{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,12]],"date-time":"2026-11-12T07:54:05Z","timestamp":1794470045689,"version":"4.9.1"},"reference-count":17,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T00:00:00Z","timestamp":1756425600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Sustainability\u2014the continued delivery of an intervention's intended benefits after external donor support ends\u2014is essential to ensure long\u2010term impact and success. In 2019, a cash transfer program in Blantyre, Malawi, provided full transport reimbursement (mean \u223c200 Euros\/family), counseling, and patient tracking for caregivers of children with common and curable cancers. This reduced treatment abandonment from 19% to 7% (<jats:italic>p<\/jats:italic> &lt; 0.001). We evaluated the program's sustainability over a 4\u2010year period post\u2010implementation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The intervention was implemented from June 2019 to June 2020. We conducted a mixed\u2010methods study to assess sustainment and sustainability. We evaluated the continuation of cash transfers and treatment abandonment rates among children (&lt;16\u00a0years) newly diagnosed with common and curable cancers from 2022 to 2024. Exploratory stakeholder interviews identified perceived facilitators and barriers to sustainability.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The program continued beyond 2020 with modifications\u2014transport reimbursement was limited to the home district. A new donor assumed funding. Reduced abandonment rates were sustained: 9% (10\/110) in 2022, 10% (13\/127) in 2023, and 3% (2\/70) in 2024 (with 40% still on treatment) (<jats:italic>p<\/jats:italic> = 0.28). Reported facilitators of sustainability included high acceptability, local ownership, demonstrated effectiveness, and availability of alternative donor support. Barriers included resource constraints, competing health priorities, and concerns about misuse of funds.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Four years after initial funding ended, the cash transfer intervention remained active with sustained reductions in treatment abandonment. These findings highlight the potential for sustained impact of financial support programs in low\u2010resource settings. Further research is needed to identify the key determinants of sustainability, informing future scale\u2010up efforts.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.32021","type":"journal-article","created":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T10:50:44Z","timestamp":1756464644000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Sustainability of a Cash Transfer Program in Malawi: A CANCaRe Africa \u201cZero Abandonment\u201d Pilot"],"prefix":"10.1002","volume":"72","author":[{"given":"Harriet","family":"Khofi","sequence":"first","affiliation":[{"name":"CANCaRe Africa, The Collaborative African Network for Childhood Cancer Care and Research  Blantyre Malawi"},{"name":"Paediatrics and Child Health Kamuzu University of Health Sciences (KUHeS)  Blantyre Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatrice","family":"Chikaphonya","sequence":"additional","affiliation":[{"name":"Paediatrics and Child Health Kamuzu University of Health Sciences (KUHeS)  Blantyre Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8932-8181","authenticated-orcid":false,"given":"Asya","family":"Agulnik","sequence":"additional","affiliation":[{"name":"St. Jude Children's Research Hospital  Memphis Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0951-3091","authenticated-orcid":false,"given":"Lillian","family":"Sung","sequence":"additional","affiliation":[{"name":"The Hospital for Sick Children  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecilia","family":"Mdoka","sequence":"additional","affiliation":[{"name":"CANCaRe Africa, The Collaborative African Network for Childhood Cancer Care and Research  Blantyre Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Molyneux","sequence":"additional","affiliation":[{"name":"Paediatrics and Child Health Kamuzu University of Health Sciences (KUHeS)  Blantyre Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ross C.","family":"Brownson","sequence":"additional","affiliation":[{"name":"Prevention Research Center at Washington University School of Public Health and Alvin J Siteman Cancer Center  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Chagaluka","sequence":"additional","affiliation":[{"name":"Paediatrics and Child Health Kamuzu University of Health Sciences (KUHeS)  Blantyre Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4309-4994","authenticated-orcid":false,"given":"Trijn","family":"Israels","sequence":"additional","affiliation":[{"name":"CANCaRe Africa, The Collaborative African Network for Childhood Cancer Care and Research  Blantyre Malawi"},{"name":"Paediatrics and Child Health Kamuzu University of Health Sciences (KUHeS)  Blantyre Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,8,29]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(18)30761-7"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(21)00720-8"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(11)70128-0"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.29367"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-98770-7"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(25)00030-1"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41562-022-01414-7"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.29899"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.28322"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.30654"},{"key":"e_1_2_9_12_1","unstructured":"\u201cPoverty Headcount Ratio at $2.15 a Day (% of Population) \u201dWorldbank accessed July 21 2025 https:\/\/data.worldbank.org\/."},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.31364"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.89.9.1322"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.phoj.2024.02.005"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-015-0274-5"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-publhealth-052220-112457"},{"key":"e_1_2_9_18_1","first-page":"261","volume-title":"Dissemination and Implementation Research in Health: Translating Science to Practice","author":"Rabin B. 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