As debate rages around the feasible application of NHI on a national scale, seemingly ad infinitum, the escalating cancer crisis in South Africa underscores the need for immediate action on the ground. Recent reports shed light on the distressing reality that individuals diagnosed with cancer, dependent on an overburdened public health system, often face extended waiting periods or impossible distances that prevent them from accessing life-saving treatment.
Yet in the Northern Cape, a remarkable success story has quietly unfolded over the last five years, impacting the lives of hundreds of cancer patients and demonstrating that the way to bring better health to the public on a macro scale may be to focus on practical micro solutions that, once proven, can be replicated around the country.
It arises out of a collaboration between the Northern Cape Department of Health, Kimberley’s Robert Mangaliso Sobukwe Hospital and private sector oncology service provider, Icon Oncology, with the shared goal of delivering the best possible care for patients needing radiotherapy services – which were previously far from home.
Jennifer Fuller, Regional Manager for Icon Oncology explains: “The average radiotherapy treatment journey spans between two to six weeks. Previously, the profound socio-economic and psycho-social toll of Northern Cape patients traveling far from their homes and families was immeasurable. During this period there was no radiation facility in the province, so patients had to travel to Bloemfontein for treatment. We collaborated with the Department of Health to treat radiation patients here in the Northern Cape. The result is a true example of how government and the private sector can work together when there is a shared focus on patient outcomes.”
Today, the province provides transport from far-off areas for treatment at Icon’s radiotherapy facility in Kimberley. If needed, accommodation is provided by the RMS Hospital for the duration of the radiotherapy treatment, which can sometimes last for six weeks.
Since the implementation of the project in October 2019, 511 cancer patients have completed radiation treatment. Previously all these patients would have had to travel to Bloemfontein to receive treatment.
“It’s a major success”, says Dr Alastair Kantani, Clinical Manager for hospital services in the Northern Cape. “It’s actually more than a success; it’s a lifesaving partnership. Personally, as a clinician, I’m proud of the fact that we, as a tertiary hospital, can give access to therapy services. Since this partnership, we’ve saved a lot of lives.”
Dr Esme Olivier, acting CEO of Robert Mangaliso Sobukwe Hospital says, “For me this collaboration between Icon and the Department of Health, specifically this hospital, is one of the best things that could happen for the sake of our oncology patients.”
“This is truly a complete collaboration” adds Fuller. “It shows that it can work – and I do believe that this can be replicated further into other provinces.”
Dr Olivier agrees: “I would really encourage every province to get involved with this. Even if they have their own radiation therapy units, just the collaboration and the expertise that Icon brings on board – they can even assist with nursing, whatever need there is that is not immediately available in public hospitals.”
Governance is key and monthly meetings are held between the two management teams to discuss patient experience, statistics, billing and other operational matters.
“This has resulted in continuous improvement of the project delivery over the past five years. This sharing of responsibility has led to the development of a very strong relationship and the interdependence has meant both parties have worked hard to make sure it works,” says Dr Olivier.
How it works – the patient journey:
The patient journey starts at the tertiary state facility, Robert Mangaliso Sobukwe Hospital, where the resident oncologist will consult with the patient once diagnosed by a surgeon or radiologist. If radiotherapy is indicated, the patient is referred to the Icon Radiotherapy unit in Kimberley.
A planning CT-scan is done by an Icon radiotherapist at Robert Magaliso Sobukwe Hospital
The treating oncologist and the Icon planning department, draws a plan on the CT-scan to determine the dose and area of radiotherapy that the patient will receive, using a sophisticated, state of the art planning system. The oncologist can access Icon’s planning system remotely and can do this work from anywhere.
This constitutes a 15 min radiotherapy session every day on Icon’s linear accelerator, until the required dose is delivered, and treatment is completed.
“The Northern Cape initiative exemplifies the potential inherent in bridging the gap between public and private healthcare sectors. It showcases how collaboration can transcend obstacles and provide specialised healthcare services and treatment to all citizens. As the country grapples with the challenges and concerns raised by the National Health Insurance (NHI) Bill, this collaborative achievement stands as a testament that the seemingly daunting task of implementing universal healthcare coverage can indeed be navigated. We must commend the vision of the Northern Cape DoH, management from the Robert Mangaliso Sobukwe Hospital and all other stakeholders who have made this project such a success,” explains Dr Ernst Marais, COO of Icon Oncology.
“It is through collaborations like this one, that we excel in providing the best possible treatment to our patients. Like Hellen Keller said: ‘Alone we can do so little, but together we can do so much’,” concludes Dr Olivier.
Slow growth in health sector spending is projected in Sub-Saharan Africa as reported in a study published in the open access journal, PLOS Global Public Health. The decline is expected to continue to 2050, according to Angela E Apeagyei and researchers at the Institute for Health Metrics and Evaluation, University of Washington, Seattle, and is driven by tepid growth in the share of government spending that is allocated to health and reductions in development assistance for health.
The research analyses data from databases covering development assistance for health, global health spending and gross domestic spending (GDP) per capita as well as an expected health spending database which provides projected health spending data to 2050. It finds that except for central and eastern Europe and Central Asia, around the world total health spending is expected to rise as a share of GDP, but in Sub-Saharan Africa (except in southern sub-Sahara Africa) it is expected to decrease.
Beyond the challenge of a low prioritisation of the health sector in the government budget, another major driver of this decline is a reduction in development assistance for health. The Millennium Development Goals led to a period of growth in health funding, and development assistance for health grew on average 11.1% annually from 2000 until 2015. It has since dropped to just 4.6% and was particularly hit by the global economic issues caused by the COVID pandemic and subsequent economic shocks such as the war in Ukraine. Although government spending on health in Sub-Saharan Africa has increased, and is expected to continue to rise, the gap left by decreases in development assistance will not be met.
Without improvements, this trend will pose a significant challenge to meeting health-related Sustainable Development Goals and the African Union’s Africa Agenda 2063. The authors hope that their analysis will help policymakers understand future health spending patterns and can translate the insights into tangible actions that can help navigate the region’s complex economic and health challenges.
The authors add: “For countries in sub-Saharan Africa, the projected growth in donor and government funding for health is expected to be significantly lower compared to countries in other regions. This worrying trend underscores the need to prioritise innovative financing strategies to strengthen health systems in line with the region’s economic growth and the broader health needs of its population.”
