The African Paediatric Fellowship Programme Colloquium, Cape Town, South Africa. Reflection on an intra-continental model for paediatric haematology oncology training, 2010–2026
Marc Hendricks1, Helen Meintjes2, Joyce Balagadde Kambugu3, Vivian Paintsil4,5, George Chagaluka6, Lawrence Osei-Tutu4, Esther Majaliwa7, Loyce Hlatywayo8, Motunrayo Adekunle9, Katlego Tsimane10, Beatrice Chikaphonya-Phiri6, Emmanuella Amoako11, Mamiki Chise10, Stella Mzumara12, Linda Kissila7, Yaa Gyamfua Oppong-Mensah4, Tumweneni Mekelaye Nghaamwa13, Jaques van Heerden14,15, Helder de Quintal1 and Alan Davidson1
1Department of Paediatrics and Child Health, Faculty of Health Sciences, Haematology-Oncology Service, Red Cross War Memorial Children’s Hospital, University of Cape Town, Rondebosch, Cape Town 7700 , South Africa
2Department of Paediatrics and Child Health, Faculty of Health Sciences, African Paediatric Fellowship Programme, Red Cross War Memorial Children’s Hospital, University of Cape Town, Rondebosch, Cape Town 7700 , South Africa
3Division of Paediatric Haematology and Oncology, Uganda Cancer Institute, Kampala 10023, Uganda
4Directorate of Child Health, Komfo Anokye Teaching Hospital, Kumasi 1934, Ghana
5Department of Child Health, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
6Department of Paediatrics and Child Health, Children’s Cancer Ward, Queen Elizabeth Central Hospital, Blantyre 300000, Malawi
7Paediatric Hematology and Oncology Services, Kilimanjaro Christian Medical Centre (KCMC), KCMC University, Moshi 2240, Tanzania
8Paediatric Haematology Oncology Unit, Zimbabwe Ministry of Health and Childcare, Parirenyatwa Group of Hospital, PO Box CY 198, Causeway, Harare, Zimbabwe
9Department of Paediatrics, Lagos State University Teaching Hospital, Lagos 21266, Nigeria
10Department of Paediatrics, Princess Marina Hospital, Gaborone 56002, Botswana
11Department of Paediatrics and Child Health, Cape Coast Teaching Hospital, School of Medical Sciences, University of Cape Coast, Cape Coast 1363, Ghana
12National Cancer Centre, Kamuzu Central Hospital, Mzimba street, Area 33, PO Box 149, Lilongwe, Malawi
13Department of Paediatrics, Windhoek Central Hospital, Windhoek 9000, Namibia
14Department of Paediatrics and Child Health, MIPRO Laboratory, Paediatric Haematology and Oncology, Antwerp University Hospital, University of Antwerp, 2650 Antwerp, Belgium
15Department of Paediatrics and Child Health, Tygerberg Hospital, Stellenbosch University, Stellenbosch 7599, South Africa
Abstract
Twelve African paediatricians from across the continent have travelled to Red Cross War Memorial Children’s Hospital (RCWMCH) under the auspices of the 2-year residential African Paediatric Fellowship Programme (APFP). Over almost two decades, the programme has delivered specialist general paediatric and subspecialist training to capacitate African healthcare centres, improved retention of specialised personnel and driven critical improvements in paediatric care across the continent. The programme boasts a commendable 89% local retention rate to date, rising to 92% if seven colleagues now displaced by conflict are excluded (as of end 2025). All but two haematology–oncology graduates have returned to their home institutions, with the remaining two still active in the field in their home countries. Haematology/oncology training started in 2010 in the haematology–oncology service at RCWMCH and 3 February 2026 marked the first return of alumni to a 1-day colloquium to learn, reflect, network and consolidate the progress made since the programme’s inception. The colloquium content centred on three key areas: education, research and service provision. Next was the University of Cape Town’s Paediatric Refresher Course with a haematology–oncology focus, attracting national and international experts in haematology, sickle cell disease, gene therapy and stem cell transplantation, leukaemia, neuro-oncology and palliative care. This afforded APFP alumni a unique opportunity to keep abreast of international best practices and to adapt and inform their local care with up-to-date treatment approaches. The groundwork of many individuals and international organisations established a foundation on which the APFP physician graduates have facilitated creative transformations of established systems of haematology/oncology care. Through APFP training and mentorship of local physician leaders, completely new components of patient care, clinical governance and academic leadership and development have been realised across ten facilities, given that one fellow is still in training. The partner site growth reported by the former fellows is testament to their tireless efforts in the face of almost unimaginable obstacles compared to counterparts in high-income countries. The APFP programme stands as a sustained, successful model for intra-African health workforce capacitation and support of African children and families with haematological/oncological diseases.
