Procuring oncology services is not only about the money, says Gauteng health committee

A shortage of specialised staff and hospitals stretched beyond capacity due to patient referrals from across South Africa and neighbouring countries places a massive burden on Gauteng's government health system.

This is according to the Gauteng legislature's health and wellness portfolio committee, which this week visited the Dr George Mukhari Academic, Steve Biko Academic, Charlotte Maxeke Johannesburg Academic and Nelson Mandela Children’s hospitals.

Chairperson advocate Ezra Letsoalo said there are complex challenges involved in delivering cancer treatment and care within the public healthcare sector.

“Contrary to perceptions, oncology services require sophisticated co-ordination far beyond what is often assumed.”

Letsoalo said MPLs learned there is a critical shortage of oncology and other specialised healthcare workers, particularly nurses in operating theatres and intensive care units.

The committee urged the department of health to fast-track the approval and implementation of revised staffing plans, proposed by hospitals, to address the shortages.

The lack of treatment for cancer patients reliant on government healthcare has been highlighted for some time.

A court case has been lodged by Section27, the Cancer Alliance and the Treatment Action Campaign over the Gauteng health department's failure to use funds allocated to it last year to source and provide oncology and radiation treatment to patients. The case is due to be heard in the Johannesburg high court next month. 

This week, DA health MPL Jack Bloom disclosed there are 2,652 cancer patients on the waiting list for radiation therapy in the province.

Despite this, he said R511m of the budget for urgent cancer cases went unspent from the last financial year and R261m in this year’s budget has also not been spent.

Health and wellness MEC Nomantu Nkomo-Ralehoko told the legislature some funds from last year were not spent because “outsourcing to private facilities needed to be readvertised”.

Bloom said historical delays due to Covid-19 and the fire at Charlotte Maxeke hospital are blamed for long waiting lists, as well as load-shedding, overcrowding of patients from other provinces and countries, and the inability to attract radiotherapists to the public sector. Also cited was the need to expand oncology infrastructure to the Chris Hani Baragwanath and George Mukhari hospitals.

The failure to provide radiotherapy timeously has severe consequences, Bloom said.

“Medical guidelines specify radiotherapy should be done within 60 days of surgery or chemotherapy, and no later than 90 days, to destroy remaining malignant cancer cells.

“I estimate hundreds of cancer patients had to be taken off radiotherapy lists in Gauteng because the 90-day limit had passed. Their lives could have been saved if the department had speedily concluded a contract with private hospitals last year.”

Letsoalo said the committee found central hospitals are stretched beyond capacity and are under pressure to provide cancer treatment and overall healthcare services.

“Oncology services at the central hospitals extend not only beyond the province but also across national borders, offering highly specialised care that is difficult to replicate at tertiary and district hospitals, which often lack essential surgical, diagnostic and pathological capabilities. Consequently, the hospitals face a high volume of referrals from other provinces, such as North West, Limpopo, and Mpumalanga, further straining an already overburdened system.

“The allocation of beds becomes increasingly complex as they accommodate patients from outside Gauteng, who are likely to require inpatient care based on clinical treatment guidelines, particularly due to their proximity to the hospitals.

“ The backlog is exacerbated by the significant number of foreign nationals seeking cancer treatment and other healthcare services in the facilities.”

Letsoalo said more than R700m is owed to Charlotte Maxeke Academic Hospital, while at Steve Biko Academic, the bill stands at more than R400m for the treatment of foreigners.

He said the committee was encouraged to see Dr George Mukhari Hospital is advancing plans to construct an additional oncology facility. 

“We remain committed to supporting Gauteng’s healthcare system and will continue working with the department of health to tackle the challenges. Our goal is to enhance oncology services, ensuring all patients receive the high-quality care they deserve, despite the complexities involved in providing such specialised treatment.” 

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