A marker used to measure immunisation coverage is to look at whether children received three doses of the vaccine against diphtheria, tetanus and pertussis. Photo by Mufid Majnun on Unsplash
By Elri Voigt
New data from the World Health Organization (WHO) and UNICEF show that globally childhood immunisation coverage stalled in 2023, while in South Africa it decreased. Elri Voigt unpacks the new data and asks local experts to put it in context.
A new report found that vaccination coverage rates around the world have not yet returned to levels seen in 2019, before the COVID-19 pandemic disrupted immunisation programmes.
There has been no meaningful change in immunisation coverage between 2022 and 2023, according to the WHO and UNICEF report published in July. It means progress in immunisation coverage has effectively stalled, leaving 2.7 million additional children who are either unvaccinated or under-vaccinated compared to pre-pandemic levels in 2019.
A marker used to measure immunisation coverage is to look at whether children received three doses of the vaccine against diphtheria, tetanus and pertussis – referred to as DTP3. Global coverage for DTP3 stalled at 84% in 2023, according to the report.
At the same time, the number of children worldwide who have not received any vaccinations has increased. We refer to these kids as zero-dose children. Ten countries account for 59% of all zero-dose children, with the global number in 2023 rising to 14.5 million compared to 13.9 million in 2022, according to the report.
Coverage slightly down in SA
Data from the report showed a slight decrease for a number of outcome measures in South Africa between 2022 and 2023. It was one of 14 countries in the African region that saw a decrease in coverage for DTP1 (the first dose of the vaccine for diphtheria, tetanus and pertussis), slipping from 87% in 2022 to 81% in 2023. Coverage for DTP3 also decreased, falling from 85% in 2022 to 79% in 2023.
South Africa was also one of 10 countries in the African region that saw a decrease in coverage for the first dose of the measles vaccine, and was singled out by the report as having the sharpest decline in coverage in the region between 2022 and 2023. Measles coverage dropped from 86% in 2022 to 80% in 2023.
Commenting on the accuracy of the new data, Professor Shabir Madhi, Dean at the Faculty of Health Sciences at the University of Witwatersrand (Wits), said it used administrative data, which can bias the estimates. He explained that the report bases vaccine coverage on the number of vaccines procured by government and deployed to facilities. For example, if a facility gets 100 doses of the measles vaccine and ends up discarding 50 doses, that doesn’t necessarily get reported.
The WHO acknowledges the potential for data inaccuracies. It stated that they calculate the estimated percentage of immunisation coverage by dividing the number of doses administered to a target population by the estimated number of people in that target population.
Madhi said a more accurate picture of childhood immunisation coverage in the country can be found in National Vaccine coverage surveys, like the Expanded Programme on Immunisation (EPI) National Coverage survey. Spotlight previously reported on results from the most recent EPI survey conducted in 2019.
Madhi said it appears the new report did not incorporate data from the EPI survey. However, even without this data, he said the WHO estimates are not too far off the local data. He remarked that he doesn’t feel “too strongly either way” about the accuracy of the WHO data since the bottom line is vaccine coverage in the country is lagging.
“Fluctuations in immunisation coverage are not uncommon,” Dr Haroon Saloojee, a professor of Child Health at Wits University told Spotlight. “One should not make too much of a fall or increase in coverage rates over one year, unless it is drastic.”
Data from the WHO report for vaccine coverage in South Africa between 2018 and 2022 had actually showed an overall upward trend, which was “promising”, according to Saloojee. However, he said the latest data from the report “holds no good news for South Africa” because the dip in coverage in 2023 was noteworthy.
How does SA compare?
“South Africa’s performance is moderate when compared globally, and poor compared to other high-middle income countries,” said Saloojee. “Considering that South Africa is a high-middle-income country, we should be performing much better in all our health indicators.”
He pointed out that countries in a similar bracket like Cuba and Uruguay have achieved high immunisation coverage through robust healthcare systems and effective public health policies.
Regarding zero-dose children, the report ranked South Africa 6th worst in the African region. In 2022, the country ranked 13th. With a total of 220 000 zero-dose children, the country accounted for 3% of all zero-dose children in the African region. Nigeria had the highest percentage at 32% of all zero-dosed children in the region, followed by Ethiopia with 14%.
‘Dysfunctionality of primary healthcare’
Apart from the international comparisons, Madhi pointed out that South Africa is not meeting its own targets of having at least 90% of children in each district fully vaccinated.
The EPI survey found that only seven of the 52 districts in the country were able to achieve the national target of 90% of children fully vaccinated under one year of age. Together, the data from the survey and the WHO clearly shows that childhood immunisation targets are not being met in the country.
For Madhi, the results from the EPI survey “speaks to dysfunctionality of primary health care in the country”. He said the immunisation of children, which is the bedrock of primary healthcare when it comes to children, acts as a “canary in the mine with regards to how well primary healthcare is working”.
He said South Africa is a leader in the field when it comes to evaluating and introducing vaccines to the public immunisation programme. But when it comes to implementation, for the vast majority of districts we “are falling completely flat on our face and coming short in terms of reaching our own targets”.
Implications for children
The health implications for children who are not unvaccinated or only partially vaccinated are significant.
“They are less protected against what can be life threatening diseases. And those life-threatening diseases include diseases such as measles, but also other life-threatening diseases such as pneumonia,” Madhi said.
“We’re selling ourselves short as a country in addition to actually compromising the health of children by not ensuring that we’re doing everything that’s possible to actually get children to be vaccinated,” Madhi added. “It also comes with other consequences, so it sort of lends South Africa to be more prone to outbreaks.”
Saloojee added that it is also likely that children who are not fully vaccinated are “not receiving many of the other health, education and social development services all children require and that is being provided by government, such as early childhood development services and child support grants”.
The reasons for immunisation coverage lagging are complex and the responsibility for fixing the problem lies with more than just one entity. Spotlight previously reported on some of the reasons children are remaining unvaccinated or under-immunised as identified by the EPI survey.
Madhi said there needs to be a fundamental relook at the country’s immunisation programme. Proper governance structures need to be put in place and the programme will need to be implemented all the way down to the sub-districts. There is also a need for real-time data and monitoring of that data so interventions can be done when children are missing their immunisations. He also suggested ring-fencing funds for vaccines, at either a national or provincial level, to ensure that money earmarked for vaccines are used for that purpose so as to ensure less stock-outs.
“The immunisation programme hasn’t changed much from what I can gather over the past 20 years, let alone the past 10 years. So we can’t expect a different outcome if the strategy that we’re using which has failed is the strategy that you continue pursuing,” Madhi said.
