Dear Health MEC Nomantu Nkomo-Ralehoko

In the 2023 budget speech delivered by the MEC for Finance in Gauteng on 9 March 2023, Treasury allocated R784-million to the outsourcing of radiation oncology services and other surgical backlogs. It has been a year since this allocation was made and to date, not a single cancer patient has received treatment through this intervention.  

It is shocking that there has been a year-long delay in providing life-saving treatment to patients living with cancer while resources in the way of funding are available, particularly as the issue of the growing number of cancer patients awaiting radiation oncology treatment has been brought to the attention of the office of the former MEC for Health, Ms Nomathemba Mokgethi, and the former head of the Gauteng Department of Health, Dr Nomonde Nolutsungu, as far back as June 2020 by Cancer Alliance and the Treatment Action Campaign. We are now approaching four years since the initial correspondence on this issue was sent to your office and still, the patients we advocate for are no better off.  

In November 2021, following a year and five months of correspondence with no response from the health department on this issue, Cancer Alliance and the Treatment Action Campaign held a protest and delivered a memorandum of demands. It was only following this gathering that in February 2022 the provincial department of health took some action on the matter and established the Gauteng Cancer Crisis Task Team. Cancer Alliance and the Treatment Action Campaign both participated in this task team. Its mandate was to assist the head of the health department to solve the cancer crisis which continues to plague the province.  

The task team met a total of eight times before it was unceremoniously dissolved. During the life span of the task team, in March 2022, Cancer Alliance – in its capacity as a member of the task team and using its own funds and resources – compiled a detailed backlog list of approximately 3,000 patients who were awaiting radiation oncology treatment. Aside from the compilation of this list, the task team achieved nothing in the mandate it was set out to achieve and this despite numerous recommendations made by Cancer Alliance and the Treatment Action Campaign on ways to resolve the cancer crisis.

As you are aware, the cancer crisis in Gauteng is propelled by the scarcity of sufficient and operational radiation oncology machinery, as well as extreme shortages in radiation oncology staff in the two radiation oncology centres in the province; namely Steve Biko Academic Hospital and Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), with the latter being the worst of the two. At its peak performance – in 2020 – CMJAH had seven operational radiation oncology machines; today it has two operational machines while servicing approximately 2,000 new patients per year.

Several tender processes aimed at purchasing new equipment have failed or have not been finalised, one such tender process for the procurement of a brachytherapy machine was initiated in 2019 and yet five years later, the machine has not been procured. The extreme delays in the procurement of replacement machinery and the building of appropriate bunkers to house machines purchased with erroneous specifications have led to a mounting backlog list as patients wait for treatment. 

The delays in the procurement and replacement of machinery aside, the task team agreed that the only workable recommendation of those offered by Cancer Alliance and the Treatment Action Campaign was the outsourcing of radiation oncology services to the private sector as a temporary solution. This would ease the pressure on the department and provide it with time to get its house in order. While this recommendation was endorsed by the former head of department, it was noted that the department did not have the funding to realise an outsourcing programme of this nature.

In response, SECTION27, alongside Cancer Alliance, approached Gauteng Treasury for assistance and motivated for the ringfencing of R784-million for the outsourcing of radiation oncology treatment for the benefit of the patients on the radiation oncology backlog list. It was only pursuant to these negotiations that the available funds were made available.  

Following the allotment of funds in March 2023, it was agreed that the Gauteng Department of Health would take specific steps to initiate the outsourcing programme. These steps included initially the updating of the backlog list as a year had passed since it was compiled in March 2022, followed by the appointment of a service provider to provide the radiation oncology services. To date, we are unsure whether the backlog list has been updated. We are however aware that there has been no appointment of a service provider to provide these services as the patients we are advocating for remain desperate for treatment.  

Over the past year, SECTION27 and Cancer Alliance have held two meetings, both of which were attended by the Gauteng Department of Health and Gauteng Treasury, the last meeting being on 2 June 2023 with the health department. In this meeting, the department undertook to take a series of steps that would ultimately culminate in an appointment of a service provider by early August 2023. These steps were never taken, and a service provider was never appointed. Instead, under instruction from the current head of the Gauteng Department of Health, Mr Arnold Malotana, officials at GDoH were instructed to cease all communications with SECTION27 and Cancer Alliance.   

