In-Depth Assessment of Oncology Services in Gauteng Province @KASIBCNEWS
The Health and Wellness Portfolio Committee comprised of multi-party members of the
Provincial Legislature recently conducted a focused intervention study to evaluate the
pressure points and operational efficiency of oncology services across Gauteng Province. The
visits, carried out from 22 October to 23 October 2024, included key central hospitals: Dr.
George Mukhari Academic, Steve Biko Academic, Charlotte Maxeke Johannesburg
Academic, and Nelson Mandela Children’s Hospitals.
This initiative provided the Committee with a deeper understanding of the complex challenges
involved in delivering cancer treatment and care within the public healthcare sector. Contrary
to perceptions, oncology services require sophisticated coordination, far beyond what is often
assumed.
Key Findings and Challenges:
Treatments Expanding Beyond Gauteng and South Africa
Oncology services at these central hospitals extend not only beyond the province but also
across national borders, offering highly specialized care that is difficult to replicate at tertiary
and district hospitals, which often lack essential surgical, diagnostic, and pathological
capabilities. Consequently, these hospitals face a high volume of referrals from other
provinces, such as Northwest, 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.
With a population of over 15 million, Gauteng bears the highest cancer care burden in South
Africa. The central hospitals, originally not designed to accommodate the current patient load,
are now stretched beyond capacity in providing both cancer treatment and overall healthcare
services. Additionally, the backlog is exacerbated by the significant number of foreign
nationals seeking cancer treatment and other healthcare services in these facilities. Over
R700 million is currently owed to Charlotte Maxeke Academic Hospital, while at Steve Biko
Academic, the bill stands at over R400 million for the treatment of foreign nationals; further
intensifying the financial strain on the system.
Human Resource Planning
The Committee observed that the human resource planning for oncology services is outdated
and does not meet the growing demands of Gauteng’s population. This mismatch has led to
significant pressure on healthcare professionals, with unfavourable staff-to-patient ratios
affecting service delivery.
Additionally, there is a critical shortage of oncology, radiology, and other specialized
healthcare workers, compounded by the private sector's ability to offer more competitive
compensation for these sought-after skills. The Occupation Specific Dispensation (OSD) in
the health sector, a national competency, directly impacts the retention of scarce skills in public
healthcare. This impact was clearly illustrated at one of the hospitals where one of the major
contributions to the backlog was owed to the shortage of specialised nurses in the operating
theatres and Intensive Care Units. These nurses play a crucial role in the value chain of cancer
treatment and care.
The Committee urges the Department of Health to fast-track the approval and implementation
of revised staffing plans, already proposed by hospitals, to address these shortages. While
the Committee recognizes the budget constraints caused by austerity measures, addressing
the critical need for specialised personnel must remain a top priority to meet growing
healthcare demands.
Infrastructure needs
Gauteng historically had only two main radiology centres. However, the Committee was
encouraged to see that Dr. George Mukhari Hospital is advancing plans to construct an
additional oncology facility. Once completed, this facility will relieve pressure on existing
services and enhance treatment capacity for cancer patients. However, it is essential to ensure that infrastructure expansions are matched by an increase in specialized personnel to operate
the facility effectively.
The Committee will closely monitor the project’s progress to ensure it meets deadlines and
improves access to care.
The Committee now fully understands the multi-faceted factors contributing to the backlog in
oncology services. The entire value chain—from diagnosis to treatment—requires a
coordinated approach, guided by clinical guidelines. With limited institutions providing cancer
care, the burden on these facilities is inevitable. As the National Health Insurance (NHI)
implementation progresses, it is expected that greater cooperation and system improvements
will help address some of the current challenges in the healthcare sector.
Appreciation of Healthcare Professionals
The tireless efforts of healthcare workers who continue to deliver essential oncology services
under immense pressure is admirable. Their unwavering commitment to patient care, despite
resource limitations, reflects their professionalism and compassion. The Committee and the
broader community deeply appreciate their dedication.
“We remain committed to supporting Gauteng’s healthcare system and will continue working
with the Department of Health to tackle these 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 specialized treatment,” concluded Adv. Ezra Letsoalo,
Chairperson of the Health and Wellness Portfolio Committee.