Saloojee said the National Department of Health can play a pivotal role in strengthening the immunisation programme by “providing leadership, resources, and policy support”. He said that to his knowledge the health department is currently preparing a national immunisation strategy to take us to 2030, but the draft is not up to scratch. The strategy, he says, will need to offer clear objectives, establish realistic indicators of, and targets for, measuring success, and attract a fully funded mandate.
Spotlight asked the National Department of Health for comment on the new WHO report and how it plans to respond to improve immunisation coverage. While the department acknowledged our questions, they did not provide comment by the time this article was first published.
Study analyzed 7 major health themes across 185 countries before and after the COVID-19 pandemic
The COVID-19 pandemic significantly widened existing economic and health disparities between wealthy and low-income countries and slowed progress toward health-related Sustainable Development Goals (SDGs), according to a new study published July 24, 2024, in the open-access journal PLOS ONE by Wanessa Miranda of Federal University of Minas Gerais, Brazil, and colleagues.
The global SDGs were established in 2015 as a wide and integrated agenda with themes ranging from eradicating poverty and promoting well-being to addressing socioeconomic inequalities. However, the COVID-19 pandemic is known to have delivered a devastating blow to global health, with large economic repercussions.
The new study investigated the potential impact of these economic disruptions on progress toward health-related SDGs. The research team used data from the official United Nations SDG database and analysed the associations between well-being, income levels, and other key socioeconomic health determinants. A yearly model was extrapolated to predict trends between 2020 and 2030 using a baseline projection as well as a post-COVID-19 scenario.
The study estimated average economic growth losses in the wake of the COVID-19 pandemic as 42% and 28% for low and lower middle-income countries and 15% and 7% in high- and upper middle-income countries. These economic disparities are projected to drive global health inequalities in the themes of infectious disease, injuries and violence, maternal and reproductive health, health systems coverage and neonatal and infant health. Overall, low-income countries can expect an average progress loss of 16.5% across all health indicators, whereas high-income countries can expect losses as low as 3%. Individual countries, such as Turkmenistan and Myanmar, have estimated a loss of progress which is as much as nine times worse than the average loss of 8%. The most significant losses are seen in Africa, the Middle East, Southern Asia, and Latin America.
The authors conclude that the impact of the pandemic has been highly uneven across global economies and led to heightened inequalities globally, particularly impacting the health-related targets of the 2030 SDG Agenda.
The authors add: “The COVID-19 pandemic significantly widened existing economic and health disparities between wealthy and low-income countries and slowed progress toward health-related Sustainable Development Goals (SDGs). Overall, low-income countries can expect an average progress loss of 16.5% across all health indicators, whereas high-income countries can expect losses as low as 3%.”
Most of the non-profit organisations that were flagged in a forensic audit by the Gauteng Department of Social Development have been cleared of all findings and have started to receive subsidies from the department again.
The forensic audit, announced by Gauteng Premier Panyaza Lesufi during his 2023 State of the Province Address, was a key intervention by former social development MEC Mbali Hlophe and aimed to uncover fraud and corruption in the non-profit sector. The department pays about R1.9-billion in subsidies to more than 700 non-profit organisations every year.
In a list circulated to affected organisations on Wednesday by the department, which GroundUp has seen, 34 of the more than 50 organisations that had audit findings against them, have been cleared after they rejected the findings. The organisations, which include drug rehabs and women’s shelters, have had to endure three months without any funding since the start of the new financial year on 1 April.
According to the list, six organisations are yet to receive the final outcome of their submissions. These include the training academies Daracorp and Beauty Hub, which collectively received R114-million in funding in 2022 and 2023. There are still unanswered questions about why these two organisations received so much in subsidies while budgets were cut for other organisations that care for people with HIV and older persons.
Social work organisation Kitso Lesedi Community Development, which has rejected the findings against them, is also still awaiting the final outcome of their submission.
The department has decided to “uphold” the decision not to fund two organisations, according to the list. These are Life Healthcare’s non-profit drug rehab in Randfontein and Tembisa Society for the Care and Welfare of the Aged. GroundUp understands that Tembisa is taking steps to appeal the decision.
Also, eight organisations are part of a Hawks investigation, according to the list. These include several foodbanks and Godisang Development, which has historically played a key role in the department’s Welfare to Work programme.
The department has not responded to GroundUp’s questions on the Hawks’ investigation, and the Hawks told us that it will be difficult to answer questions without a case number.
According to the department, 14 officials have been suspended since the forensic audit was launched, but their identities, the allegations against them, and the status of their disciplinary processes remain unknown.
Total Organisations on List
51
Organisations cleared
34
Hawks Investigation
8
Organisations yet to receive outcome
6
Organisations that did not make submissions (But one of these organisations, Carroll Shaw, claims it made a submission)
2
Organisations that remain unfunded due to investigation (decision upheld after submissions)
2
The forensic audit caused catastrophic delays in this year’s funding adjudication process, forcing hundreds of organisations to survive the first two months of the 2024/25 financial year without any funding. Some organisations retrenched staff, scaled down services or even shut down.
The department decided to centralise the process of allocating funds and appointed external adjudication panels. The department claimed this was because of findings by the Auditor-General, but the Auditor-General told GroundUp no such findings or recommendations were made.
The centralisation delayed the allocation of funds and the whole process ultimately collapsed, with the department deciding to simply extend contracts with organisations already signed in 2023.
The department did not respond to GroundUp’s questions.
Organisations vindicated
Organisations that have been cleared and have received findings told GroundUp that they feel vindicated and relieved.
Derick Matthews, CEO of Freedom Recovery Centre, which provides in-patient drug rehabilitation, told GroundUp that they have started admitting patients again and ordering supplies.
“Crazy days, but super excited,” Matthews said.
Mpule Lenyehelo, director of A Re Ageng, which runs women’s shelters and gender-based violence care centers, says it will take time to repair the relationship with the department.
“I am very angry and disappointed with the department,” Lenyehlo said. “Their allegations were unfounded and could not be substantiated as we have always received positive feedback from their monitoring and evaluation team. What the department seems to conveniently forget is that the organisation is providing essential services to the most vulnerable people in the community as well as 114 staff members in terms of job creation.”
One organisation caught in the cross fire was MES. The organisation never appeared on the list of organisations under investigation but nevertheless received a letter saying that there was a finding against them and that they would not be receiving funding. The finding was that they had not spent their full subsidies.
Leona Pienaar, CEO of MES, said she was confused because there was no money left over. She wrote to the department asking for clarity but received no reply. She then wrote to FSG Africa, the forensic auditing firm that was appointed to conduct the probe. FSG Africa told Pienaar that they made no findings against MES. After meeting with the department, MES finally had their funding for 2024/25 reinstated.