Keywords: African paediatric fellowship programme, haematology oncology training, post-graduate education, skills development and capacitation, low- and middle-income countries
Correspondence to: Marc Hendricks
Email: Marc.Hendricks@uct.ac.za
Published: 18/08/2026
Received: 24/03/2026
Publication costs for this article were supported by ecancer (UK Charity number 1176307).
Copyright: © the authors; licensee ecancermedicalscience. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Introduction
The African Paediatric Fellowship Programme (APFP) was established in 2007 to build capacity in centres of excellence in Africa where specialised services for children were in their infancy or nonexistent. Red Cross War Memorial Children’s Hospital (RCWMCH) in Cape Town, South Africa, has trained over 200 subspecialist paediatricians and paediatric surgeons through this programme. Acceptance to the training programme is predicated on full sponsorship and guaranteed employment at the candidate’s home institution on completion of the training (www.apfp.uct.ac.za).
The APFP haematology–oncology programme began in 2010 and offers a 2-year physician training programme with an option to complete the fellowship examination (Certificate in Medical Oncology [Paediatrics]) with the Colleges of Medicine of South Africa (CMSA) and includes exposure to radiotherapy and bone marrow transplantation, with a mandatory requirement to complete an MPhil dissertation through the University of Cape Town (UCT). A Haematology Oncology Diploma (UCT) (https://health.uct.ac.za/research-research-groupings-cancer-research-initiative/training-opportunities) is available for candidates whose funding can only support a 1-year on-site attachment. To date, the programme has a 100% local retention rate for oncology trainees who all returned to fulfil their commitment to their home countries (Figure 1).
Figure 1. Photograph (Julia Challinor): the APFP haematology oncology programme director, trainers and alumni.
The APFP oncology training opened its doors to the first fellow from Uganda and has since graduated additional candidates from Uganda (2), Ghana (2), Tanzania (1), Malawi (3), Nigeria (2), Botswana (2) and Zimbabwe (1) (Figure 2). Three fellows are currently in training, from Tanzania, Ghana and Namibia (Table 1). The APFP has been intentional in supporting growth in nodal paediatric oncology units (POUs) in specific English-speaking sub-Saharan African regions, building clinical teams that include both doctors and nurses essential for delivery of care. Supported by the Harry Crossley Children’s Nursing Development Unit in the Department of Paediatrics, nurses from partner institutions spend a 6-week training attachment to the unit at RCWMCH, which helps to expand local teams and bolster direct patient care. To date, 26 nurses working with the APFP paediatric oncology graduates have been trained and returned to their home institutions to collaborate and support the APFP physician leaders in strengthening local care.
Figure 2. Partner countries of the haematology oncology training platform for the APFP.
Table 1. The APFP haematology/oncology alumni year/s of enrolment and home facilities.
Since its inception, the APFP programme has graduated nine candidates through the CMSA and two through the UCT. Five graduates have earned an MPhil (UCT) (three with distinction), and two graduates are pursuing PhDs. The APFP programme recently celebrated the academic progression of one alumna to associate professor (Ghana) and a graduate’s successful term as Continental President for Africa for the International Society of Paediatric Oncology (SIOP), while others occupy key roles in continental clinical and research societies. Many alumni have gone on to participate in established and new regional and continental cancer disease-specific research programmes and are now widely published in international peer-reviewed journals.
