Read in magazine

By harnessing the capacity in the private sector, leveraging expertise of the total oncology community, and ensuring innovative approaches to data management and multidisciplinary care, South Africa can make significant strides in improving cancer care outcomes and ensuring equitable access to quality treatment for all its citizens, writes Dr Ernst Marais

Cancer remains a significant healthcare challenge in South Africa, demanding comprehensive strategies to improve access to quality treatment and care. Among the critical components of cancer management, radiotherapy services play a crucial role, yet numerous challenges persist across the country. This article examines the systemic obstacles facing radiotherapy services in South Africa and explores potential avenues for progress.

Disparity between Public and Private Healthcare Sectors

In South Africa, a glaring disparity exists between the public and private healthcare sectors, leading to divergent experiences for patients seeking medical treatment. While the private sector offers world-class facilities, advanced technology, and shorter waiting times, it primarily serves those who can afford the high costs associated with private healthcare. Conversely, the public healthcare system, tasked with serving the majority of the population, grapples with resource constraints, overcrowded facilities, and lengthy waiting lists.

This imbalance perpetuates inequalities in access to healthcare, with marginalised communities bearing the brunt of inadequate services and substandard care. Bridging this gap requires concerted efforts to strengthen public healthcare infrastructure, address systemic challenges, and promote equitable access to quality medical services for all South Africans, regardless of socioeconomic status.

Challenges in Radiotherapy Services

Limited Access to Radiotherapy Facilities

South Africa has insufficient radiotherapy infrastructure (linear accelerators specifically—these are the machines used for radiation therapy) to meet the current, yet increasing, demand for cancer treatment. This leads to extended waiting periods for patients, particularly those in rural and underserved areas where facilities are scarce. 83 linacs are serving a population of 62 million, of which only 32 are in the public sector, the disparity between the private and public sectors becomes evident, highlighting the need for increased investment in radiotherapy infrastructure.

Equipment Maintenance

Maintaining aging machinery, including linear accelerators (linacs) and afterloaders (used mainly in cervical cancer treatment), remains a struggle. Equipment breakdowns and delays in maintenance contribute to treatment backlogs and compromise patient care. With technological advancements outpacing the capabilities of older machines, there’s a pressing need for investment in modern equipment to ensure optimal patient outcomes.

Human Resource Constraints

The shortage of skilled personnel, including radiation oncologists, medical physicists, radiation therapists and engineers, poses a significant obstacle to effective radiotherapy service delivery. This shortage hampers the capacity of existing facilities to meet the needs of cancer patients adequately. Addressing this challenge requires comprehensive workforce development strategies and collaboration between the private and public sectors to optimise the utilisation of available expertise.

Geographic Disparities

Disparities in access to radiotherapy services persist between urban and rural regions, exacerbating inequities in cancer care. Given that a radiotherapy course can take up to 6 weeks to complete, patients in remote areas often face significant barriers, such as transportation costs and logistical challenges, when seeking treatment. Improving access to radiotherapy services in underserved areas is crucial to ensuring equitable healthcare delivery across the country.

Infrastructure and Logistics

Inadequate infrastructure and logistical challenges, such as unreliable power supply and transportation networks, impede the efficient operation of radiotherapy facilities. Additional investment in uninterrupted power supply (UPS), generators, and transportation infrastructure is essential to overcome these obstacles and ensure the timely delivery of cancer care services, and further increases the cost of care.

Financial Barriers

Affordability remains a major concern for many cancer patients in South Africa. Only 9 million people in South Africa have access to medical aid schemes that cover radiotherapy services and even this population often struggle to afford the direct out-of-pocket expenses associated with treatment. Indirect costs associated with a cancer diagnosis, such as loss of work, travel, and accommodation, while on treatment, are often overlooked. Addressing financial barriers requires innovative financing models and support mechanisms to ensure that all patients can access essential cancer care services without facing financial hardship.

Quality Assurance and Regulatory Compliance

Ensuring adherence to quality and safety standards in radiotherapy services is essential. However, resource constraints and regulatory compliance issues present challenges in maintaining consistent standards of care across facilities. Strengthening quality assurance mechanisms and regulatory oversight is critical to enhancing the safety and effectiveness of all radiotherapy treatments.

Private Sector Collaboration with the Government

The collaboration between the private sector and the government presents a promising avenue for resolving cancer care challenges in South Africa. Through strategic partnerships and contractual agreements, the private sector has extended its radiotherapy services to government facilities in key regions such as Kimberley, George, and Nelspruit. These collaborations signify a concerted effort to address the disparities in access to quality cancer care, particularly in underserved areas.

In Kimberley, an agreement between a private sector entity, Icon Oncology, and the Northern Cape Department of Health has facilitated the provision of curative and palliative radiotherapy services. Patients from across the Northern Cape are referred to the Robert Mangaliso Sobukwe Hospital (RMSH), where resident oncologists make treatment decisions and prescribe the necessary radiation therapy. Patients then receive the treatment in the private Icon facility. The seamless coordination between RMSH and Icon ensures that patients receive timely and effective radiotherapy treatments, despite logistical challenges such as transport and accommodation.

Similarly, in George, uninsured patients referred from George Provincial Hospital (GPH) have benefited from the private sector’s radiation therapy services for over a decade. Following a recent tender process, Icon was awarded the contract to provide radiation therapy services, while subcontracting local oncologist practices to support treatment delivery. This collaborative model enhances access to specialised oncology care for patients, leveraging the expertise of private practitioners while maintaining close collaboration with multidisciplinary teams at Groote Schuur Hospital. Moreover, the private sector’s collaboration extends beyond South Africa’s borders, with subcontracted radiotherapy services provided to patients from Eswatini. These cross-border partnerships demonstrate the potential for regional collaboration in addressing cancer care needs and enhancing treatment access for patients across borders.

In addition to its clinical services, Icon’s innovative approach to data management, exemplified by its proprietary software e-Auth®, contributes to improved treatment outcomes and resource optimisation. By streamlining protocol management and facilitating data sharing with the National Cancer Registry, the quality and efficiency of cancer care delivery is enhanced, ensuring that patients receive evidence-based treatments tailored to their specific needs.


Oncology, probably more than any other medical discipline, requires a multidisciplinary approach. In any public-private relationship, careful consideration should be given to the effective coordination of care. Robust and excellent working relationships must be established between the government and private sector, across different departments, to solve problems that are unique to each hospital. While challenges persist, particularly in the realm of radiotherapy infrastructure and workforce shortages, the collaboration between the private sector and the government sector presents a viable solution. By harnessing the capacity in the private sector, leveraging expertise of the total oncology community, and ensuring innovative approaches to data management and multidisciplinary care, South Africa can make significant strides in improving cancer care outcomes and ensuring equitable access to quality treatment for all its citizens.

Dr Ernst Marais is the Chief Operating Officer and Executive Director of ICON ONCOLOGY HOLDINGS.

By Editor