Lisa Vetten, chair of the Gauteng Care Crisis Committee, which has led litigation against the department and organised pro-bono legal assistance for affected organisations, says that she appreciates recent efforts by the new MEC Faith Mazibuko and some officials in the department to resolve the issues faced by the nonprofit sector.
“Corruption deprives people of services and has no place in the social care sector. But serious questions should be asked about the value of this audit, which not only came at great cost to organisations and their beneficiaries, but also, up to this point, hasn’t yielded much of substance,” said Vetten.
Most tuberculosis (TB) tests still require a trip to the clinic. Now, new technology has made it possible to test people at home. This could be a big deal for South Africa, where much TB goes undiagnosed. We unpack the findings and implications of a recent study into such TB home testing.
One of the biggest challenges in combatting TB in South Africa is that many people who fall ill with the disease are diagnosed late, or not diagnosed at all.
The World Health Organization (WHO) estimates that 280 000 people fell ill with TB in the country in 2022. Of these, roughly 66 000 were not diagnosed, and accordingly also not treated. Apart from the damage to the health of the people who are not diagnosed and treated, this also has implications for the further spread of TB since untreated TB is often infectious TB – people become non-infectious within a few weeks of starting TB treatment.
Typically, people who fall ill with TB only get diagnosed once they turn up at clinics with TB symptoms – this is called passive case-finding. In recent years, there has been a growing recognition that passive case-finding alone is not good enough if we want to diagnose more people more quickly. As a result, many people in South Africa considered to be at high risk of TB are now offered TB tests whether or not they have symptoms – an approach called targeted universal testing. Screening for TB using new mobile X-ray technology has also been piloted in the country.
Now, in the latest such active case-finding innovation, researchers have been offering people TB tests in the comfort of their own homes.
Dr Andrew Medina-Marino, a senior investigator at the Desmond Tutu Health Foundation (DTHF), tells Spotlight no one in the world was testing for TB at home until they recently started doing so at the DTHF’s new research site in the Eastern Cape.
The testing is done using a molecular testing device, roughly the size of a two litre Coke bottle, called the GeneXpert Edge. The GeneXpert Edge is a portable version of the GeneXpert machines that have been used in labs across the country to diagnose TB for over a decade.
The GeneXpert Edge is a standardised testing device that detects TB DNA in sputum. (Photo: Nasief Manie/Spotlight)
One challenge with the device was that it needed to be plugged into a power outlet in a wall and not all homes in the area have power. “So what we did is, we hooked up a car-like battery to the device and we were able to take it into people’s homes,” says Medina-Marino.
‘Acceptable and feasible’
A study lead by Medina-Marino, and recently published in Open Forum Infectious Diseases, set out to determine the acceptability and feasibility of in-home testing of household contacts of people with TB.
The study was conducted among 84 households in Duncan Village, a township in the Buffalo City Metropolitan Municipality in the Eastern Cape. The Metro had an estimated TB incidence of 876 cases per 100 000 population in 2019, according to the National Institute for Communicable Diseases. This number is much higher than the latest WHO estimate of 468 per 100 000 for South Africa as a whole.
From July 2018 to May 2019, people diagnosed with pulmonary TB were recruited from six government health clinics in the area. They were asked for permission to visit their homes to screen their household contacts for TB. Household contacts were verbally assessed for signs or symptoms of TB, including night sweats, weight loss, persistent cough and a fever.
Households where people had any signs or symptoms of TB were randomised to either be referred to a local clinic for TB testing or tested immediately in their home. Of the eighty-four randomised households, 51 household contacts were offered in-home testing. Everyone accepted the offer for in-home testing.
For the test with the GeneXpert Edge, Medina-Marino says household contacts had to produce a sputum sample. About 47% (24/51) were able to produce sputum. This was then mixed with a reagent containing the required components for a polymerase chain reaction test. This solution was then loaded into a disposable cartridge/test module and inserted into the Edge device. Results were available in about 90 minutes. Anyone who received a positive test result in their home were immediately referred to a clinic for TB treatment.
Regarding the 47 household contacts referred for testing at the clinic, only 15% (7 people) presented for clinic-based TB evaluation, 6 were tested, and 4 out of 6 returned for their results.
Ultimately, the study found that in-home testing of household contacts for TB was acceptable and feasible.
“It’s feasible. If you compare the rate of uptake of treatment versus the rate of uptake for testing, it looks like it’s performing much better when you do home based testing versus referral for testing at the clinic,” says Medina-Marino.
Risk of stigma?
Similar to when HIV home-based testing studies were carried out, Medina-Marino says prior to their study, community members expressed concerns about stigmatising houses that were visited. “[A] lot of people were saying: ‘If you go to people’s houses, you’re going to stigmatise the household.’”
But what they actually found was that people didn’t feel stigmatised. Household contacts of people with TB felt that coming to the house to test people brought a sense of security in the home. He adds that it was easy for people to believe the results because everything was done in front of them.
In instances where people didn’t have TB, Medina-Marino says household contacts were comforted that they didn’t have to be scared of the person tested. In instances where people did have TB, he says the attitude of household contacts was supportive to start treatment.
How the test compares to other tests
Apart from testing for TB, the GeneXpert Edge can also detect whether someone’s TB is resistant to rifampicin. This is one of the medicines in the standard four-drug combination used to treat TB.
Unlike the latest lab-base GeneXpert tests, the GeneXpert Edge does not detect resistance to any TB medicines other than rifampacin. “It is hard to fit the probes needed to detect other forms of resistance into the cartridge,” says study co-author Professor Grant Theron, head of the Clinical Mycobacteriology and Epidemiology Research group at Stellenbosch University’s Molecular Biology and Human Genetics Unit.
Theron notes that the sensitivity and specificity of GeneXpert Edge is similar to that of lab-based GeneXpert machines if the tests are done on specimens from the same type of patient and the same test cartridge. (High sensitivity means the likelihood of false negatives is low wile high specificity means the likelihood of false positives is low.)
Performance may however differ because of differences between people who test at home and people who test at the clinic. Theron explains that in their study they tested people who did not yet feel sick enough to go to get tested at the clinic. People who are sicker, and who are accordingly more likely to go to the clinic, are likely to have more pathogen in their sputum samples and be easier to diagnose.