On 3 February 2026, APFP alumni from partner institutions were invited to a hybrid-format colloquium hosted by the haematology–oncology service at RCWMCH to share their developmental journeys, the inspiring gains that have been made since returning to their home institutions and to problem-solve the significant challenges they still face.
The colloquium: themes, intersections and consensus
The meeting focused on key areas of local-regional service delivery, education and training and cancer disease-specific research, with each alum reporting their progress and challenges in these domains.
Enhancing paediatric oncology collaboration
The meeting focused on various aspects of managing multidisciplinary teams in paediatric oncology across Africa. This discussion centred on the importance of understanding and implementing the philosophy behind various treatment protocols, emphasising the need for collaboration with radiation oncologists and surgeons. It highlighted the necessity of preparing comprehensive referrals and familiarising partners with protocols. This was identified as a key intervention to the successful improvement of childhood cancer services by all participants.
Childhood cancer treatment in low- and middle-income countries (LMICs)
Session II was dedicated to reviewing cancer disease-specific research and outcomes at local POUs and across the continent. Data were presented on the limited availability of neurosurgical services and adjuvant therapies in Gaborone, Botswana, highlighting the need for improved surgical resection, post-surgical care and neurorehabilitation to enhance outcomes. Local diagnoses had more than trebled between 2008 and 2019, with a modest 43% overall survival (CI: 0.29–0.56) at 2 years, with most deaths a result of disease progression [1].
A Malawian centre shared their 10-year experience at Kamuzu Central Hospital in Lilongwe treating Burkitt lymphoma, noting improvements in survival rates after adopting a rituximab-based regimen and enhancing supportive care. The discussion also covered the WHO Global Initiative for Childhood Cancer’s (GICC) goal to increase survival rates to 60% by 2030, emphasising the need to address health system challenges, pathology, surgery and advocacy in low- and middle-income countries (LMICs). Data from Blantyre, Malawi, on acute lymphoblastic leukaemia (ALL) management showed improved survival rates (Figure 4) as well as dramatically reduced mortality from 80% in 2020 to 17% in 2025 (Figure 5). The challenges of delayed diagnosis, limited access to certain treatments and the need for better supportive care remain. It was noted how the introduction of flow cytometry had improved the local capability to make an accurate leukaemia diagnosis.
Advancements in cancer treatment protocols
In a review of lymphoma management in Africa, South Africa’s success with harmonised treatment for Hodgkin lymphoma, which achieved 100% survival in low-risk patients and 91% in high-risk patients [2], was foregrounded. This was juxtaposed against high-income countries shifting from traditional chemotherapy to regimens incorporating immunotherapy and checkpoint inhibitors with promising results from a trial substituting Brentuximab in OEPA and COPDac regimens that showed 97.4% event-free survival and 98.7% overall survival [3]. Also highlighted was the potential role for metronomic chemotherapy, emphasising its effectiveness, in certain paediatric cancers while acknowledging challenges with drug availability and managing patient expectations in low- and middle-income settings.
APFP alumni advancing paediatric oncology in Africa: in situ growth and innovation
Centres reported progress in service delivery at Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi, highlighting the growth from two beds to a fully equipped facility with 272 new cases annually. Emphasis was placed on the importance of building both infrastructure and clinical teams, as well as the need for a comprehensive plan to guide collaborations. Similar progress of paediatric oncology care at Kamuzu Central Hospital in Lilongwe, Malawi, revealed a widened footprint for basic paediatric oncology nursing training, mentorship of clinical officers from district hospitals, improved fundraising through the Thitha Project and improved survival rates from less than 30% to over 60%. Delayed recognition of cancer and late diagnosis, inadequate radiology and pathology services, an inconsistent availability of drugs and blood products, a lack of outpatient space and treatment abandonment were highlighted as major ongoing challenges to successful service provision.
