CHILDHOOD CANCER CONTROL IN RESOURCE-POOR SETTINGS: A NARRATIVE REVIEW OF CHALLENGES USING THE HEALTH SYSTEMS PLUS FRAMEWORK

ABSTRACT Background: Childhood cancer control in resource-poor settings faces multiple barriers across the continuum of care, from delayed diagnosis to treatment abandonment and limited survivorship support. While individual challenges are well-documented, understanding how they interact and reinforce one another is essential for designing effective interventions. The Health Systems Plus (HS+) Framework offers a comprehensive model specifically tailored to pediatric oncology. This narrative review examines childhood cancer control challenges through the HS+ domains. Methods: This narrative review synthesizes existing literature on childhood cancer control barriers in low-resource environments, mapping findings onto the HS+ framework. We reviewed peer-reviewed articles, policy reports, and case studies published between 2010 and 2025. Thematic analysis was conducted across framework domains with attention to cross-domain interactions. Results: Of 750 documents screened, 40 met inclusion criteria for detailed analysis, representing 35 countries across five WHO regions. Key challenges identified include inadequate workforce training, limited diagnostics and essential medicines, fragmented referral systems, financial toxicity, and weak health information systems. Crucially, these challenges form self-reinforcing cycles: weak governance perpetuates underfinancing, which constrains workforce development, which compromises service delivery, which erodes community trust. Conclusion: Improving childhood cancer survival in resource-poor settings requires moving beyond siloed interventions toward integrated health systems strengthening. The HS+ framework provides a valuable structure for identifying leverage points where strategic investments can disrupt negative feedback loops and catalyze systemic improvement. Keywords: Childhood cancer control, low- and middle-income countries, health systems strengthening, HS+ framework, resource-poor settings