Children and adolescents account for a small yet critically important proportion of global cancer cases with 160000 newly diagnosed cases annually compared to 14.1 million adult cases. In high income countries, advancements have increased childhood cancer survival rates from 10% to over 80%. However, only 20% of the global burden live in these areas while the rest 80% residing in low-middle income countries lack access to timely diagnosis and treatment. Unlike common childhood diseases, cancer requires complex multidisciplinary care and substantial investment. Historically developing countries have focused mainly on infectious diseases to reduce under-5 mortality sidelining malignancies. However, childhood cancers are now recognized by global health authorities as a pressing concern, and we now need to understand the challenges in delivering appropriate health care in these low-middle income countries.