APFP alumni across sites reported continued growth of patients serviced, bed capacity and physical infrastructural expansion. Increases in staffing cadres and care expansion in nursing, nutritional support, physiotherapy and palliative services, parent support projects and delivery of specialised services, e.g., radiotherapy, were also noted.
At the Cape Coast Teaching Hospital in Ghana, there is planned construction of a 24-bed green-energy shipping container unit to serve as an independent oncology centre servicing the central, western and northwestern regions. This will decongest patient referrals to Korle Bu Teaching Hospital (Accra) and Komfo Anokye Teaching Hospital (Kumasi), providing care for families closer to their homes and hopefully reducing abandonment of care due to distance from the hospital. Cape Coast Teaching Hospital will pilot a new integrated digital tool, COMPASS, to support community parent navigation for early childhood cancer recognition and referral. This project is supported by an MCM grant from 2025.
In Tanzania, at Kilimanjaro Christian Medical Centre, there are plans to open a large radiotherapy unit, which will revolutionise the management of solid and brain tumours. There are also plans to build a new on-site housing facility for parents and children and a new bone marrow transplantation unit for children with sickle cell disease.
In Malawi, at QECH, there has been a reduction of treatment abandonment from 19% to 6% (p < 0.001) with the support of several nongovernmental organisations (NGOs) and provision of full travel and nutritional costs, welcome packs, counselling and patient appointment tracking (n = 150), 2019–2021 [4]. Intensive training of 1,363 healthcare workers across 288 health facilities has significantly increased the new patient presentation from 181 in 2019 to 272 in 2025 (p = 0.006) (unpublished data, abstract entitled, ‘Improving diagnosis of childhood cancer in Malawi, the impact of early warning signs training’, which was accepted for oral presentation at SIOP Africa 2026 in Lagos, Nigeria, 14–17 May 2026).
In Zimbabwe, at Parirenyatwa Hospital in Harare, critical partnerships with local NGO KidzCanTM have driven significant increases in newly diagnosed children and demographic reach through public sector advocacy work with clinicians actively promoting cancer-related priorities through television, radio and paper press engagements. This large national referral hospital has 30 beds dedicated to childhood cancers and a four-bed paediatric intensive care unit. Current efforts are to develop standard operating procedures, improve chemotherapy administration safety and improve childhood cancer awareness in community health workforces and among public sector district medical officers.
Several of the speakers noted that their active engagement with the media at every opportunity was key to progressing paediatric oncology services and care, including as a way of providing the public with the information needed to hold governments and services accountable.
Engaging doctoral research in paediatric oncology
The colloquium research session encompassed personal reflection on doctoral research experiences and explorations of research opportunities in SIOP and more broadly across the African continent (Figure 3). Careful selection of the research question and supervisorial support were highlighted as fundamental components to successful completion. Additional recommendations included repeated grant applications to support operational costs of projects and salary support during time away from work, protected time and space to write and early identification of related attachments for development of new research skills. Importance was placed on attending international conferences to share data, build research partnerships, create visibility of one’s area of research interest and attract funding. Additionally, personal self-awareness, seeking support and maintaining a focus on personal and academic growth were also considered important. In closing, the impact of doctoral research on clinical protocols and treatment guidelines in South Africa and Africa at large was incontrovertible and created new opportunities for future genomic research projects. Attendees were encouraged to pursue their academic goals proactively, to engage with the global scientific community and to celebrate their achievements while learning from failures. A new doctoral candidate identified curiosity, desire and reward as key drivers for successful completion. She also reflected on the ongoing support and encouragement she received from her supervisors after she had left the centre when her training was completed.
Figure 3. Photograph (Marc Hendricks): APFP colloquium, 2026. Listening and learning together.
Figure 4. Trends in diagnoses of ALL at Queen Elizabeth Hospital, Malawi, 2020–2025.
