In our article dated 10 March 2023, we indicated that Gauteng treasury made R784-million available for the outsourcing of radiation oncology services and to service other surgical backlogs. Since then we have been advised by the Gauteng health department that R250-million of that amount has been set aside to outsource radiation oncology for cancer patients – some who have been waiting since 2021.

Today, this urgent service has still not been outsourced.

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, the Cancer Alliance and SECTION27 met the Gauteng department and 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. It was agreed that the department would embark on a three-step process to update the list of patients awaiting radiation oncology services to reflect the current backlog.

As indicated in our previous article, in March 2022 the Cancer Alliance had, at its own cost, engaged the services of an independent consultant and with the consent of Charlotte Maxeke Johannesburg Academic Hospital, compiled a list of patients who had been waiting for radiation oncology for more than a year. It was found there were about 3,000.

So, the first step involved updating this backlog list to include patients who had not been serviced in 2022 and to remove those who had received radiation oncology in the meantime.

This lack of urgency and intention shown by the department in the slow manner in which it is handling this matter, are cause for great concern.

To date, the department has not produced its updated backlog list. However, it confirmed that about 300 patients had been serviced since the Cancer Alliance backlog list was compiled in 2022, which leaves about 2,700. Some patients may in the meantime have been added to the backlog or died, so the real number could be a bit higher or lower.

The second step 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 is to conclude contracts with private-sector providers to provide radiation oncology services.

Yet, at this point, we are unsure what developments the Gauteng health department has made on step two, given that it has 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 department in the slow manner in which it is handling this matter, are cause for great concern.

The meeting

Following numerous attempts, we finally met the department to get feedback on the progress. 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 – the Cancer Alliance and SECTION27 – contend that patients waiting for radiation oncology services for more than 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 – an aggressive type of breast cancer – soon thereafter and received chemotherapy for six months, beginning in October 2020. Luckily, Noluthando’s cancer reacted well to chemotherapy and she was scheduled for surgery 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 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. 

Read more in Daily Maverick: Between hope and hell – helping patients navigate the Gauteng cancer maze

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, she did not receive these services.

Noluthando’s cancer returned for a third time. Unfortunately, as it stands, her cancer is now not responding to chemotherapy. 

The cost of repeated chemotherapy and surgery due to the delay in accessing radiation oncology services is not the only one that Noluthando has to bear. She tells us her experience has caused trauma and anxiety for both her mother and her daughter. The uncertainty of her future has affected her daughter’s academic progress as well as 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 that cannot be replaced with any other.

More undertakings 

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.

At the meeting of 2 June 2023, the Gauteng health department 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 two weeks. This would mean by Friday, 23 June 2023. The prospective service providers would then be given two weeks to return with proposals, by Friday, 7 July 2023. These would be assessed by a committee and the final award would be made by 21 July 2023. The plan is to ensure patients are treated through this outsourcing programme by the beginning of August 2023.

Our hope is that the Gauteng health department 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 thousands of patients, very little has been done to date to ensure these patients get the long-overdue care that they need. The department must and can do better. DM

* 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.

This article was published by Spotlight – health journalism in the public interest.