Moving beyond the tracer conditions: positioning childhood cancer within the scale-up of PEN-Plus in Africa

The 3rd International Conference on PEN-Plus in Africa (ICPPA) reaffirmed PEN-Plus’s potential to decentralise care for severe, complex non-communicable diseases and injuries among underserved populations, particularly children and adolescents. Although childhood cancer was recognised as a sentinel condition in the original Lancet Commission report, it has not yet been fully embraced within PEN-Plus implementation. This gap is striking given that nearly 90% of the over 100–000 children who develop cancer annually in sub-Saharan Africa die, largely as a result of underdiagnosis and late-stage presentation. First-level referral hospitals could therefore help bridge primary and tertiary care, improving timely diagnosis, early treatment, and adherence. Accordingly, the next phase of PEN-Plus should be defined not only by expanding coverage to improve access to care, but also by strengthening equitable, child-centred, and integrated service delivery within national primary health care systems and communities – including extending comprehensive services to other orphaned conditions such as childhood cancer.