The unconventional path of cancer patients in South Africa

The scientific progress in the management of different types of cancer does not necessarily translate into immediate or affordable treatment for the majority of patients, say the writers.

Today, citizens worldwide observe World Cancer Day, an international day marked on February 4, to raise awareness of fundamental cancer issues and encourage its prevention, detection, and treatment.

In South Africa, a noteworthy trend has emerged that challenges conventional wisdom: an increasing number of cancer patients, despite having private medical aid, are choosing treatment within the challenged confines of public health facilities.

This seemingly perplexing choice becomes clearer upon closer examination, revealing a number of reasons illuminating the intricate challenges of the country’s healthcare framework.

A critical factor influencing this decision is the confluence of access and affordability. While private medical aid covers exclusive healthcare facilities, the associated costs can be a significant deterrent.

Public facilities, burdened as they may be, present a financially tenable alternative. Given the protracted and resource-intensive nature of cancer treatments, radiation treatment, chemotherapy and follow-up care, the financial strain of private healthcare becomes overwhelming, compelling patients to seek economically viable solutions within the public sector.

Contrary to expectations, financial considerations only partially drive this choice. Many patients actively select public hospitals for the expertise and specialised care they offer.

Some public health institutions in South Africa boast highly skilled oncologists and access to cutting-edge technologies, rendering them formidable competition from their private counterparts.

At DKMS Africa, an international non-profit organisation dedicated to saving patients’ lives with blood cancer and disorders, we are privileged to work with dedicated haematology clinicians and transplant doctors in state and private hospitals.

They enable us to give each patient needing a stem cell donation a fighting chance.

However, the lack of diversity of stem cell donors in South Africa, particularly among Black, mixed-race, Indian and Asian people, renders it extremely difficult for all diagnosed patients to find a matching donor.

Hence, we have enabled clinicians to have the power to do donor searches in the comfort of their own offices through this digital platform.

For some, the decision to opt for public facilities is rooted in the sense of community and support networks these institutions provide.

Public hospitals often cater to a diverse and inclusive patient population, fostering a shared experience and understanding among patients.

In contrast, private healthcare, at times, is perceived as more isolating, lacking the communal aspect crucial in navigating the emotional and physical tribulations of cancer treatment.

In South Africa, we are also acutely aware that no more than 16% of our population belongs to private medical aid, according to the Council for Medical Schemes.

A prevailing perception among some patients is that the quality of care is comparable, if not superior, to that offered in private institutions.

Trust in the capabilities of healthcare professionals and the efficacy of treatment regimens in public hospitals plays a pivotal role in shaping patient decisions.

However, the ability of South African patients to access the best and most affordable cancer treatments, both in the public and private sectors, is rapidly diminishing.

This erosion is a direct consequence of the hollowing out of local state institutions, stemming from poor planning, incapacity, and corruption, particularly within the health sector.

Despite South Africa boasting some of the world’s leading oncology experts, the scientific progress in the management of different types of cancer does not necessarily translate into immediate or affordable treatment for the majority of patients.

Both the public and private health sectors, along with policymakers, medical scheme administrators, and drug company executives, are falling short in adequately addressing the needs of cancer patients in South Africa.

The pricing of medicines and treatments, often tailored for first-world markets, proves exorbitant and unaffordable for many patients, with little to no penalty or repercussion.

The extended periods of exclusivity enjoyed by some medications further limit competition, exposing a system that inexplicably favours the pharmaceutical industry and contributes to a challenging landscape for cancer patients in the country.

While the motivations behind this trend are multifaceted, acknowledging the systemic challenges ailing South Africa’s public healthcare system is imperative.

Overcrowded facilities, protracted waiting times – sometimes extending to 18 months – and resource constraints contribute to the uphill battle patients and healthcare providers face.

This experience serves as a poignant call for substantial improvements in the public healthcare system, ensuring that every citizen, irrespective of financial means, can access quality cancer care.

In navigating this intricate decision-making process, cancer patients and blood cancer patients, in particular in South Africa, carefully weigh financial considerations, trust in expertise, and a sense of community.

This trend underscores the need for a nuanced comprehension of healthcare choices in the country, emphasising the urgency of addressing systemic challenges within the public healthcare system.

* Dr Hendricks and Dr Parasnath are renowned haematologists serving as directors on the board of DKMS Africa, an international non-profit

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