、加强利益相关者合作以及增加对加纳儿科肿瘤学家能力建设的投资。
