Background Pediatric hematopoietic stem cell transplantation (HSCT) is a life-saving therapy for malignant and non-malignant hematologic diseases. However, access to this high-complexity treatment remains limited and uneven across the Andean subregion. This study aimed to evaluate the current status, capacity, and equity of pediatric HSCT programs in six Andean countries (Bolivia, Chile, Colombia, Ecuador, Peru, and Venezuela) within the framework of WHO Global Initiative of Childhood Cancer. Methods A mixed-methods, cross-sectional situational assessment was conducted between November 2024 and January 2025 under the coordination of the Andean Health Organization (ORAS-CONHU) and the Pan American Health Organization (PAHO). Standardized national and center-level surveys (34 and 150 items, respectively) were applied to Ministries of Health and HSCT centers to collect data on infrastructure, workforce, financing, quality management, and barriers to access. Quantitative data were analyzed descriptively and validated by national committees, complemented by qualitative interviews with key stakeholders. Results Twenty-seven HSCT centers were identified across the subregion, revealing major disparities in access and capacity. Chile reached 100% coverage of estimated transplant needs, while Colombia, Peru, and Venezuela achieved 80%, 29%, and 42.5%, respectively. Bolivia and Ecuador had the lowest coverage (1.6% and 24%). Only 28% of units were pediatric-exclusive, and less than two-thirds met full quality and training standards. High-cost medicines, limited infrastructure, and shortages of specialized personnel were identified as critical barriers, while regional collaboration and national policies emerged as key facilitators. Conclusion The study highlights significant inequities in pediatric HSCT access and capacity across the Andean subregion. Strengthening infrastructure, workforce training, financing mechanisms, and data systems, supported by sustained regional cooperation, is essential to achieve equitable, high-quality transplant care for all children.

Background and Aims: Late detection is a critical factor related to high childhood cancer mortality in low- and middle-income countries. A previous study in Peru showed that DT (Diagnosis Time), the time interval between the onset of symptoms and the definitive diagnosis, was 107 days. A strategy with multiple interventions has been implemented to reduce DT as part of the Global Initiative for Childhood Cancer. This study analyzes the reduction in the DT of childhood cancer in Peru in the last four years. Methods: Data of children and adolescents registered in the GICC hospital-based registry were retrospectively analyzed. Patients belonged to eleven hospitals nationwide. The association between clinical-demographic variables and DT was investigated. Other intervals analyzed were patient time (PT), medical time (MT), and treatment time (TT). Results: This study included 2,268 patients under the age of 20 registered between 2020 and 2023. The median DT was 26 days (IQR: 9–61), and the mean DT was 57 days (SD: 97.8; range: 0–962). Patients whose parents had lower educational levels, those aged 12 to 20 years, and those diagnosed with solid tumors had significantly longer DT. The median PT (time interval between the onset of symptoms until the first contact with a healthcare professional) was 19.5 days (IQR: 7-44), Early child education and primary educational level of parents was associated with longer PT. The median MT (time interval between the first contact with a healthcare professional and the definitive diagnosis) was 10 days (IQR:2-30). A comparative analysis of the data collected from 2012-2014, and the data collected in this study was made. The Kruskal-Wallis analysis showed a significant reduction in DT, mainly at the expense of MT between both periods (p<0.001), demonstrating the impact of the strategy on the interval that depends on healthcare professionals. The median TT (time interval between the definitive diagnosis of cancer until the start of treatment) was 8 days (IQR:1-19), with no significant reduction over time compared to the 2012–2014 period. Conclusions: Over the past four years, the early detection strategy has proven effective in reducing the DT of childhood cancer in Peru. This strategy should be incorporated into public policies to ensure its sustainability and the continuous improvement of outcomes.