Strategic planning for the establishment of pediatric oncology units in low-resource settings: a qualitative study to explore key strategic elements and lessons learned
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BACKGROUND: Globally, 80% of children with cancer live in low- and middle-income countries (LMIC) and 20% or less are expected to survive. Research demonstrates a gap on recording experiences of planners who have successfully established a pediatric cancer unit (PCU), lack of studies on systematic, evidence-based planning of a PCU, and absence of an actionable, practical framework that guides planners. OBJECTIVES: This qualitative study used a case study approach to examine the key elements in the planning process of effectively establishing a new PCU and identify the challenges that need to be addressed. METHODS: Porter’s Value Chain Model served as the theoretical framework to guide the research agenda. Semi-structured in-depth interviews were conducted in 2017 with a purposive sample of 35 key informants reflecting experiences from 30 countries. An interview guide was developed and recruitment continued until saturation. Participants included physicians, nurses, architects, administrators, consultants, and academicians. Data were also employed from three other sources: document review, observation, and pre-dissertation findings. Interviews were recorded, transcribed using REV, and analyzed using NVIVO. Data were analyzed using a thematic analysis and principles of grounded theory method were applied in the interview guide design and analysis. RESULTS: Respondents reported nine strategic elements essential in the process: leadership, mission, planning principles, organizational structure, situation analysis, medical model, financing, stakeholders, and international partnerships. Corruption, distrustful culture, ineffective communication, and lack of data were cited as key barriers. DISCUSSION: Documenting best practices and implementing a data-driven, systems-based planning is essential in advancing local PCU management know-how in LMIC. The modified Porter’s Value Model showed promise as a generalizable model for future public health practitioners and created a framework for systems-based, multidisciplinary approach in strategic planning.
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