Background: The implementation of an early warning signs and symptoms (EWSS) intervention to address delayed detection and referral of pediatric cancers in Kenya and Cameroon uses an integrated multi-framework approach to address process, determinants, strategies, equity, and implementation outcomes. A key feature is planning and execution within implementing organizations and settings managed by self-identified leadership (LIT; country-wide) and operational (OIT; county/region-specific) implementation teams. Multi-level, cross-sectoral teams enhance intervention uptake and promote ownership and sustainability. The LITs and OITs plan, facilitate and execute activities required for intervention implementation, ensuring that all steps are tailored to the local context and needs.
 
Objectives: To describe the development and function of the implementation teams to support EWSS implementation in both countries, ultimately to decrease total diagnostic intervals and improve survival and quality of life.
 
Methods: Country LITs and OITs were formed in Phase 1 of implementation, with core guidance from country project facilitators and key health sector leaders. Teams determined the frequency and format of meetings, and the research team provided minimal guidance on phase-related implementation activities. LITs and OITs were established to support the planning, delivery, and management of implementation activities across study sites. LITs support the work at all levels, ensuring alignment and coherence across the system and building capacity and sustainability. OITs focus on day?to?day implementation by building readiness, installing and maintaining local implementation supports, monitoring fidelity and outcomes, and solving operational barriers. They translate the intervention into routine practice through continuous action planning, data use, and system alignment at the point of service delivery.
 
Results: In Phase 1 (Exploration), teams reviewed EWSS core components and were introduced to the implementation approach at a launch event. They began identifying potential barriers and facilitators and strengthened team composition. In Phase 2 (Preparation), the LITs and OITs contextualized the EWSS program. They applied the St. Siluan signs and symptoms of childhood cancers to inform training content, implemented iterative tiered training for regional hospital healthcare staff and district community HCWs, and established defined, navigable referral pathways. They also determined training frequency, duration, and delivery methods; selected trainers and trainees; adapted content to local health systems to ensure relevance, feasibility, and sustainability; identified local cancer champions; established communication channels (e.g., WhatsApp) for healthcare providers; and communicated implementation activities to the Ministry of Health via the LIT. Now in Phase 3 (Initial Implementation), OITs are supervising ongoing training of approximately 250 healthcare workers across 20 facilities, assessing program fidelity, and identifying areas for improvement through monitoring and evaluation checklists. In Phase 4 (Measure and Sustain), LITs and OITs will work to embed sustainable training through professional development and continuing medical education and to institutionalize referral pathways within local ministries.
 
Conclusions/Implications: LITs and OITs lead and manage the EWSS intervention in Kenya and Cameroon, ensuring it is systematically planned, contextually adapted, collaboratively implemented, and sustainably integrated into local health systems to enhance early detection and referral for childhood cancer. Their performance is tracked and assessed using training metrics, process indicators, and stakeholder feedback.