Reducing surgical and cancer treatment backlogs in Gauteng’s health system is an urgent priority

Recently an opinion piece was published on this platform bemoaning what the author described as a “… lack of urgency” to tackle the backlog of cancer treatment in Gauteng, accusing the Gauteng Department of Health (GDoH) of sitting on the money “… earmarked to outsource urgent cancer treatment”.

There is no disputing the fact that there is a need to act with urgency in attending to the backlog in surgical and oncology services.

A number of factors such as shortages of personnel and equipment, the knock-on effect of the Covid-19 pandemic that stretched the capacity of the healthcare system as a whole, and the unfortunate fire that broke out at the Charlotte Maxeke Johannesburg Academic Hospital in 2021 had a ripple effect when it comes to cancer treatment, not only for the province, but for the country as a whole, given the interdependence of the system.

It is within this context that the MEC for health and wellness, Nomantu Nkomo-Ralehoko, when she tabled the department’s budget vote on 25 May specifically focused on the need to channel more resources toward oncology services.

Funding is a crucial factor for the success of any healthcare initiative. Understanding this, the Gauteng Provincial Treasury has demonstrated its support for this vital cause by allocating R784-million specifically to address the surgical backlog, including radiation oncology services. This financial backing represents a firm commitment to improving cancer care and provides us with the necessary resources to make this initiative a reality.

The MEC further announced that as part of expanding services to communities, oncology services will now cover township-based teaching hospitals, namely, Chris Hani Baragwanath Academic Hospital and Dr George Mukhari Academic Hospital. Currently, oncology services are provided at Charlotte Maxeke, Baragwanath and Steve Biko Academic hospitals. About 2,000 patients per month benefit from oncology services at Charlotte Maxeke and Steve Biko hospitals.

Furthermore, to ensure that patients requiring radiation oncology services are not disadvantaged, the provincial department, through engagement with multiple stakeholders such as Cancer Alliance and SECTION27, has identified the need to appoint private sector providers to supply radiation oncology services for this financial year.

Outsourcing these services is a strategic move aimed at harnessing the expertise and efficiencies of the private sector. This is expected to be instrumental in enhancing the quality of care and reducing waiting times for patients in need of radiation therapy. The outsourcing must be done within the confines of applicable legislative frameworks such as the Public Finance Management Act and supply chain management processes.

The tender process is currently under way after the department completed specifications for the outsourcing of radiation oncology services for Charlotte Maxeke and Steve Biko academic hospitals.

To expedite the outsourcing approach, the provincial department envisaged following a closed tender to invite a limited number of service providers to bid. The technical proposal was divided into three categories:

1. Professional/specialist radiation oncologists;


2. Technical service/oncology treating machines; and


3. Radiation planning service.

Market analysis revealed there are a number of service providers who can provide these services.

To prevent any irregularities, the department followed an open tender process with a shortened tender advert period of 14 days. This will allow specialist radiation oncologists and radiation planners the opportunity to tender as per categories 1 and 3.

Nearing implementation

We recognise the urgency of the situation and assure the public that we are committed to handling the outsourcing of radiation oncology services diligently and are nearing implementation.

The impact of outsourcing radiation oncology services is expected to be far-reaching. By leveraging the capabilities and expertise of external service providers, we aim to improve the accessibility and quality of radiation therapy for cancer patients. This showcases a proactive and adaptive approach in response to the mounting challenges posed by the increasing prevalence of cancer.

Additionally, we have advertised a tender for a brachytherapy machine for Steve Biko Academic Hospital. Bids closed at the end of May.

Specifications for a linear accelerator (Linac) machine for Charlotte Maxeke were made and the advertisement of the tender is under way. These machines are essential in the treatment of cancer and acquiring them is a significant step in improving the quality of cancer care.

The department has, furthermore, procured four Linac machines, two of which have been allocated to Chris Hani Baragwanath and two to Dr George Mukhari academic institutions.

The commissioning and operationalisation of the four Linac machines depend on the construction of special bunkers for the safe operation of radiation therapy equipment. The turnkey project to construct these bunkers at Chris Hani Baragwanath and Dr George Mukhari is envisaged to be completed in this financial year.

By strengthening our infrastructure and expanding our resources, we are positioning the department to provide better care for cancer patients.

As we forge ahead with these initiatives, we remain mindful of the tremendous responsibility we carry in the fight against cancer. Our actions today have the potential to bring hope and make a meaningful difference in the lives of countless individuals and families affected by this disease. Through continued investment, innovation and strategic partnerships we are striving to drastically reduce the surgical and radiation oncology backlogs. DM

Dr Stephen Mankupane is the acting head of hospital services at the Gauteng Department of Health.

This article was first published by Spotlight — health journalism in the public interest.