OPINION: Worrying lack of urgency as Gauteng Health sits on money earmarked to outsource urgent cancer treatmentMoney was made available in March to the Gauteng Health Department to outsource radiation oncology services and address surgical backlogs in the province. PHOTO: SECTION27 and Cancer Alliance

OPINION: Worrying lack of urgency as Gauteng Health sits on money earmarked to outsource urgent cancer treatment

Comment & Analysis

It is almost three months since – partly through the efforts of SECTION27 and Cancer Alliance – money was made available to the Gauteng Health Department to outsource radiation oncology services and address surgical backlogs in the province.

In our article dated 10 March 2023, we indicated that Gauteng Treasury made available an amount of R784 million for the outsourcing of radiation oncology services as well as to service other surgical backlogs. Since then, we have been advised by the Gauteng Department of Health that, of the R784 million, an amount of R250 million has been set aside to realise the outsourcing of radiation oncology services set to benefit cancer patients – some who have been waiting since 2021.

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Fast-forward to today and there has still been no outsourcing of this urgent radiation oncology service.

This lack of urgency on the part of Gauteng Health, while every passing day becomes a matter of life and death for cancer patients is deeply concerning.

How we got here: the three-step process

On 27 March 2023, Cancer Alliance and SECTION27 met with the Gauteng Department of Health and the provincial treasury to discuss and solidify the steps to be taken to, with the money made available, ensure the urgent realisation of the outsourcing project. At this meeting, it was agreed that the Gauteng Department of Health would embark on a three-step process whereby it would update the list of patients awaiting radiation oncology services to reflect the current backlog.

A pink badge ribbon on woman chest to support breast cancer
Many cancer patients in Gauteng have been waiting for years to get radiation oncology treatment. PHOTO: Marco Verch/Flickr

As indicated in our previous article, Cancer Alliance in March 2022, had, at its own cost, employed the services of an independent consultant and with the consent of Charlotte Maxeke Johannesburg Academic Hospital, compiled a list of patients awaiting radiation oncology for over a year. At the time, it was found that there were approximately 3 000 patients awaiting radiation oncology services.

So, the first in the three-step process Gauteng Health was set to embark on, involved updating this backlog list to include patients who had not been serviced in 2022 and to remove those who had received radiation oncology services in the meantime.

To date, the Gauteng Department of Health has not produced its updated backlog list. They, however, confirmed that approximately 300 patients have been serviced since the Cancer Alliance backlog list was compiled in 2022, which places the backlog list at approximately 2700. Some patients may in the meantime have been added to the backlog or passed away, so the real number could be a bit higher or lower.

This lack of urgency and intention shown by the Gauteng Department of Health in the slow manner in which they are handling this matter is cause for great concern.

The second step of the process is to attend to the medical assessment of the patients on the backlog list and to develop a list of qualifying criteria for those who will be referred to the private sector, depending on what is decided in the briefing with the private sector. The third step of the process is to conclude contracts with private sector providers to provide radiation oncology services.

Yet, at this point, we are unsure what developments the Gauteng Department of Health has made with respect to step two of the process, given that they have not yet completed an updated backlog list. We are aware that step three of the process has yet to be initiated.

This lack of urgency and intention shown by the Gauteng Department of Health in the slow manner in which they are handling this matter is cause for great concern.

activists during a march to charlotte maxeke hospital. poster reads cancer patients matter.
Activists during a protest march in 2021 at Charlotte Maxeke Johannesburg Academic Hospital where they delivered a memorandum outlining their concerns. PHOTO: SECTION27 and Cancer Alliance

The meeting

Following numerous attempts, we finally met with the Gauteng Department of Health to get feedback on the progress made. The meeting was held on Friday, 2 June 2023.

There, to our surprise, it was still unclear whether the radiation oncology services would be handled by way of a tender or an outsourcing arrangement. Outsourcing, as explained to us in a presentation by the National Department of Health, is the process that was used during the COVID-19 pandemic that allowed state hospitals to send their sick patients to private hospitals to make up for the demand in the public sector. While a deviation from the normal tender process, this is a lawful process used in urgent cases.

We – Cancer Alliance and SECTION27 – contend that patients waiting for radiation oncology services for over two years now with some who have had repeated recurrences of their cancers as a result of not obtaining radiation oncology services in time (and thus have had to repeat chemotherapy treatment and/or surgery) amount to an urgent issue which is deserving of a deviation from the normal tender process.

The personal cost

Take, for example, **Noluthando Ndlovu, who first approached the public healthcare system in September 2020. She was diagnosed with inflammatory breast cancer – which is an aggressive type of breast cancer – soon thereafter and received chemotherapy for a six-month period, beginning in October 2020. Luckily, Noluthando’s cancer reacted well to the chemotherapy and she was scheduled for surgery the following year in early May 2021. Much to her relief, the surgery was a resounding success. All that was left was for her to obtain radiation oncology treatment within the three months as required by the Clinical Guidelines for Breast Cancer Control and Management published by the National Department of Health, in line with international cancer treatment protocols. But Noluthando did not receive this treatment and her cancer returned in August 2021. She then had to undergo the gruelling process of chemotherapy and surgery and was again eligible for radiation treatment in October 2022.

Again, Noluthando did not receive these services.

sign for radiation oncology
Of the R784 million Gauteng Health received, an amount of R250 million has been set aside to realise the outsourcing of radiation oncology services set to benefit cancer patients. PHOTO: Nasief Manie/Spotlight

Noluthando’s cancer returned for the third time. Unfortunately, as it stands, Noluthando’s cancer is now not responding to the chemotherapy. The cost of the repeated chemotherapy and surgery due to the delay in accessing radiation oncology services is not the only one that Noluthando has to bear. She relays to us that her experience has caused trauma and anxiety for both her mother and her daughter. The uncertainty of her future has impacted her daughter’s academic progress and has affected Noluthando’s progress in her career. Her story is not an isolated incident. While radiation oncology is not in itself a cure for cancer, it is an important and crucial step in the treatment protocol and one which cannot be replaced with any other.

More undertakings

The plan is to ensure that patients are treated through this outsourcing programme by the beginning of August 2023.

When asked, Gauteng Health acknowledged that the tender process would take longer than the outsourcing process and its success also depends on the response received from the market. However, by comparison, the outsourcing project would guarantee that patients like Noluthando are able to access the service from the private sector as soon as it is concluded.

scrabble blocks spelling Cancer
The World Health Organization in February this year said that an estimated 1.1 million new cancer cases are being reported in Africa each year with around 700 000 deaths from cancer. PHOTO: DialysisTechnicianSalary

At the meeting of 2 June 2023, the Gauteng Department of Health agreed to obtain a deviation from the normal tender process by Friday 9 June 2023. Following this, the department would hold a briefing session with prospective service providers within a two-week period. This would mean by Friday, 23 June 2023. The prospective service providers will then be given a period of two weeks to return with proposals, by Friday, 7 July 2023. These proposals will be assessed by a committee and the final award will be made by 21 July 2023. The plan is to ensure that patients are treated through this outsourcing programme by the beginning of August 2023.

Our hope is that the Gauteng Department of Health will, this time, live up to its undertakings. It is worrying that despite being provided with resources to help ensure access to radiation oncology services for the thousands of patients, very little has been done to date to ensure that these cancer patients get the long overdue care that they need. The department must and can do better.

*Mapipa is an attorney at SECTION27.

**Identity withheld

NOTE: This opinion piece was written by an employee of SECTION27. Spotlight is published by SECTION27 and the Treatment Action Campaign, but is editorially independent, an independence that the editors guard jealously. The views expressed in this article are not necessarily those of Spotlight.