‘A breakthrough for TB’
Home-based tests is a significant breakthrough in TB because of its crucial role in detecting cases early and enabling timely tracing and testing of household contacts, says Dr Ntokozo Mzimela, a lecturer in integrated pathology in the Faculty of Health Sciences at Nelson Mandela University.
She tells Spotlight it also offers several advantages over clinic-based tests. “They are highly accessible, facilitate mass testing, reduce the risk of disease transmission, and address patient reluctance by allowing testing in the comfort and privacy of one’s home.”
Mzimela adds the GeneXpert Edge and portable X-ray screening serve complementary roles in TB diagnosis. “While the X-ray reveals lung abnormalities, the Edge confirms the presence of TB bacteria. Both tools are essential and should be used in conjunction to provide comprehensive diagnostic insights and ensure accurate and timely treatment for patients,” she says.
Professor Keertan Dheda agrees that home-based testing could link up neatly with portable X-ray, but adds it is still too early to determine where home-based TB testing will fit into the country’s TB testing programme. Dheda heads up the Division of Pulmonology at Groote Schuur Hospital and the University of Cape Town.
“We don’t yet know whether testing everyone is the right approach or whether reflex testing based on chest x-ray abnormalities is the right approach,” Dheda says. “Now that feasibility has been established, it means that more studies can be undertaken, and operational research can be commenced.”
Further studies are already underway, Medina-Marino tells Spotlight.
He says the study in Duncan Village found that about 60% of household contacts who had TB symptoms could not cough up a sputum sample. His team therefore decided to combine in-home testing with an oral swab.
“So in the study that we’re doing now in households, we found an additional 12 people who cannot produce sputum but on their swab test, they showed a positive swab result. Tongue swabs increase yield of case finding among those unable to produce sputum,” he says.
American diets may have gotten healthier and more diverse in the months following the start of the COVID-19 pandemic, according to a new study led by Penn State researchers.
The study, published in PLOS ONE, found that as states responded to the pandemic with school closures and other lockdown measures, citizens’ diet quality improved by up to 8.5% and food diversity improved by up to 2.6%.
Co-author Edward Jaenicke, professor of agricultural economics in the College of Agricultural Sciences, said the findings provide a snapshot of what Americans’ diet and eating habits might look like in the nearly complete absence of restaurant and cafeteria eating.
“When dine-in restaurants closed, our diets got a little more diverse and a little healthier,” Jaenicke said. “One post-pandemic lesson is that we now have some evidence that any future shifts away from restaurant expenditures, even those not caused by the pandemic, could improve Americans’ food diversity and healthfulness.”
Prior to the pandemic, the researchers said, the average US diet was considered generally unhealthy. According to the Dietary Guidelines for Americans, eating patterns in the US have remained far below the guidelines’ recommendations, with only slight improvements in the population’s average Healthy Eating Index score between 2005 and 2016.
Also, before the pandemic, the research team was in the midst of a grant-funded project that asked how people would feed themselves after a giant global catastrophe, such as an asteroid strike or nuclear war. In particular, Jaenicke’s team was tasked with investigating how consumers and food retailers might behave during such a disaster.
“At first, the most impactful events we could study using actual, real-world data were hurricanes and other natural disasters,” Jaenicke said. “But then, along came the COVID-19 pandemic, and we realised that this event was an opportunity to study the closest thing we had to a true global catastrophe.”
For the study, the researchers analyzed data from the NielsenIQ Homescan Consumer Panel on grocery purchases, which includes 41,570 nationally representative U.S. households. Data consisted of the quantity and price paid for every universal product code each family purchased during the study period.
Data was gathered from both before the pandemic hit and after the pandemic led to schools, restaurants and other establishments temporarily closing. Because states did not respond to the pandemic simultaneously, the researchers designated each household’s post-pandemic period as the weeks following the date that their county of residence closed schools in 2020.
Jaenicke noted that this allowed the team to show a true causal effect of the pandemic school closures, which generally occurred around the same time that restaurants and other eateries also closed.
“To establish causality, an individual household’s pre- and post-pandemic food purchases were first compared to the same household’s food purchases from one year earlier,” Jaenicke said. “This way, we controlled for the food-purchasing habits, preferences and idiosyncrasies of individual households.”
The researchers found that in the two to three months following pandemic-based school closures (roughly March to June 2020) there were modest increases in Americans’ food diversity, defined as how many different categories of food a person eats over a period of time.
They also found larger, temporary increases in diet quality, meaning the foods purchased were healthier. This was measured by how closely a household’s purchases adhered to the U.S. Department of Agriculture’s (USDA) Thrifty Food Plan, which was designed to meet the requirements of the recommended healthy diet according to the Dietary Guidelines for Americans.
These patterns were found across households with many different demographics; however, those households with young children, lower incomes and without a car exhibited smaller increases in these measures.
“During the COVID-19 pandemic, dine-in restaurants closed, schools and school cafeterias closed, and many supermarket shelves were empty,” Jaenicke said. “Since about 50% of Americans’ food dollars are spent on ‘away from home’ food from restaurants and cafeterias, the pandemic was a major shock to the food system.”
The researchers said there are several possible explanations for these findings. First, because other studies have found that food from restaurants is often less healthy than food made at home, the dramatic decrease of meals eaten at and purchased from restaurants during the pandemic could have contributed to an increase of food diversity and healthfulness at home.
Second, they said it was possible that a global pandemic triggered some consumers to become more health conscious and contributed to them buying healthier, more diverse groceries. Third, because the pandemic caused widespread disruptions to the supply chain, it’s possible that when familiar products were sold out, consumers shifted to newer ones that led to increased diversity and healthfulness.
Finally, school and business closures may have led to many households having more time to cook and prepare foods than they had before, while others – like those with small children – may have had less free time than pre-pandemic.
Jaenicke said that in the future, additional studies could continue to explore how different disasters affect purchasing and eating habits.
Douglas Wrenn, associate professor of environmental and resource economics at Penn State, and Daniel Simandjuntak, research associate at Newcastle University, were also co-authors on the study.
Children lining up to see the dentist at the Ekuphumleni Community Hall, near Whittlesea. (Photo: Sue Segar/Spotlight)
By Sue Segar
The Keready project uses mobile clinics to take healthcare services to rural areas. Sue Segar spent time with the project as they took eye, dental, and other healthcare services to communities in the Eastern Cape.
In the small Eastern Cape town of Bizana, hundreds of children stream into a large hall at the Oliver and Adelaide Tambo Regional Hospital on a brisk Tuesday morning in May. There’s a festive but orderly vibrancy in the air – the scene made all the more colourful by different school uniforms and young voices from tiny six-year-olds to learners in their late teens.
