Supporting the early development of decentralised oncology units in Portuguese-speaking African countries: initial results of the GONCO program in Angola and Cape Verde.

Cancer burden is expected to increase in the next decades, especially in low- and middle-income countries (LMICs). There, including in Portuguese-speaking African countries, cancer care remains fragile and highly centralised. Global ONCOlogy Initiative (GONCO) is a pragmatic initiative launched in Portugal to support the development of decentralised oncology services through short, targeted interventions. This paper presents its conceptual design and the first two pilot projects, implemented in Lubango (Angola) and Mindelo (Cape Verde). GONCO follows a three-step model: digital planning, fieldwork and digital follow-up. In both sites, the program was co-developed with local teams and focused on establishing multidisciplinary tumour boards, improving service coordination and building capacity in clinical management, protocols and research. In Lubango, GONCO helped launch the oncology unit and research group. In Mindelo, it supported service restructure planning and the creation of a breast cancer working group. Remote collaboration sustained momentum after field visits. Challenges included hierarchical barriers, unreliable digital infrastructure and non-sustainable funding. Despite these, GONCO demonstrated that focused and adaptable models can catalyse oncology development in resource-constrained hospitals. GONCO provides a replicable, light-footprint model for early oncology development in LMICs.