IARC 60th Anniversary - 19-21 May 2026
Session : Global Advances in Transforming towards Resilient and Equitable Health System
Political Economy of Childhood Cancer Care: Insights from Four East African Countries
IBEKA P. 1,2, CHUKWU O. 2, OJO T. 2, WARAICH S. 3, PETRICCA K. 4, GITHANG'A J. 5, SCHROEDER K. 6, KANYAMUHUNGA A. 7, NJUGUNA F. 8, KAMBUGU J. 9, DENBURG A. 1,2
1 Child Health Evaluative Sciences, Peter Gilgan Centre for Research & Learning, Hospital for Sick Children, Toronto, ON, Canada, Toronto, Canada; 2 Institute for Health Policy Management and Evaluation (IHPME), University of Toronto, Toronto, Canada; 3 Department of Medicine, Toronto Metropolitan University, Toronto, Canada; 4 AMR Policy Accelerator, Global Strategy Lab based at York University and the University of Ottaw, Ottawa, Canada; 5 Haematology and Blood Transfusion Unit, Department of Human Pathology, University of Nairobi, Nairobi, Kenya; 6 Pediatric Oncology and Global Health, Duke University, North Carolina, United States; 7 Pediatrics & Child Health Department, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda; 8 Department of Child Health and Paediatrics, Moi University Teaching and Referral Hospital, Eldoret, Kenya; 9 Division Pediatric Hematology and Oncology, Uganda Cancer Institute, , Kampala, Uganda
Background: Access to essential cancer medicines is a key determinant of effective pediatric oncology care and survival. In East Africa, access to childhood cancer medicines is shaped by the interaction between commercial determinants of health across manufacturing, registration, distribution, and health system arrangements, which are further mediated by normative instruments such as national essential medicines lists (NEMLs) and the national cancer control plans (NCCPs). However, these instruments frequently prioritize adult cancers over pediatric needs, contributing to persistent inequities in access to childhood cancer medicines across the region.
Objectives: This study examines the political and economic dynamics shaping access to essential medicines for childhood cancer in four East African countries: Kenya, Uganda, Rwanda, and Tanzania, to identify policy-relevant implications for reducing inequities.
Methods: A comparative qualitative study using semi-structured interviews (n=64) was conducted with key stakeholders across policy, clinical, civil society, and pharmaceutical sectors between February 2020 and July 2021. Using Walt and Gilson’s Policy Triangle Framework, complemented by a political economy lens, we conducted a thematic analysis to explore how policy design, health system arrangements, and normative frameworks interact to influence equitable access to childhood cancer medicines across the countries.
Result: Across all countries, normative instruments such as NEMLs and NCCPs formally recognize cancer but have historically centred on adult malignancies. Incorporation of childhood cancer into NCCPs has been a relatively recent advancement in Kenya, Rwanda, and Uganda, and specificity regarding pediatric services remains limited. In addition, financing gaps persist, with weak or absent budgets for childhood cancer care. Procurement arrangements further constrain access. Centralized public procurement systems designed to prioritize high-volume, low-cost commodities structurally disadvantage low-volume pediatric formulations. Kenya, Tanzania, and Rwanda rely on national procurement agencies to enforce procurement laws. In contrast, the Uganda Cancer Institute has independent legal authority to procure cancer-specific commodities, thereby improving the prioritization of pediatric needs. Commercial determinants compound these effects. Small market size, high registration fees, and protracted approval timelines discourage manufacturers and importers from registering or stocking pediatric oncology medicines. These dynamics produce thin supplier bases, repeated tender failures, and reliance on a small number of wholesalers and private pharmacies, leading to high prices. COVID–19 supply chain disruptions exposed limited health system resilience, with shipment delays, stockouts, and price spikes. Across all countries, these disruptions were reported to disproportionately harm rural and low-income families, increasing the risk of treatment abandonment.?
Conclusion: Across the countries, normative instruments intended to guarantee equitable access currently interact with adverse commercial determinants, thereby constraining the pediatric oncology market. The study reframes access to childhood cancer medicines in East Africa not merely as a technical supply-chain challenge but as a political-economy problem rooted in the misalignment between market incentives and government stewardship. Strengthening the use of evidence in policy design will be essential to align commitments to childhood cancer control with real-world outcomes. Given the shared structural and commercial barriers across the countries, coordinated action in the region is a promising strategy to improve access to childhood cancer medicines and mitigate future commercial or epidemiological shocks.