Introduction Survival rates for childhood cancer remain far lower in low- and middle-income countries (LMICs) compared to high-income countries (HICs). In Tanzania, challenges in cancer care for children are driven by shortages of trained providers, limited infrastructure, and constrained access to essential medications. This study evaluates pediatric oncology capacity and infrastructure in Northern Tanzania to identify system gaps and opportunities for improvement. Methods A cross-sectional survey of capacity for pediatric cancer care was conducted at 25 hospitals across the Kilimanjaro, Arusha, Manyara, and Tanga regions in Tanzania. Facilities included health centers, district hospitals, regional hospitals, and one zonal referral hospital. Using a tool adapted from the International Society of Paediatric Oncology (SIOP) Global Mapping Survey, the World Health Organization Essential Medicines List, and the Global Initiative for Childhood Cancer, we collected data on hospital infrastructure from hospital leaders and staff. Key indicators included diagnostic imaging, pathology services, oncology workforce, medicine availability, treatment modalities, and cancer case volumes. Descriptive statistics were summarized using R. Results Of the facilities surveyed, only one hospital (Kilimanjaro Christian Medical Centre) had a dedicated pediatric oncology ward and subspecialized staff. Although all facilities reported access to basic imaging such as x-ray and ultrasound, advanced imaging modalities (CT, MRI, specialized imaging) were confined to higher-level hospitals. Only 1 out of 25 hospitals offered pathology and pediatric surgical services. Among 20 essential pediatric oncology medicines assessed, only dexamethasone was universally available. District hospitals, despite serving the largest pediatric catchment areas and recording the highest admissions for children, lacked dedicated pediatric oncology wards. Discussion Pediatric oncology services in Northern Tanzania are constrained by shortages in infrastructure, personnel, diagnostics, and medications. District hospitals have limited capacity to treat childhood cancer, resulting in critical delays in diagnosis and treatment. Strengthening infrastructure at the district level, creating efficient referral systems, and embedding pediatric oncology care into broader health systems may improve survival outcomes for children with cancer.
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