They’ll be assessed, and helped by doctors from Keready – an organisation offering mobile health services in many far-flung communities lacking healthcare services.
For weeks leading up to today, outreach teams from Keready’s mobile clinic operation have gone from school to school, asking teachers to identify children with eye problems. Today they arrived on various forms of transport – some on the back of a bakkie – from deeply rural communities as far as 100 kms away. Most of the children have little access to health services, particularly eye care, so the response is substantial.
I have travelled here with three doctors and an admin assistant from Keready’s East London office. They join other healthcare staff, including from the health department, for this two-day mega outreach in partnership with the Umbono Eye Project.
“Over the past three months, school educators identified 492 learners from 26 schools who have impaired vision,” says Ewan Harris, a pharmacist and consultant by training and a former deputy director-general of education in the Eastern Cape, who heads up Keready’s Eastern Cape team. “We will attend to these learners and if necessary, provide them with prescription spectacles and meds.”
Ntombizedumo Bhekizulu, a teacher at the Mhlabuvelile Senior Primary School at Ludeke Mission, has come with 16 children, “the ones who struggle to see what we write on the chalkboard”.
Bulelwa Mqhayi from Nomathebe Primary School in Isithukutezi adds: “It’s great that they can help these kids. Most of the parents are unemployed and on social grants and don’t have the money to take the kids to specialists. The clinics don’t help us with eye problems.”
The youngsters will also have a range of other health checks and will be sent to see one of the doctors on site if found to be in need of further health assistance. The health department has deployed a mobile dental unit, an audiologist, as well as a medic to provide advice on family planning and reproductive health.
A child being signed in for a health check at Bizana. (Photo: Sue Segar/Spotlight)
Before arriving at the registration desk, the children have already been given deworming tablets and a Vitamin A supplement, provided by the health department, while each group is given a health talk on age-dependent topics ranging from hand hygiene, to TB and HIV.
After handing in their registration and consent forms, the children go through basic vision screening tests by a team of “eye care ambassadors” – young people supported with employment opportunities through the Social Employment Fund, which is managed by the Industrial Development Corporation.
If the school children fail the eye screening test, they are sent to see optometrist Johan van der Merwe.
In between patients, he tells Spotlight he’s already found a number of “low vision candidates” and one who might need to be placed in a special school. “I’ve just done a full refraction on one child … It’s clear that he has a lens defect,” says Van der Merwe. Placing his hand on the head of another small boy, he continues: “This little one has been very quiet … he’s struggling to communicate. He needs thick lenses, or an operation by a specialist.”
Van der Merwe, who has been an optometrist for 22 years, joined the Umbono Eye Project permanently almost two years ago after volunteering his services once a week. “Before I joined, I was working in a mall in East London. I never saw sunlight.” He adds: “It has been very rewarding to make a difference to these children.”
Optometrist Johan van der Merwe assesses a child at Bizana. (Photo: Sue Segar/Spotlight)
At another mobile site, health department dentist, Dr Unathi Mponco, has been busy with youngsters suffering from a range of dental ailments. “There were sore teeth, rotten teeth, mobile teeth, and some children had very swollen gums…. Whatever I can treat on the mobile truck, I deal with here – otherwise if they need X-rays or the cases are more serious, I refer them to the hospital’s dental unit for a comprehensive exam,” she says.
In a mobile van outside the hall, health department medic Siyabonga Chonco has been consulting teenage girls all day offering family planning services. “The Alfred Nzo district has the highest rate of teen pregnancies in the Eastern Cape. We are trying hard to curb teenage pregnancy,” he says.
The teens are invited to ask any questions and to say whether they are sexually active and ready to take contraceptives. Chonco says in almost every case, he senses great relief from the learners to speak to an impartial young person. “They tell me that, at the clinics, the older nurses can be quite harsh…. They open up to me, especially with questions about contraceptives.”
He says broadly, young people are interested in long-term contraceptives. “They don’t want to have to go to clinics all the time.” Some will walk away with a contraceptive implant – a flexible plastic rod about the size of a matchstick that is placed under the skin of the upper arm to prevent pregnancy over three years – while others will choose injectables or pills.
At the end of two days in Bizana, the team has seen nearly 750 youngsters from about 40 schools, with 432 having had their eyes screened and 52 eligible for specs. For six of those children, the spectacles will be life-changing, says Van der Merwe.
Doctors Eileen Kaba and Anda Gxolo consulting with their little patients. (Photo: Sue Segar/Spotlight)
Apart from a few “high” prescriptions that might have to be ordered from overseas, a member of the team will deliver the specs personally to each learner, an occasion which is a highlight for the team. “When we first put the glasses on their faces, you just see smiles. The parents are so thankful. It makes this so worthwhile,” says Van der Merwe.
Keready is working closely with the provincial departments of health and education. The NGO recently received the Eastern Cape’s Batho Pele Award for enhancing healthcare in the province.
“We could never reach all these children as government,” says TD Mafumbatha, mayor of the Winnie Madikizela-Mandela municipality, adding “this is what collaboration looks like”.
But where did it all begin?
Keready, loosely translated as “We are ready”, was set up in February 2022 to encourage young people to vaccinate against COVID-19.
One of the people behind Keready is Harris, a pharmacist and consultant by training and a former deputy director-general of education in the Eastern Cape. Harris was working as a consultant for the Fort Hare Institute of Health, when he was asked to help design the Eastern Cape’s COVID vaccine rollout strategy.
“The COVID programme was a success because, through advanced digitisation, we were able to map the 84 000 communities in South Africa to their nearest schools, clinics and hospitals,” he says.
And it is out of that awareness of the spatial distribution of healthcare needs that Keready was born.
After the COVID programme ended, Harris, as national lead for the project, was tasked with setting up Keready’s offices in four provinces, including employing provincial leads, and staff as well as doctors and nurses. “Our vision was to give young doctors the opportunity to manage at the highest level, under our guidance.”
Implemented by DG Murray Trust (a South African philanthropic foundation) in partnership with the National Department of Health, Keready is funded by the German government through the KfW Development Bank.
The project reached full scale late last year with 46 mobile health clinics in four provinces: Eastern Cape (8), Gauteng (16), KwaZulu-Natal (13), and the Western Cape (9).
These mobile clinics move into different communities every day. At times they use a loud-hailer to attract people. Sometimes they are based at schools, other times at taxi ranks and other hubs of activity.
