Summary Abstract: Each year, low- and middle-income countries (LMICs) account for over 85% of the 400,000 newly diagnosed pediatric cancer cases. However, there is a 60% survival gap between LMICs and high-income countries (HICs). In the past 5-years, global capacity building and targeted interventions have led to significant increases in survival rates for children with cancer in many LMICs. For example, at Bugando Medical Centre in Tanzania, 2-year overall survival rate has increased from 19% to 49%. With more patients completing treatment, it is important to extend capacity development to include post-treatment follow-up care to support this vulnerable population of childhood cancer survivors in Tanzania. This proposal is a supplement to the Duke Cancer Center Support P30 Grant (CCSG) (5P30CA014236- 47), which established the Duke Global Cancer Initiative, a partnership with Bugando Medical Centre (BMC) in Mwanza, Tanzania with a goal to improve the quality of global pediatric cancer care through research and clinical capacity development. To extend capacity development to include survivorship care, key knowledge gaps remain, including the current health system capacity to implement follow-up care guidelines and the culturally and contextually relevant needs and barriers for survivors of childhood cancer. The planned childhood cancer survivor cohort will provide baseline survivorship data and allow future research to determine the extent of late effects of treatment, long-term complications, and competing causes of mortality, which have not been previously quantified in sub-Saharan Africa. Implementing follow-up care guidelines into clinical practice in countries like Tanzania represents a tremendous opportunity to continue to optimize outcomes for children with cancer globally.