With cancer numbers continuing to rise in South Africa, and with health systems in a perilous state, Cancer Alliance SA and concerned stakeholders are calling for a National Cancer Act (NCA), and making a case for a National Cancer Institute that would hold the government to account in this regard.
After an extensive research collaboration with legal and health scholars in this country as well as in the UK, and the Cancer Association of South Africa (CANSA), the Alliance has released a comprehensive summary report and policy briefing document supporting its call.
The authors say a key appeal of such a coordinating mechanism promulgated by Parliament is that commitments would be legally binding and contain accountability mechanisms, unlike measures such as South Africa’s National Cancer Strategic Framework 2017-2022 and National Policy Framework for Palliative Care 2017-202
The country is facing a crisis with cancer prevention and control. Predictions are that an additional R50bn will be needed by 2030 to mount an effective public health response, but given inadequate state funding to meet these demands, and with poor coordination of services, geographic disparities and public vs private inequities, it is highly unlikely SA will be able to fulfil its human rights obligations to cancer patients.
Against this backdrop, Cancer Alliance investigated legal responses to similar challenges in six countries with National Cancer Acts (NCAs). Although there are differences between these Acts, the United Kingdom, the US, Japan, Kenya, the Philippines and Chile share similar approaches to: developing a national cancer plan; establishing a national cancer prevention and control coordinating body; financing cancer care and research; ensuring social protections; achieving equitable services; improving cancer surveillance; and, instituting accountability mechanisms.
Current gaps in SA
These include lack of a cancer policy framework and governance – and a coordinating body to set, implement and finance strategic decisions.
For instance, the National Cancer Strategic Framework for South Africa 2017-2022 remains largely unimplemented and has been extended by one year, while the Cervical Cancer Prevention and Control Policy 2017 (updated from the previous 1998 policy) continues to experience challenges because cytology-based screening programmes at primary care level and subsequent referral pathways for treatment at higher levels of care are still being implemented across provinces.
The Breast Cancer Prevention and Control Policy of 2017 is ineffective due to the lack of implementation at provincial level.
Importantly, these policies were developed to set minimum standards of care with little or no attention to eliminating healthcare inequities.
Cancer prevention measures
These are generally ineffective, although South Africa has taken steps in this regard through legislation and regulations on tobacco, alcohol and obesogenic diets. However, they have been insufficient in tackling the NCD crisis and adequately mitigating cancer risks.
Early detection and cancer management
When it comes to early detection, South Africa lags way behind its peers on the continent. And on managing the disease, the intended cooperative but decentralised health system created by the National Health Act No. 63 of 2003, as amended, has not been able to achieve uniformity or equity in the delivery of cancer health services,
And even those who can afford private medical aid are often not guaranteed quality cancer treatment due to imposed limits on cost and/or invoking Prescribed Minimum Benefits (PMBs) that outline what medical aid schemes will cover.
The costs of some cancer medicines in South Africa are more than double the price of, for example, the same in India, due to our country’s weak patent systems, including: poor patentability criteria, easy granting of patents, unnecessary issuance of secondary licences, and limited mechanisms to challenge patents before they are granted.
Palliative care
The management of advanced and terminal cancer diagnoses necessitates cross-cutting palliative care for all South Africans. Supportive medicines are also part of Appendix 3 of the Global Action Plan on NCDs but the National Policy Framework and Strategy on Palliative Care remains unimplemented across the provinces.
Research
Despite budgetary constraints, an analysis of cancer research outputs across Africa identified a high output in South Africa compared with most other countries on the continent. These research investments should be harnessed further to improve the evidence base for local cancer prevention and control mechanisms.
Implementation research could include studies on health outcomes, quality of life and cost, and should be a key component of a national cancer control plan.
Elements needed for an NCA in South Africa
To provide overarching coordination of existing legal, policy, budgetary and regulatory frameworks and/or accountability mechanisms, any legislative response to expand healthcare access for cancer should include the tasking of a national cancer prevention and control coordinating body; a cancer programme/plan; financing that will guarantee funding for treatment and care as well as for research and innovation; strengthening of the availability, quality and equitable distribution of cancer care; social protections for patients and families; surveillance that will enhance data collection and population-based reporting on cancer, and accountability mechanisms ensuring oversight, compliance, monitoring and evaluation in relation to implementation of the NCA.
The authors urge key stakeholders from the government, health professionals, civil society and the private sector to initiate a national debate on how best to address legislative and policy gaps in South Africa’s current cancer frameworks.
Cancer Alliance Policy Documents and Brief (Open access)
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Cancer Alliance: R50bn needed for cancer over next decade
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