Pan American Health Organization · 1st edition, 2026 · 62 pages
A harmonized monitoring and evaluation framework with standardized indicators for childhood cancer programmes in Latin America and the Caribbean.
- Issuer
- Pan American Health Organization
- Edition
- 1st edition, 2026
- Audience
- National childhood cancer programme managers, GICC focal points, health policymakers, paediatric oncology clinical and administrative staff, cancer registry authorities, civil society organisations, researchers, and evaluators
- Evidence
- Expert consensus through modified Delphi method with 60 experts and validation at GICC regional meetings
- Reviewed
- 16 Oct 2026 · GMJ
What this guideline says
GMJ summary
This technical framework, developed by the Pan American Health Organization within the Global Initiative for Childhood Cancer (GICC), establishes a standardized monitoring and evaluation (M&E) system for childhood cancer interventions across Latin America and the Caribbean. The framework supports the GICC goal of achieving at least 60% survival for childhood cancer by 2030 through improved early diagnosis, access to treatment, and strengthened health systems.
The compendium organises indicators across five operational domains: governance (national policies, legislation, and participation in global initiatives), timely diagnosis (incidence, diagnostic delays, training, and awareness campaigns), health system capacity (specialized units, workforce, essential medicines, and treatment protocols), cancer registries (hospital-based and population-based coverage), and comprehensive care (treatment abandonment, palliative care, and hematopoietic stem cell transplantation). Additionally, two cross-cutting impact indicators measure overall 5-year survival and cancer mortality rates among children and adolescents under 19 years of age.
Developed through a modified Delphi process with 60 experts and validated at regional meetings, the framework provides technical guidance on indicator selection, data sources, measurement frequency, and disaggregation levels. It promotes results-based strategic management, evidence-based decision-making, and accountability whilst strengthening national team capacities in data collection, analysis, and use at institutional, national, and regional levels.
Key points
For clinicians — doses and thresholds as stated in the guideline
- The framework targets a 60% survival rate for childhood cancer by 2030 through systematic monitoring across five domains: governance, timely diagnosis, health system capacity, cancer registries, and comprehensive care
- Two impact indicators track overall 5-year survival in children and adolescents under 19 years diagnosed with cancer and cancer mortality rate per 1,000,000 population in this age group
- Countries should verify inclusion of all 45 WHO essential medicines for childhood cancer (2025 version) in their national essential medicines list
- Treatment abandonment is defined as failure to initiate or interruption of curative treatment for four or more consecutive weeks without medical justification
- The recommended ratio is one paediatric oncologist or oncohematologist for every 10–50 paediatric cancer patients
- Timely diagnosis requires measuring two intervals: patient interval (symptom onset to first healthcare visit) and health system interval (first visit to diagnostic confirmation), both reported as median days
- Population-based cancer registries should aim for complete geographic coverage of the paediatric population under 19 years
- Specialized cancer care units must have staff trained in paediatric palliative care, access to opioids and essential analgesics, and protocols for pain and symptom management
Summary matrix for Domain I: Governance of cancer in children and adolescents
Table extracted from the guideline
| Code | Indicator | Type | Pillar | Facilitator |
|---|---|---|---|---|
| GOB-01 | Specific legislation for comprehensive care of children and adolescents under 19 years with cancer | Process | U, E | Linked governance, Financing |
| GOB-02 | National cancer plan for children and adolescents under 19 years or one that includes a paediatric component | Process | U, E | Linked governance, Financing |
| GOB-03 | Official participation in the Global Initiative for Childhood Cancer | Process | U, E | Linked governance |
| GOB-04 | Official participation in the Global Platform for Access to Childhood Cancer Medicines | Process | R, U | Linked governance |
| GOB-05 | imPACT assessment with a paediatric component | Process | E, C | Linked governance |
Source: Pan American Health Organization, Framework for monitoring and evaluation of childhood cancer: CureAll Americas compendium of standardized indicators. Reproduced in summary form.
From the guideline
Verbatim
“The general goal of this framework is to standardize the implementation of M&E for CureAll projects in Latin America and the Caribbean.”