People of all ages who visit the clinics are provided with a range of health services, including screenings and tests for HIV, TB and diabetes, as well as given family planning advice and immunisations. Medication is prescribed, and, where possible, dispensed on the spot.
Keready also runs a WhatsApp line where youth can ask young doctors and nurses any health-related questions and get straightforward, non-judgemental answers.
When learning about Keready during a walkthrough of exhibition stands set up at the Birchwood Hotel in Boksburg during the 2023 Presidential Health Summit, President Cyril Ramaphosa described the movement as “NHI on Wheels” because of its efforts in addressing universal health coverage.
From Bizana to Whittlesea
Two weeks later, I am again travelling with the same Keready team – this time to Whittlesea, outside Queenstown. Over two days, we visit the Ekuphumleni Community Hall and Kopana School in Ntabethemba. A highlight of this outreach is that teenage girls will be supplied with sanitary pads, thanks to a collaboration with pharmaceutical and healthcare company Johnson & Johnson.
On day one, hundreds more pupils than anticipated arrive. School principals were over-enthusiastic in spreading the word of the outreach resulting in taxi-loads of pupils from unexpected schools arriving. Irate teachers try to negotiate a way for their pupils to be seen.
Teacher Nolitha Tuta tells me many of the children she’s brought are from child-headed households and some have had little to no access to healthcare services.
While waiting in the queue, a mother of a child from Bhongolethu Primary School describes how she walked for hours to bring her child for eye testing.
Children line up for their health checks at the Kopana School in Ntabethemba. (Photo: Sue Segar/Spotlight)
Despite having waited until the end of the day, students from Zweledinga High end up being driven back home at sunset without being assisted.
After two days in Whittlesea, nearly 1 200 pupils from 36 schools have arrived. Nine schools were turned away. Nearly 700 learners have been screened for eye conditions, with 88 eligible for specs and four referred to an ophthalmologist.
The doctors look exhausted. Dr Anda Gxolo says over the past two days numerous children presented with ear problems. There were also long lines for dental care this time.
Despite the long hours, Dr Phumelele Sambumbu, who manages five of the eight Keready mobile clinics in the Eastern Cape, says she loves her work. “I come from these parts – from a village between Cofimvaba and Tsomo. My old grandmother is bedridden. I know first-hand how difficult it is to have access to care when you’re from a village like that and when you suffer from ailments like that. The idea of bringing health services to people who would otherwise struggle to access them is what drives me,” she says.
Mapping the need
Based on its relationship with the department of health, Keready has ambitious plans to expand its grassroots outreach programmes to help narrow the gaps in healthcare nationally.
A map on the wall of Keready’s office shows the number of government clinics in the Eastern Cape relative to schools. There are around 700 clinics in the province, but over 5000 schools (which works out to more than seven schools per clinic). Nationally, the ratio is similar with around 3 400 clinics and 25 000 schools.
It’s no surprise then that, according to Harris, staff on Keready’s 46 mobile clinics in the four provinces where it operates cannot keep up with demand for their services.
“Based on our mapping of the national population, we know there are 2 500 communities that don’t have reasonable access to a clinic. Just to deal with the gaps, we need 2 500 mobile clinics. We can tell you exactly where in the country to put them,” says Harris.
To reach ill people who are ill but don’t know it, Keready aims for nurse-supervised ambassadors to do door to door visits in communities to check who has TB, HIV and hypertension. “We have digitised every street and every house by satellite. Each house would be marked off; if TB’s picked up, it is mapped,” says Harris.
Plans for the door to door programme are well under way, he says. “In the Eastern Cape, Keready has partnered with the Small Projects Foundation to train 80 young people [as nurse-supervised ambassadors] from the Industrial Development Corporation’s Social Employment Fund to do health testing house to house.”
Eventually, says Harris, there could be 80 people linked to each of the 46 mobile clinics, meaning that a total of 3 680 trained people could be going from door to door.
“Going forward we’d want to find the disease before the disease finds us – TB, HIV, hypertension, diabetes and general growth issues [in children] are the core areas we will address in this programme,” he says.
But the extent to which Keready can deliver on its ambitious expansion plans will depend on funding and to what extent government continues to implement services using mobile clinic outreach programmes. The German financial contribution to the Keready project comes to an end in September. “We are working day and night to get more funding,” says Harris. He says they will soon be meeting with potential donors.
Non-profit organisations whose funding by the Gauteng Department of Social Development has been withdrawn say they are being unfairly punished for “frivolous” and “flimsy” findings made by forensic auditors.
Among the organisations concerned are women’s shelters, drug rehabilitation centres and organisations that provide meals and social work services to homeless people. Many say they have no choice but to scale down their services and even close their doors.
Only seven in-patient drug rehabilitation centres, out of 13 that received funding last year, will be receiving funds for the first two quarters of this financial year, the department confirmed to GroundUp on Wednesday. Six rehabs are under investigation, the department said.
A manager at a children’s home told GroundUp earlier this week that they had to send a teenager struggling with substance use disorder back to their family because there were no state-funded in-patient drug rehabilitation centres available in the West Rand.
Forensic auditors were appointed by the department in 2023 to probe allegations of maladministration and fraud in the non-profit sector. The department’s budget for non-profit organisations is R1.9-billion for 2024/25, but Gauteng premier Panyaza Lesufi has promised it will be increased to R2.4-billion. Fourteen department officials have been suspended based on findings of forensic audits, the department has said.
The forensic audits were supported by outgoing MEC Mbali Hlophe. Hlophe has claimed several times that non-profit organisations in the province were “stealing from the poor” and that there has been extensive corruption in the sector.
A report provided by the department to the Gauteng Care Crisis Committee last week, on the orders of the Gauteng High Court, contains a list of 53 organisations that are under investigation, out of several hundred funded by the department.
Among the organisations on the list are Daracorp and Beauty Hub which received millions of rands in subsidies for training, while others have had their budgets cut.
But while organisations such as these have received large amounts of funding under questionable circumstances, the department has not provided evidence that this applies to all organisations on the list.
In May, almost two months into the new financial year, organisations flagged in the investigations started receiving letters informing them that they would not receive funding due to the findings made by the auditors. Some only received the letters in June.
When they requested clarity from the department, some received details in writing. But others were only given reasons for the suspension of their funding during a meeting with the department’s lawyers on Wednesday.
GroundUp spoke to representatives of five organisations who attended Wednesday’s meeting. They said the findings they were presented with on Wednesday were minor issues that should have been picked up by the department’s own monitoring and evaluation teams and would have been quickly resolved. They said they did not understand why a forensic audit was necessary.
