Activist organisations this week challenged the Gauteng Department of Health in court over the R784m budget intended to tackle an oncology backlog, accusing it of misusing the money – which the Department denied, saying the funds were used for service planning.
The organisations, which include Cancer Alliance, Section27 and Treatment Action Campaign, are seeking an interdict to prevent the funds, allocated to tackle radiation and surgical backlogs, from being mismanaged.
News24 reports that in February, the department dismissed claims that it was deliberately delaying the finalisation of a tender for the outsourcing of oncology radiation services for breast and prostate cancer patients. It said it had made progress in addressing the backlog since the R784m allocation in May 2023, and that R534m of this amount had been invested this financial year in oncology medical and allied equipment, like linear accelerator machines and the building of bunkers for some of the machines.
Additionally, it added, R250m had been allocated for outsourcing the radiation oncology tender, which was “at an advanced stage of finalisation”.
But in its heads of argument, Section27, representing the groups, claimed there was a misuse of funds and inefficiencies within the Department.
Advocate Lerato Zikalala for Section27 expressed scepticism about resource allocation.
“I don’t know if they are actually using it for the backlog list. The state lacks the equipment and personnel to effectively address the backlog, which is why we are experiencing delays,” she said.
Daily Maverick reports that Section27 is arguing four main points:
1. For the court to declare unlawful and unconstitutional the Department’s lack of action in using the funds set for cancer treatment for that cause.
2. To direct the Department to take necessary steps to ensure waiting patients get the urgent treatment they need, whether through the private or public sector.
3. Prevent the Department from spending the funds on anything outside the scope of treating cancer patients.
4. Review and set aside the decision to award the planning contract without treatment, on the basis that it is irrational.
According to Section27 attorney Khanyisa Mapipa, before the court case there were dialogues between Cancer Alliance, Section27, the Department of Health and the Treasury to put together a plan on how the funds would be spent for the betterment of the patients.
“There was also an agreement that the Department would outsource services from the private sector because internally, it did not have the capacity… neither the machines or the staff. It’s not to say it is not doing the services, but there is a backlog. So the plan was to deal with that and ask if we could use the same mechanism used in Covid-19 times to do the procurement quickly and efficiently such that cancer patients could get help.
“An agreement was reached with the Department that it would expedite the tender process but it didn’t do that. It went on a normal tendering process that took six months to draw up, and then another to appoint a service provider. And when it did appoint a service provider, it was just for planning and not services or treatment,” Mapipa said.
The Department’s oncology tender was dissected during the proceedings, revealing a three-pronged plan aimed at streamlining services.
Zikalala noted that it covered professional oncologist services, radiotherapy facilities, and radiation planning services, each with specific technical requisites.
“It says …the technical proposal … for professional oncologist services refers to a radiation oncologist or plural, so one or several, that is able to provide radiation radiotherapy simulation and planning at Charlotte (Maxeke) and Steve Biko (hospitals),” she said.
But she highlighted the current lack of equipment and personnel available to the Department and the consequent reliance on private sector resources.
She raised concerns about R250m set aside for reducing patient backlogs, further complicated by delayed planning services, and said the convoluted tendering process, reissued in July 2024 but lacking updates from state respondents, has frustrated patients.
In response, Gauteng Health attorney William Mokhare SC said the Department was addressing the backlog and had its own waiting list.
He said when a patient came in for treatment, the backlog list was updated in real time.
On concerns surrounding the tender process, he said: “The tender has been reissued …it is a process that is still unfolding.”
And regarding the budget allocated for backlog management, he said that “from the R784m, we have taken R250m only, for planning services”.
Additionally, he said that the backlog was there before there was an allocation of funds.
“We are saying the application should be dismissed and there should be costs issued,” he said.
Accountability
One of the many cancer patients attending the court case, and who has been on the cancer treatment waiting list for four years, said it was disappointing for the Department to prolong and argue instead of taking accountability.
At least 3 000 cancer patients were awaiting radiation treatment as of 2022.
A recent Assessment of Oncology Services in the province by the Health and Wellness Portfolio Committee in the Legislature echoed the multi-faceted factors contributing to the backlog.
Essentially, it notes, the province historically has only two main radiology centres; outdated human resources planning for oncology services; the growing demands of Gauteng’s population, referrals of patients from other provinces, and foreign nationals seeking cancer treatment and other healthcare services at these facilities.
“The provision of radiation oncology services is crucial in cancer treatment, making this case extremely urgent,” according to the statement.
“When patients do not receive radiation treatment within the recommended three-month time frame, they often experience recurrences of the cancer. This, in turn, requires additional medical assessment, cancer staging, and sometimes further surgery and chemotherapy before they become eligible for radiation treatment again.
“The delay in integrated radiation oncology treatment results in the tragic loss of more lives among cancer patients. Therefore, Section27, Cancer Alliance, and the TAC urge the Department of Health to urgently fulfill its constitutional duty of granting these patients access to cancer treatment.”
The matter will not be going back to the Gauteng Division of the High Court in Johannesburg.
According to Mapipa: “What we have agreed with the judge is that they can decide on the new affidavits based on the papers. We waived the right to have verbal arguments presented on the new information. Both parties have agreed to that, and after this, the judge will have everything needed, to decide. We hope to at least get a court order before the close of term on 13 December.”
See more from MedicalBrief archives:
Gauteng Health sued over unspent cancer millions
Gauteng Health still mum on oncology tender