Editor’s perspective
Why this matters for Georgia and the region
Prof. Giorgi Pkhakadze, MD, MPH, PhD
Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration
As Editor-in-Chief of the Georgian Medical Journal and Chair of the Public Health Institute, I recognise that this PAHO framework offers Georgia a structured approach to childhood cancer monitoring that aligns with our universal health coverage programme established in 2013. The most critical recommendation for Georgian clinicians and policymakers is measuring the two diagnostic intervals—patient and health system—because delays in our referral pathways from regional centres to Tbilisi tertiary facilities remain a documented challenge. The framework's emphasis on the 1:10–50 paediatric oncologist-to-patient ratio provides an evidence-based benchmark against which to assess our current workforce capacity at Iashvili Children's Central Hospital and plan specialist training. One realistic implementation caveat is that establishing population-based cancer registries with complete geographic coverage will require substantial investment in health information infrastructure and interoperability between our existing disease surveillance systems and hospital records, which currently operate on fragmented platforms.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 16 Oct 2026
Applicability
Georgia and the South Caucasus
This framework is directly relevant to Georgia and neighbouring South Caucasus countries as they strengthen childhood cancer care within universal health coverage programmes. Georgia would need to assess current capacity across the five domains: establishing or updating national childhood cancer legislation and plans, measuring diagnostic intervals from symptom onset through the three-tier health system, mapping specialized oncology units and paediatric oncologist density against the recommended 1:10–50 ratio, evaluating coverage of the 45 WHO essential medicines in the national formulary, and determining population-based cancer registry coverage. The framework’s equity dimensions—geographic, economic, sociocultural, and clinical—are particularly pertinent given regional disparities between Tbilisi and rural areas. National implementation would require coordination between the Ministry of Health, the National Centre for Disease Control and Public Health, tertiary referral hospitals (such as Iashvili Children’s Central Hospital), and integration with existing health information systems and the universal healthcare programme introduced in 2013.
Questions this guideline answers
Quick answers
What is the target survival rate for childhood cancer under the Global Initiative?
The GICC aims to achieve at least 60% overall 5-year survival for children and adolescents under 19 years of age diagnosed with cancer by 2030, whilst reducing their suffering through improved early diagnosis, access to quality treatment, and strengthened health systems.
How is treatment abandonment defined and measured?
Treatment abandonment is defined as failure to begin indicated curative treatment or interruption for four or more consecutive weeks without medical rationale or formal discharge. It is calculated as the number of patients who dropped out divided by the total who started treatment, multiplied by 100, and should be disaggregated by sex, age group, cancer type, stage, and geographic region.
What are the two components of time to diagnosis?
Time to diagnosis comprises the patient interval (days from symptom onset to first documented healthcare visit for symptoms suggestive of cancer) and the health system interval (days from first visit to diagnostic confirmation). Both should be reported as median days with interquartile range.
Which essential medicines must be included in national lists?
Countries should include all 45 WHO essential medicines for childhood cancer from the 2025 Essential Medicines List, including cytotoxic agents, targeted therapy, immunomodulators, hormones, and supportive care drugs. The percentage of inclusion is calculated by dividing the number of WHO medicines in the national list by 45 and multiplying by 100.
Related on GMJ
Interconnected resources
Dictionary of Public Health
Conditions A–Z
GMJ News coverage
- Onsite Training and Mentorship Accelerates Childhood Cancer Diagnosis in EthiopiaAug 2026
- Largest study maps bacterial ecosystems within human tumors across 33 cancer typesSep 2026
- Immunosuppression Linked to Rare T-Cell Lymphoma in Transplant Recipients: NEJM Case ReportJul 2026
- Correction issued for MAGE-A4/A8 immunotherapy trial in advanced solid tumoursJul 2026
Quality & accreditation
Other guidelines on this topic
- Target Product Profile – Developing In Vitro Diagnostics for Low- and Middle-Income Settings
- Consolidated guidance for strengthening national routine surveillance systems: updated HIV case definitions, advanced HIV disease indicators and surveillance checklist
- Water and Sanitation Technologies for Health-care Facilities: Current Status and Context in the Western Pacific Region
- Measuring the progress and impact of the UN Decade of Healthy Ageing (2021–2030): framework and indicators recommended by WHO Technical Advisory Group
- Guidance for countries to assess adolescent health and well-being
- Issuer
- Pan American Health Organization
- Type
- Guidelines and Technical Manuals
- Edition
- 1st edition, 2026
- Status
- Current
- Published
- 2026-09-23
- Languages
- English (also available in Spanish)
- Scope
- Monitoring and evaluation framework for childhood cancer programmes in Latin America and the Caribbean, covering children and adolescents under 19 years of age
- Audience
- National childhood cancer programme managers, GICC focal points, health policymakers, paediatric oncology clinical and administrative staff, cancer registry authorities, civil society organisations, researchers, and evaluators
- Pages
- 62
- Licence
- CC BY-NC-SA 3.0 IGO
- ISBN
- 978-92-75-13150-3 (PDF)
- Evidence
- Expert consensus through modified Delphi method with 60 experts and validation at GICC regional meetings
- Record history
- Created 16 Oct 2026 · updated 16 Oct 2026 · next check Apr 2027
Pan American Health Organization. Framework for monitoring and evaluation of childhood cancer. CureAll Americas compendium of standardized indicators. Washington, D.C.: PAHO; 2026. Available from: https://doi.org/10.37774/9789275131503.GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.
Was this article helpful?
