Abstract
Background: Robust population-based cancer registries (PBCRs) are essential for generating high-quality data for cancer control planning and policy. Ethiopia currently has one fully operational PBCR—the Addis Ababa Population-Based Cancer Registry (AAPBCR)—while national efforts to expand cancer registration into peripheral regions are underway. The NORA consortium, funded by the German Federal Ministry of Research, Technology and Space (BMFTR) (Grant 01KA2220B) to the RHISSA Programme, supports these efforts by strengthening cancer registry infrastructure, training, and sustainability within low- and middle-income country (LMIC) contexts.

Objectives: This study aims to (1) assess the operational status of five emerging peripheral cancer registries in Ethiopia—Gondar, Jimma, Harar, Hawassa, and Mekelle; (2) identify opportunities and challenges in scaling up PBCR functions; and (3) highlight LMIC-led capacity-building contributions enabled through the NORA–RHISSA partnership.

Methods: A multi-site descriptive evaluation was conducted based on registry activity reports, supervision documents, training logs, and CanReg?5 implementation data from 2024–2025. Each registry was assessed using IARC/AFCRN PBCR readiness criteria, including staffing, infrastructure, data-source coverage, catchment definition, data quality, and software utilization. Capacity-building activities from NORA–RHISSA—including on-site mentorship, virtual training, and equipment support—were documented and synthesized.

Results: Gondar demonstrated the highest PBCR readiness, with a defined catchment population (~573,386), multiple data sources (pathology, oncology, surgery, private clinics), and active CanReg?5 use. Jimma expanded its target population to ~3.5 million but remains primarily oncology?unit based, with data-quality gaps linked to staffing shortages. Harar produced detailed clinical datasets but lacks a defined denominator and broader source integration. Hawassa holds substantial oncology case volumes but requires harmonized workflows, formal MoUs, and sustainable funding. Mekelle has strong institutional commitment and infrastructure but minimal active case capture.

Across sites, common challenges included incomplete medical records, limited access to pathology and private-sector data, variable staffing, and inconsistent remuneration. The NORA–RHISSA programme contributed to key improvements: provision of the relevant technical support and guidance and registry materials, deployment and troubleshooting of CanReg?5, ICD?O?3 coding training, institutional leadership engagement, and multi-site supervision missions led jointly by Ethiopian and international partners. These activities strengthened local ownership, technical capacity, and system readiness—demonstrating a scalable model for LMIC-based cancer registry development.

Conclusions/Implications: Scaling up PBCRs in Ethiopia is achievable with continued