The Solomon Islands is a low income nation in the South Pacific with significant challenges in health care resourcing. The National Referral Hospital (NRH) in Honiara is the country’s only tertiary referral hospital. There is limited availability of pathology and medical imaging services. There is only a small range of cytotoxics on the formulary. A scoping visit was carried out in 2016 funded by the John James Foundation with recommendations made to assist in the development of coordinated cancer services and to establish a medical oncology unit. This was followed by an observership visit to Canberra by an NRH doctor in 2017 supported by the Foundation. Following a request from the Solomon Islands Ministry of Health, the Australian Government Department of Foreign Affairs and Trade (DFAT) arranged a mission under the Royal Australasian College of Surgeons (RACS) Pacific Islands Programme (PIP) to the NRH with a team consisting of a medical oncologist, haematologist, oncology clinical nurse consultant and oncology pharmacist to help in the commissioning of the NRH Medical Oncology Unit in September 2018. The aims were to: 1) create protocols and guidelines for procurement, storing, mixing, administration and disposal of chemotherapy agents suitable to NRH context. 2) To conduct training for health staff assigned to the new department on their respective responsibilities. The team with the assistance of an Australian Volunteers International (AVI) Pharmacist have helped the NRH staff to develop localised Solomon Islands Oncology Guidelines. Donated equipment and supplies have helped with the establishment of the service. Another DFAT Oncology mission visit was made in 2019 followed by two NRH oncology nurses coming to Canberra on observership. These collaborative initiatives have contributed to building the capacity and capability of the NRH Medical Oncology Unit to treat cancer patients.