Figure 5. Trends in mortality for ALL at Queen Elizabeth Hospital, Malawi, 2020–2025.
Collaborative paediatric oncology research in Africa
The diverse cancer disease and discipline-specific opportunities for APFP alumni available through the SIOP Africa Research Committee as a mechanism for personal academic development, building research networks and increasing and developing curricula and registries were presented. The SIOP Africa Scientific Committee aims to connect researchers and coordinate research efforts across the continent. Various SIOP Africa working groups, including those focused on Burkitt’s lymphoma and retinoblastoma, have reported success by utilising existing regional resources and expertise. The committee’s approach emphasises national and continental collaboration, mentorship and the development of local expertise. The APFP program contemporaneously contributes to this success and is supported by the committee to realise their research goals.
Paediatric oncology networking and funding opportunities
Opportunities for APFP graduates to engage with SIOP at large are myriad. Membership in this international network of paediatric haematology/oncology professionals and parent groups through Childhood Cancer International offers multiple networking as well as funding opportunities for paediatric oncology projects. Specific research funding through the SIOP Programme for Advancing the Research Capacity is available for cooperative groups conducting regional clinical trials. Challinor mentioned several important networks for APFP graduates, e.g., Young SIOP Network (under 40 years old), Nutrition Network, Survivorship Network, Supportive Care Network and Women Leaders in Paediatric Oncology Network. She also encouraged participants to consider running for Steering Group positions in SIOP Networks as a path to further leadership within SIOP and exposure of their work and successes in their local facilities and regional collaborations. SIOP has several prizes to recognise outstanding efforts by clinicians and Challinor presented these for consideration by the participants to highlight their successes. She also mentioned Foundation S support of several SIOP initiatives and opportunities for funding LMIC nursing and physician capacity building projects through the My Child Matters programme. Increasing global attention to the challenges of childhood haematology/oncology care across Africa can galvanise external resources and funding to complement limited financing from national governments and local NGOs.
Challenges
APFP alumni identified shared barriers to childhood cancer care as a lack of political will to drive change in the sector given other competing health priorities for ministries of health. Limitations of human, consumable and fixed resources are also a factor affecting clinical care. Traditional, cultural and economic drivers of health-seeking behaviour and shortages of specialised skills to complete multidisciplinary groups drive treatment decisions in consideration of child and family poverty, malnutrition and food insecurity. In this regard, alumni emphasised the importance of steadily advancing service development wherever possible, noting that even incremental successes can help cultivate support from African policymakers, donors and communities.
Implications for future training
Across the African paediatric oncology hubs, formal training reliably produces clinically competent specialists. Fellows graduate with strong theoretical grounding, extensive clinical exposure and solid supervised experience. Yet, clinical readiness is only part of what they require. The more compelling question trainers must ask is whether their training programmes prepare their graduates for the weight of complex responsibility they inherit the moment they return home.
‘Our graduates return as de-facto leaders: service anchors, decision-makers and moral back-ups. Their training is designed for more than just competence, as they are quietly shaped by resilience under pressure. Their long-term impact depends less on brilliance and more on belonging, mentorship and continued connection: being anchored (by the programme) is both intentional and critical’. Dr Joyce Kambugu-Balagadde, APFP alumna, 2010 and 2015, SIOP Africa President, 2023–2025.
The APFP and global alignment
The APFP directly supports the WHO GICC, begun in 2018, following the CureALL Framework and specifically the framework pillar for Centres of Excellence (strengthen training of multidisciplinary workforce). The APFP graduates who return to their home countries take action under pillars regimens for management (develop national standards of care for management) and evaluation and monitoring (invest in cancer research infrastructure) [5]. The APFP also supports the UN General Assembly (December 2025) Political declaration of the fourth high-level meeting of the General Assembly on the prevention and control of noncommunicable diseases and the promotion of mental health and well-being, to ‘Improve childhood cancer survival through scaling up interventions in order to achieve a survival rate of at least 60% globally by 2030, as proposed by the GICC’, since specialised paediatric oncologists are essential for successful care [6].
