Paediatric Oncology System Integration Tool (POSIT) for the joint analysis of the performance of childhood cancer programs and health systems

To help understand how health systems and sociopolitical contexts intersect with and impact the performance of childhood cancer care in low- and middle-income countries (LMICs), we have developed a systems-level framework for analyzing the performance of LMIC childhood cancer programs within their health system contexts: The Paediatric Oncology System Integration Tool (POSIT). POSIT development was informed by consultation with experts in global paediatric oncology, a literature review of childhood cancer performance assessment in LMICs, and a review of general health system literature. Review results were thematically analyzed and conceptually integrated with results from expert consultation to produce our final framework. Our findings from the childhood cancer performance literature demonstrate a current gap in efforts to strengthen the performance of childhood cancer at a health systems-level in LMICs. The POSIT framework incorporates important system-level determinants of childhood cancer performance and synthesizes these with general health system concepts. It outlines the key functional domains of childhood cancer systems - governance, financing, health workforce, infrastructure, health information systems, medicines and health technologies, and demand generation - and elaborates on these by articulating sub-functions of specific relevance to childhood cancer. It delineates several performance objectives - access, efficiency, effectiveness, and responsiveness - and breaks these down into measurable dimensions. Lastly, it outlines the sociopolitical factors influencing childhood cancer system performance. We hope this work will facilitate future comparative research on childhood cancer in LMICs through a health policy and systems lens: a necessary endeavour for informing cross-contextual learning to strengthen childhood cancer systems.