In August 2023, SECTION27 and Cancer Alliance learnt that the funding ringfenced by the Gauteng Treasury was at risk of being returned to treasury coffers as unused funds and as part of treasury’s cost containment measures in the 2023 Medium Term Budget. SECTION27 and Cancer Alliance’s pleas to the Gauteng Treasury helped secure the funding for a second time. It was only after threats of litigation directed at the Gauteng Department of Health, following the 2023 Medium Term Budget that the department advertised a tender for the outsourcing of radiation oncology services in October 2023, with a closing date on 2 November 2023. The 90-day validity period concluded on 1 February 2024.  

Read more in Daily Maverick: Gauteng Health’s silence on R784m oncology backlog tender is worrying – Cancer Alliance

In January 2024, SECTION27 made further follow-ups on the appointment of a service provider, instead of announcing the appointment, on 1 February 2024, coincidentally being the last day of the tender validity period, the health department issued the aforementioned media statement in which it sought to dismiss “misleading claims on delays in awarding of cancer treatment tender” and assure the public and the media that the department was in the final stages of making an award. The department has yet to deliver on this promise, too. Nothing in the actions or inaction demonstrated by the department in the past four years refutes the claims that its officials have failed to deliver radiation oncology treatment to the people who so desperately need it.  

In fact, in a response to a SECTION27 opinion piece titled “Worrying lack of urgency as Gauteng Health sits on money earmarked to outsource urgent cancer treatment” published in Spotlight in June 2023, the department admitted to a delay in the provision of radiation oncology services and attributed this delay to shortages in machinery, the Covid-19 pandemic and the fire at CMJAH in 2021.

However, these excuses mean very little to patients like Frances du Toit, a cancer survivor and mother of four, who after over two years of waiting, finally gave up on standing by for radiation oncology services at CMJAH. In July 2023, Frances and her husband eventually took the decision to obtain loans from the bank and sell some of their material possessions to fund radiation oncology services in the private sector. Frances’ treatment cost her a total of R153,000, a debt she now has looming over her head.

Unfortunately, very few of those who rely on the public healthcare system have access to or are able to afford loan facilities. These people rely on your office as the custodian of their right to access healthcare. For example, Ms Thato Moncho, a single mother, has been waiting for radiation oncology treatment for more than three years. In this time, Ms Moncho has suffered three recurrences of her cancer, with the latest pathology results showing that her cancer has now spread to her lungs. Any further delays in treatment place Ms Moncho and patients like her at risk of suffering further recurrences and possibly even death.  

The department has delayed significantly in the provision of these services at its own facilities. Even after the intervention of civil society organisations, which saw to the allocation of funding specifically for the assistance of patients on the backlog list, the department has still delayed.

There has been no legitimate explanation provided by the department for its inability to act in accordance with its mandate in this instance and yet the lives of patients continue to hang in the balance.

We therefore demand that you take immediate and urgent actions to realise the outsourcing of radiation oncology services in the province, as undertaken by your department time and time again, including updating the radiation oncology backlog list – to the extent that this has not been done yet – and appointing a service provider to provide complete and integrated radiation oncology services for the patients on the backlog list.  

We further demand that you provide us with an update regarding the progress made by the department on the tender under consideration according to your department’s press statement released on 1 February 2024, mentioned above. In an attempt to drive home the importance and urgency of this matter, SECTION27, Cancer Alliance and the Treatment Action Campaign – accompanied by cancer patients awaiting services in the province – will be engaged in protest action on Tuesday, 30 April 2024, where we intend to deliver a list of our demands to you or your chosen representative.  

It is unconscionable that the lives of thousands of people remain in jeopardy for years when resources have been made available to service their needs. We hope that you will see this as an opportunity to meet the department’s constitutionally mandated responsibilities to secure radiation oncology services for these patients. DM

Khanyisa Mapipa is with SECTION27, Salomé Meyer with the Cancer Alliance and Ngqabutho Mpofu with the Treatment Action Campaign.

This open letter was published by Spotlight – health journalism in the public interest. Sign up to the Spotlight newsletter.