The organisations have not received any funding from the department since the end of the financial year in March, and are battling to keep going.
“Flimsy and frivolous”
Derick Matthews, CEO of the Freedom Recovery Centre, which until March was funded for 52 beds for in-patient drug rehabilitation, told GroundUp that the allegations against the centre are “flimsy” and “frivolous”.
Matthews was told at Wednesday’s meeting that Freedom Recovery Centre had not submitted audited financial statements for 2022. GroundUp has seen evidence that he submitted the audited financial statements.
Matthews said the department had never before raised concerns about the organisation’s compliance with legislation. He said every quarter the department’s monitoring and evaluation officials would check the centre’s financial statements and that no concerns had ever been raised.
The auditors also found a “high turnover of security personnel” at Freedom Recovery Centre which was causing “instability in the organisation”. Matthews explained that this was because the security staff are employed from the centre’s skills development programme, through which a person who has been sober for a year works for three to six months at the centre.
“They are paid salaries from DSD funding. Our security is not working directly with the residents so they cannot impact the stability of the centre,” Matthews said.
The third finding against Freedom Recovery Centre was that staff members were being given “loans”. Matthews explained that sometimes when the department paid subsidies late, the centre would pay part of staff salaries from the tuck shop’s funds, which would later be deducted from their salaries.
Matthews says that they are in the process of discharging their last state-funded patients. “Both government-funded centres that we have been told to send people to during this crisis are full, they can’t help us. In the last week, I’ve received about 12 phone calls of people that needed urgent help and we can’t even help or intervene,” he said.
Representatives of other organisations GroundUp spoke to had similar concerns about the findings against them but did not want to be named for fear of victimisation.
They also raised concerns that their meeting on Wednesday was with only one department official and the department’s lawyers, while the organisations themselves did not have lawyers present.
They were told they have until Monday to provide evidence to dispute the allegations against them.
At the meeting on Saturday convened by Gauteng Premier Panyaza Lesufi, it was agreed that the organisations would receive an interim service-level agreement from the department by Monday, which would be finalised once the organisations were cleared. But not one organisation GroundUp spoke to has received an interim service-level agreement. Then on Wednesday they were told they will receive the agreements next week.
One organisation under investigation, Child Welfare Tshwane, was finally paid by the department last week after Gauteng High Court Judge Ingrid Opperman issued a directive that the organisation be paid to prevent harm to the beneficiaries.
GroundUp sent detailed questions to the Gauteng Department of Social Development, but we were told that the department will not be responding to media queries relating to the non-profit sector until further notice.
While cancer survivors are increasing in countries like the United States, South Africa faces a different reality, with 4000 people dying from blood cancer every year. Dr Sharlene Parasnath, Head of the Department of Clinical Haematology and Stem Cell Transplant Unit at Inkosi Albert Luthuli Central Hospital and DKMS Africa board member, believes that this discrepancy is largely due to the quality of care provided to patients who rely on the state healthcare system.
Counting the costs
She explains that South Africa’s state sector relies predominantly on conventional chemotherapy to treat patients as opposed to newer targeted immunotherapies. “These may be accessible to some patients in the private sector and standard care in developed countries but are out of reach for public healthcare due to their unaffordability. Countries that use more targeted therapies not only improve overall survival but also decrease the undesirable adverse effects of cancer treatments. These therapies may be given with chemotherapy or on their own and work by attacking specific genetic mutations in cancer cells. Examples include monoclonal antibodies (MABs) and Bispecific T cell engagers (BiTES), which mimic the immune system to destroy cancer cells. There are also tyrosine kinase inhibitors (TKIs) which block the signals that promote cancer cell growth.”
“The prohibitive costs of these treatments are why stem cell transplants are being encouraged in South Africa since they offer those with blood cancers a chance of a cure,” points out Dr Parasnath. “However, this approach comes with challenges. For instance, the state will not pay for a transplant from an unrelated donor, despite two thirds of patients in need of a transplant being unable to find a suitable donor from within their family.”
Fewer nurses, fewer transplants
“Human resource constraints, particularly the shortage of specialist nurses, is another factor hindering more stem cell transplants from being carried out,” she notes. “Currently, there is no formalised training for nurses in haematology in South Africa. So, what tends to happen is that the majority of blood cancer patients end up being cared for either by oncology-trained nurses or registered general nurses with limited practical education and training in the kind of care they require. Important aspects of nursing which can improve patient outcomes include dietary restrictions, visitor guidelines, decreasing bleeding risk, infection control and early detection of potential complications such as graft rejection, graft vs. host disease and veno-occlusive disease that can develop following a stem cell transplant.”
She stresses that human resource constraints in terms of mental health support is also detrimental to patients with blood cancers. “Unfortunately, this tends to be the case both in the public and private sectors, as one out of three people diagnosed with cancer ends up struggling with a mental health disorder such as anxiety or depression as well, yet less than 10% of patients are referred to seek help. The South African Society of Psychiatrists has even warned that if left untreated or undiagnosed, this could impact the patient’s ability to function on a daily basis, including undergoing treatment.”
Dr Parasnath emphasises another glaring gap in mental health support. “NGOs offer on-site social workers for hospitalised children with blood cancer, but adults, especially those who are not members of medical aid schemes, often have no options available to them. Not only do they grapple with the emotional toll of their diagnosis and treatment side effects, but this is further complicated by anxieties around their finances and the wellbeing of their children.”
The Cancer Association of South Africa’s (CANSA) Fact Sheet on Cancer and Mental Health highlights that there remains a huge unmet need for mental health in cancer care, calling for more effective clinical integration of relevant services, which must be informed by patient choice and clinical need, and accessible throughout the patient’s whole cancer journey. It also stresses the need for measurement of patient quality of life as a marker of treatment effectiveness.
“The Department of Health must recognise clinical haematology as a discipline in its own right with its own unique needs. For too long, it has had to feed off of the limited oncology budget. But if we are to up the blood cancer survival rate, funding must be provided for necessities such as more modern treatments, unrelated stem cell transplantation and formalised training of nurses,” says Dr Parasnath.
She also urges South Africans to increase the pool of available stem cell donors either by registering themselves or supporting organisations like DKMS Africa which connects patients with potential matches by providing access to a global registry of over 12 million donors. Financial donations directly address two critical needs: funding the registration of new donors and assisting patients facing financial challenges as a result of the transplant process.”
“With focused efforts, South Africa can join the global trend of increasing blood cancer survival rates, offering a brighter future for patients and their families,” concludes Dr Parasnath.
