Despite R784m being set aside by the provincial treasury in March last year for the outsourcing of radiation treatment in Gauteng, the money has still not been spent, said furious activists and cancer patients, who marched to the offices of the provincial department of health on Tuesday demanding that the money be used.
SECTION27, Cancer Alliance and Treatment Action Campaign (TAC) said that not a single patient has received treatment through this intervention a year later, writes Silver Sibiya for GroundUp.
In an open letter to health MEC Nomantu Nkomo-Ralehoko last week, Khanyisa Mapipa from SECTION27, Salomé Meyer from the Cancer Alliance and Ngqabutho Mpofu from TAC said that in March 2022, Cancer Alliance had compiled a detailed list of 3 000 patients who were awaiting radiation oncology treatment.
They said there were shortages of staff in the two radiation oncology centres in Gauteng – Steve Biko Academic Hospital and Charlotte Maxeke Johannesburg Academic Hospital – and that the latter had only two operational machines compared with the seven it was using in 2020.
Tenders for new equipment had been delayed and the backlog of patients was increasing, they said.
As a result, SECTION27 and Cancer Alliance had asked the provincial treasury to set aside R784m to outsource radiation treatment, and although the funds had been allocated in March 2023, a year later, no service provider has yet been appointed.
“It has actually been four years since the matter was brought to the Department of Health,” said Mapipa on Tuesday.
Department of Health spokesperson Motalatale Modiba said the department had received the memorandum and would respond to it.
He conceded there had been delays which, he said, were caused by tender processes, but confirmed a tender had now been awarded.
Department failed
In their open letter to the provincial MEC, published in Spotlight, the three organisations accused the Gauteng Department of Health of failing in fulfilling its obligations to the patients, demanding that urgent action be taken.
They wrote:
Dear MEC Nomantu Nkomo-Ralehoko,
In the 2023 budget speech delivered by the MEC for Finance in Gauteng on 9 March 2023, Treasury allocated R784m 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 12-month delay in providing life-saving treatment to cancer patients while resources are available, particularly as the issue of the growing number of patients awaiting radiation oncology treatment was brought to the attention of the office of the former MEC for Health, Nomathemba Mokgethi, and 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 was sent to your office and still, the patients we advocate for are no better off.
In November 2021, after a year and five months of correspondence with no response from the Health Department, Cancer Alliance and the Treatment Action Campaign held a protest and delivered a memorandum of demands.
It was only after this gathering that in February 2022, the provincial Health Department took some action 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 eight times before it was unceremoniously dissolved. During the lifespan of the 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 3 000 patients who were awaiting radiation oncology treatment.
Aside from our compilation of this list, the task team achieved nothing in its intended mandate, despite numerous recommendations made by Cancer Alliance and the Treatment Action Campaign on ways to resolve the situation.
As you are aware, the cancer crisis in Gauteng is propelled by the scarcity of operational radiation oncology machinery, as well as extreme shortages in radiation oncology staff in the two radiation oncology centres, 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 just two, while servicing around 2 000 new patients per year.
Several tender processes aimed at purchasing new equipment have failed or have not been finalised. One – 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 equipment that was 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 give it time to get its house in order.
While this recommendation was endorsed by the former head of department, it was noted that the department does 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 ring-fencing of R784m for the outsourcing of radiation oncology treatment for patients on the backlog list.
It was only pursuant to these negotiations that the funds were made available.
After the allotment, in March 2023, it was agreed that Gauteng Health would take specific steps to initiate the outsourcing programme, including updating the backlog list as a year had passed since it was compiled in March 2022, and appoint a service provider for the radiation oncology services.
To date, we are unsure whether the backlog list has been updated.
However, we are aware that there has been no appointment of a service provider to dispense these services – and the patients for whom we are advocating 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 initiate a series of steps to ultimately culminate in appointing a service provider by early August 2023.
These steps were never taken, and a service provider never appointed.
Instead, under instruction from the current head of the Gauteng Department of Health, 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 ring-fenced by Gauteng Treasury was at risk of being returned to Treasury coffers as unused funds and as part of cost containment measures in the 2023 Medium Term Budget.
Pleas from SECTION27 and Cancer Alliances to the Gauteng Treasury helped secure the funding for a second time.
It was only after threats of litigation directed at Gauteng Health after 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.
In January 2024, SECTION27 made further follow-ups, but instead of announcing the appointment, on 1 February 2024 (coincidentally the last day of the tender validity period), the Health Department issued the aforementioned media statement in which it sought to “dismisses misleading claims on delays in awarding of cancer treatment tender” and assuring the public and media that it 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, attributing this 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 more than two years of waiting, finally gave up on standing by for radiation oncology services at CMJAH.
In July 2023, Du Toit and her husband eventually took the decision to obtain loans from the bank and sell some of their material possessions to fund radiation in the private sector. The treatment cost her 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 loans.
These people rely on your office as the custodian of their right to access healthcare. For example, Thato Moncho, a single mother, has been waiting for radiation oncology treatment for more than three years, during which time she had had three recurrences of her cancer, with the latest pathology results showing it has now spread to her lungs.
Any further delays in treatment place her 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 dragged its heels.
There has been no legitimate explanation 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 yet been done, and appointing a service provider to provide complete and integrated radiation oncology services for patients on the list.
We further demand that you provide us with an update on progress made by the department on the tender under consideration according to your department’s press statement on 1 February 2024.
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 –yet resources have been made available to service their needs.
We hope you will see this as an opportunity to meet the department’s constitutionally mandated responsibilities to secure radiation oncology services for these patients.
Memo received
Department of Health spokesperson Motalatale Modiba said the department had received the memorandum and would respond to it.
He conceded there had been delays which, he said, were caused by tender processes, but confirmed a tender had now been awarded.
“In May, the process to treat patients will start in both hospitals. The heads of oncology in Charlotte Maxeke and Steve Biko hospitals are busy with … on-boarding,” he said.
X-ray centre
While the department has been tardy about initiating cancer treatment for patients, it has been more efficient in opening a second, new X-ray and scanning diagnostic centre in Soweto, aimed at accelerating early disease detection in under-resourced communities.
The first centre was opened in Alexandra in November, reports News24.
“This will help reduce queues in some of our hospitals so that whatever they are diagnosing with here will make it easier and quicker to treat,” said the MEC at the launch.
She said it was “affordable, especially for the middle class”, while those without medical aid would pay less than R500 for X-rays.
Nkomo-Ralehoko said the department planned to roll out more centres like this across Gauteng, with the next area it was eyeing being Tembisa.
See more from MedicalBrief archives:
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