Improving Access to Radiotherapy in Gauteng: A Framework for Equitable Cancer Care
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Ethical Considerations
2.3. Methods
Phase 5: Framework Development
3. Results
3.1. Foundation: Policy & Governance
3.1.1. The Challenges
- Lack of effective cancer control planning, resource allocation, and leadership at the national and provincial levels.
- Inadequate cancer planning as depicted in the literature on cancer control in South Africa.
3.1.2. The Impact of Inadequate Policy and Governance
- Equipment maintenance issues: delays in equipment maintenance due to budget constraints and bureaucratic processes also impacts availability. As one healthcare professional mentioned in the structural quality assessment phase, “We often have to wait months for repairs, which leads to treatment delays.”
- Financial burden on patients: lack of financial assistance programs and inadequate health insurance coverage, resulting in significant out-of-pocket expenses for patients. This directly affects Affordability. As stated by the one patient in the patients’ experience phase, “I had to sell my belongings to pay for transport to the hospital. It was a big financial strain on my family.”
- Information gaps: insufficient patient education and support, leading to confusion about the treatment process and a desire for more information from healthcare providers. This impacts Accommodation and Acceptability. As one patient noted in the patients’ experience phase, “I didn’t really understand what radiotherapy was or what to expect. I felt like I was just going through the motions”.
3.1.3. The Proposed Solutions: A Multi-Pronged Approach
Develop Comprehensive National Cancer Control Plans
Increase Investment in Cancer Care
Promote Collaboration Between Public and Private Sectors
Address Financial Barriers to Care
Improve Patient Education and Support Services
3.2. Pillars: Core Components of the Radiotherapy System
3.2.1. The Challenges in Public Facilities in Gauteng
- Higher patient loads: the sheer volume of patients seeking treatment at public facilities strains resources and contributes to longer waiting times, directly impacting the accessibility of care. As noted in the qualitative study, some patients reported waiting months for initial consultations.
- Limited radiotherapy equipment: the availability of functional radiotherapy machines is a major concern, affecting the availability of services. The mixed-methods assessment indicated that public facilities often have fewer machines per patient compared to private facilities. Equipment downtime further exacerbates this issue.
- Staffing shortages: a shortage of trained personnel, including radiation oncologists, medical physicists, and radiation therapists limits the capacity of public facilities to provide timely and effective treatment, reducing availability. This can also affect the acceptability of care if patients feel rushed or uncared for.
3.2.2. The Proposed Solutions to Strengthen Each Pillar of the House Framework
Increase Investment
Streamline Processes
- Develop and implement standardized referral guidelines with clear criteria for radiotherapy eligibility.
- Establish a multidisciplinary tumor board with representatives from different specialties to facilitate communication and coordination of care.
- Implement AI algorithms to assist in treatment planning, potentially reducing the time required and optimizing treatment plans for individual patients. This aligns with improving the accommodation of patients.
- Employ AI-powered predictive analytics to optimize scheduling and resource allocation, reducing waiting times and improving service delivery efficiency.
Enhance Patient Support
- Provide comprehensive patient support services, including information and education about radiotherapy treatment, financial assistance, and psychosocial support.
- Develop patient navigation programs to help patients navigate the complexities of the cancer care system.
3.3. Roof: Equitable Cancer Care & Improved Outcomes
- Accessibility: Geographic and structural barriers to accessing radiotherapy services must be minimized. This includes addressing transportation challenges, streamlining referral processes, and establishing services in underserved areas.
- Affordability: Financial barriers, such as high treatment costs, transportation expenses, and lost income, must be addressed to ensure that all patients can afford radiotherapy treatment. The findings emphasize the financial burden on patients, with many reporting significant out-of-pocket expenses.
- Accommodation: Healthcare facilities should be organized and services delivered in a way that meets the needs and preferences of patients. This includes flexible appointment scheduling, shorter waiting times, clear communication about the treatment process, and culturally sensitive care. The patients expressed confusion about the treatment process and a desire for more information.
- Acceptability: Cultural beliefs and other factors that may influence patients’ willingness to seek and adhere to radiotherapy treatment must be addressed. This involves providing culturally sensitive care, addressing the stigma associated with cancer, and promoting trust in the healthcare system.
- Foundation: Sound policies and governance structures are essential to ensure equitable resource allocation and effective cancer control planning. These policies should prioritize the 5As to create a supportive environment for cancer care.
- Pillars: Strengthening the core components of the healthcare system (service delivery, health workforce, information, medical products/technologies, financing, and leadership/governance) is crucial for improving the 5As and achieving equitable outcomes.
- Roof: By addressing the 5As and strengthening the foundation and pillars of the “House” approach, the goal of equitable cancer care and improved outcomes can be achieved for all patients, regardless of their socio-economic status or geographic location, as evidenced by the qualitative study of patient experiences.
- Monitor key indicators related to access, such as waiting times, travel distances, and out-of-pocket expenses.
- Track cancer incidence, mortality, and survival rates across different socio-economic and geographic groups.
- Regularly assess patient satisfaction and experiences to identify areas for improvement.
4. Discussion
Adaptability and Generalizability
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
SDG | Sustainable Development Goal. |
LMICs | Low-Middle Income Countries. |
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Phase of Project | Study Focus | Main Themes | Supporting Citation |
---|---|---|---|
Systematic Review | Barriers to Radiotherapy Access in Sub-Saharan Africa | Health System Barriers, Patient Socio-demographic Barriers, Provider Factors | [13] |
Quantitative Analysis | Time Intervals from Diagnosis to Treatment | Delays in Diagnosis, Delays in Treatment Initiation, Variations in Time Intervals | [14] |
Mixed Methods Assessment | Structural Quality Indicators of Radiotherapy Services | Limited Radiotherapy Facilities, Staff Shortages, Equipment Challenges | [15] |
Qualitative Study | Patient Experiences of Radiotherapy Access | Financial Burden, Lack of Information, Transportation Challenges, Psycho-social factor | [unpublished patient experience] |
Framework Development | Strategies to Improve Radiotherapy Access in Gauteng | Infrastructure Development, Workforce Training and Retention, Task Shifting, International Collaboration, Financial Investment |
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Ramashia, P.N.; Nkosi, P.B.; Mbonane, T.P. Improving Access to Radiotherapy in Gauteng: A Framework for Equitable Cancer Care. Int. J. Environ. Res. Public Health 2025, 22, 1071. https://doi.org/10.3390/ijerph22071071
Ramashia PN, Nkosi PB, Mbonane TP. Improving Access to Radiotherapy in Gauteng: A Framework for Equitable Cancer Care. International Journal of Environmental Research and Public Health. 2025; 22(7):1071. https://doi.org/10.3390/ijerph22071071
Chicago/Turabian StyleRamashia, Portia N., Pauline B. Nkosi, and Thokozani P. Mbonane. 2025. "Improving Access to Radiotherapy in Gauteng: A Framework for Equitable Cancer Care" International Journal of Environmental Research and Public Health 22, no. 7: 1071. https://doi.org/10.3390/ijerph22071071
APA StyleRamashia, P. N., Nkosi, P. B., & Mbonane, T. P. (2025). Improving Access to Radiotherapy in Gauteng: A Framework for Equitable Cancer Care. International Journal of Environmental Research and Public Health, 22(7), 1071. https://doi.org/10.3390/ijerph22071071