Title : Strengthening early warning systems and health system responses to improve childhood cancer outcomes in Nepal

Background: Childhood cancer is an emerging public health priority, with significant survival disparities between high-income and low- and middle-income countries. While survival rates exceed 80% in high-income settings, they remain below 30% in many areas with limited resources, largely due to delayed diagnosis and limited access to timely treatment. In Nepal, low awareness of early warning signs, depend on traditional healing practices, and weak referral systems contribute to late-stage presentation. Symptoms such as persistent fever, unexplained bruising, or lumps are often misdiagnosed, resulting in critical delays. Strengthening early detection and improving health system responsiveness are essential to improving outcomes.  
 
Methods: This study draws on program implementation and training supported by World Child Cancer in Nepal. A review of relevant literature informed the design of Early Warning Signs and Symptoms (EWSS) interventions, including capacity building of healthcare providers, engagement with Female Community Health Volunteers (FCHVs), and strengthening referral systems through shared care networks. 
 
Results: EWSS training significantly improved the knowledge and confidence of frontline health workers in identifying suspected childhood cancer cases. Increased community awareness contributed to earlier care-seeking behavior among caregivers. Strengthened referral systems enabled more timely and coordinated patient transfers to specialized centers. The development of shared care networks improved access to diagnosis and treatment closer to home, reducing delays and treatment abandonment. Over 200 healthcare professionals were trained, leading to improved diagnostic pathways and enhanced collaboration across levels of care. Collectively, these interventions contributed to earlier diagnosis and improved continuity of care. 
 
Conclusions: Improving childhood cancer outcomes in resource-limited settings requires an integrated approach that combines early detection with health system strengthening. The Nepal experience demonstrates that empowering community health workers, enhancing provider capacity, and strengthening referral networks can significantly reduce diagnostic delays and improve access to life-saving treatment. These interventions are scalable and adaptable to similar settings, offering a practical model for addressing inequities in childhood cancer care globally. 

I am a public health professional with over five years of experience in program coordination and health system strengthening in Nepal. Currently a Program Officer at World Child Cancer, supporting early diagnosis, treatment access, and quality care for children with cancer. Focus areas include Early Warning Signs and Symptoms (EWSS), capacity building, and strengthening referral systems through shared care networks. Experienced in training healthcare providers and working with Female Community Health Volunteers (FCHVs) to raise community awareness. I am interested in reducing diagnostic delays, improving treatment adherence, and advancing equitable childhood cancer care in resource-limited settings.