The APFP and African imperatives
African-specific action to address the WHO GICC goals is outlined in a recent publication outlining continental action to achieve the 2030 GICC goal. As the African authors note, ‘In resource-limited settings, strong leadership is essential in applying available, tools and innovative ways to achieve these results. Meeting the 23rd target of 60% survival, double the current estimate [in Africa], can only be achieved by unified team approach’ [7].
The APFP graduates form a significant portion of the expertise and leadership across Africa, thus complementing the parallel effort by the French African Pediatric Oncology Group, a consortium of 22 facilities in 18 French-speaking African countries [8]. These two groups, joined in collaboration under SIOP Africa, ensure that paediatric haematology/oncology physician and nurse capacity building is a priority and sustained by continual professional educational opportunities and research. It is essential that African paediatric oncology treatment facilities are led by regional expertise and lessons learnt [9]. The APFP curriculum and clinical experiences encompass the regional knowledge and skills necessary for the graduates to provide tailored and effective care in their facilities in consideration of their resources, cultures, traditions and family beliefs and priorities. On 3 February 2026, WHO Regional Director for Africa, Dr Mohamed Janabi, released a statement for World Cancer Day calling for ‘urgent, equitable and sustained action’ on the continent [10]. APFP, RCWMCH and UCT have stepped up to support the expansion of childhood cancer treatment across Africa and improve access to care for all children regardless of their geography, which meets the SIOP mission of ‘no child should die of cancer: cure for more, care for all’.
Conclusion
The APFP Haematology Oncology training programme is an African success story in evolution and serves as a reproducible model for similar settings. It is constantly writing and rewriting itself through experiential trial and error and is underpinned by a structured learning programme and ongoing post-programmatic support and mentorship, which itself is in flux and must adapt to a changing continent, as cancer emerges as the new major cause of mortality in sub-Saharan Africa, predicted to supersede HIV and tuberculosis, as we head towards 2040.
Acknowledgment in absentia
Dr Albert Kamugisha (Uganda), 2010, and Dr Mohamed Shamsudeen (Nigeria), 2017, AFPF alumni.
Conflicts of interest
The authors have no conflicts of interest to declare.
Funding
The 2026 APFP Colloquium was funded by programmatic funding. Three APFP fellows were funded by the Global Hope Programme (Texas Children’s/Baylor College), and one fellow was funded by the Namibian government, while the remainder were funded by programmatic funding from UCT-APFP donors. Nursing teams were funded by World Child Cancer, United Kingdom, and one team was funded by St. Jude Global, USA.
Participated on-line
Dr Joyce Balagadde-Kambugu (Uganda), 2011/2016, and Dr Beatrice Chikaphonya-Phiri (Malawi), 2022, APFP alumnae.
Author contributions
Marc Hendricks (conceptualisation and drafting, figure design, writing and editing); Helen Meintjes (programme manager, logistics, programme data, writing and editing); Joyce Kambugu-Balagadde (writing and editing); Vivian Paintsil (writing and editing); George Chagaluka (writing and editing); Lawrence Osei-Tutu (writing and editing); Esther Majaliwa (writing and editing); Loyce Hlatywayo (writing and editing); Motunrayo Adenkunle (writing and editing); Katlego Tsimane (writing and editing); Beatrice Chikaphonya-Phiri (writing and editing); Mamiki Chise (writing and editing); Emmanuella Amoako (writing and editing); Stella Mzumara (writing and editing); Linda Kissila (writing and editing); Yaa Gyamfua Oppong-Mensah(writing and editing); Tumweneni Mekelaye Nghaamwa (writing and editing); Jaques van Heerden (writing and editing); Helder de Quintal (writing and editing); Julia Challinor (conceptualisation, conference summaries, writing and editing); Alan Davidson (conference summaries, writing and editing).
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