National Cancer Strategic Framework for South Africa 2017-2022

Objectives

The National Cancer Strategic Framework seeks equitable, comprehensive cancer prevention and control for all South Africans, reducing cancer-related deaths, disability, suffering and financial strain through person-centred, human rights-based care that respects the dignity of people living with cancer, their families and communities.[1][2][3]It provides an overarching evidence-based framework for the major cancers affecting children, adolescents, women and men, while responding to disease burden, social determinants and health-system constraints.[4][1]

• Strengthen governance, leadership, cancer services, the workforce, technology and infrastructure, surveillance and research, and sustainable financing, using the World Health Organization health-system building blocks as a reference.[5]
• Reduce preventable cancer incidence by addressing tobacco use, alcohol consumption, unhealthy diet, physical inactivity, obesity, infectious causes, sun exposure, occupational hazards and environmental exposures.[6][7]
• Deliver an integrated life-course continuum spanning surveillance, education and awareness, prevention, screening and early detection, diagnosis, treatment, rehabilitation, psychosocial and supportive care, survivorship, follow-up and palliative care.[8][9][3]
• Prioritise lung, colorectal, cervical, prostate and breast cancers in adults, alongside childhood, adolescent and young adult cancers, while allowing provinces to identify additional priorities according to local circumstances.[7]
• Improve access for populations facing disproportionate barriers, including black African, poor, uninsured and rural communities, and reduce inequities in service distribution, waiting times, staffing, equipment and treatment availability.[10][11]
• Improve survival and quality of life through timely diagnosis and treatment, including prioritisation of curable cancers where resources are limited, with palliative care commencing at diagnosis.[12][13]
• Support progress towards the Sustainable Development Goals, including target 3.4, South Africa’s National Development Plan 2030 and World Health Organization non-communicable disease targets.[2][10]

Implementation

Implementation is intended to build on existing health-service platforms through coordinated national, provincial and district action, with provincial and district cancer plans adapted to local needs.[3][5]Government leads implementation in partnership with health departments, civil society, communities, academia, researchers, non-profit organisations and public and private oncology providers, supported by governance, accountability, stakeholder engagement, evidence-based decision-making and continuity of care across programmes and levels of service.[14][2][3]

• Organise services across household, community, primary, district, secondary, tertiary, quaternary and academic settings, using existing services, strengthened platforms and new services as resources become available.[9][15]
• Provide prevention, education, cervical screening and treatment of pre-cancerous lesions at community and primary-care levels, while concentrating specialised diagnosis and curative treatment in secondary, tertiary and quaternary centres with appropriate expertise and technology.[16][15][13]
• Establish clear two-way referral pathways and inter-provincial agreements so suspected cases move without unnecessary delay to designated diagnostic centres and patients can access geographically appropriate cancer-care centres.[15][13][17]
• Strengthen multidisciplinary care through community workers, nurses, doctors, oncology specialists, diagnostic personnel, pharmacists, social workers, psychologists, rehabilitation professionals, researchers, epidemiologists, statisticians and data managers.[15][18]
• Develop diagnostic algorithms, co-ordinated communication procedures and management protocols aligned with national and international guidance, while maintaining access to functional equipment, medicines, devices and supply chains.[13][18]
• Develop provincial packages of care covering workforce, equipment, medicines, consumables, transport and laboratory requirements, and urgently review service-delivery problems affecting access and effectiveness.[15][19]
• Expand supportive care, rehabilitation and survivorship services beyond recurrence surveillance, including a National Cancer Survivor Care Plan to co-ordinate treatment histories, surveillance schedules, health priorities and follow-up arrangements.[20]
• Strengthen palliative care from tertiary hospitals to patients’ homes, supported by qualified providers, governance, monitoring and evaluation, and adequate financial resources.[20][19]
• Use public-private partnerships where public infrastructure is inadequate, subject to clear, fair and transparent criteria, and consider phased treatment-centre improvements based on facility tiers, validated caseloads and revised expenditure estimates.[21][22][23]
• Monitor implementation through a plan and information systems that assess governance, screening coverage, stage at diagnosis, referral and laboratory turnaround times, time from diagnosis to treatment, loss to follow-up, workforce capacity, equipment availability and stock-outs.[5][24]
• Strengthen cancer surveillance through pathology-based, tumour and population-based registries, including the National Cancer Registry and the South African Children’s Cancer Study Group Tumour Registry, and use research and routine operational data to guide planning and resource allocation.[21][22]
• Complete detailed costing, incrementally increase funding through phased implementation, protect essential provincial Goods and Services budget components in constrained conditions, and assess equipment contracts or leasing arrangements subject to cost analysis.[22][25][26]

Monitoring & Evaluation

The framework establishes monitoring, evaluation, surveillance and accountability as core elements of cancer control, linking evidence generation to planning, implementation, resource allocation and service improvement across national, provincial and district levels.[3][5][24]

• Monitor implementation through a dedicated monitoring and evaluation plan, periodic assessments, strengthened information systems, and analysis of epidemiological and routine operational data.[24][22]
• Track governance through indicators such as approved cancer policies and strategies, including implementation of breast and cervical cancer policies.[5]
• Measure service performance through screening coverage, stage at diagnosis, intervals from screening to diagnosis and from diagnosis to treatment, laboratory turnaround times, and the proportion of patients lost to follow-up at each stage.[5]
• Assess workforce, technology and supply capacity through measures including cancer-control training, inclusion of cancer control in undergraduate curricula, filled treatment-centre posts, equipment availability, machine downtime, maintenance turnaround times, and vaccine and medicine stock-out days.[5]
• Strengthen surveillance through adequate facility reporting and laboratory testing, functional pathology-based and population-based registries, the National Pathology Based Registry, and the South African Children’s Cancer Study Group Tumour Registry.[5][22]
• Use compulsory cancer notification regulations, introduced in 2011, to support reporting to the National Cancer Registry and population-level surveillance.[9]
• Develop sentinel sites for population-based cancer registration to complement pathology-based registration, model national cancer incidence and support reporting to the International Agency for Research on Cancer.[21]
• Use mortality information released by Statistics South Africa and the Department of Home Affairs to assess effects on life expectancy and support intervention and research priorities.[12]
• Review District Health Information System and Annual Performance Plan indicators alongside risk-factor datasets, including HIV antenatal reports, the South African National Health and Nutrition Examination Survey, tobacco-consumption reports and human papillomavirus post-vaccination surveillance.[12]
• Use facility audits as a baseline for cancer-treatment infrastructure and capacity, and monitor radiation-treatment waiting times, including for gynaecological, prostate and palliative radiation services.[16][11]
• Verify health-system information, validate caseload assumptions and revise expenditure estimates before finalising treatment-centre improvements, recognising limitations in available data.[22]
• Document cancer-medicine adverse events and apply pharmacovigilance to manage complications of cancer and treatment.[18]
• Establish and maintain monitoring and evaluation systems for palliative care, supported by governance, leadership and adequate financing.[20][19]
• Use a National Cancer Survivor Care Plan to coordinate treatment histories, surveillance schedules, follow-up arrangements and general health priorities for survivors.[20]

Registry and mortality evidence have important limitations: the pathology-based registry may miss cancers diagnosed clinically or radiologically, coding can delay reporting, death certification may be inaccurate, and childhood cancer ascertainment and mortality data are incomplete.[10][27][6][21]

Government is responsible for implementation with relevant stakeholders, under principles of governance, leadership, accountability, equity, local responsiveness and evidence-based decision-making.[3]However, the supplied material does not provide reporting intervals, performance thresholds, named accountability bodies or a fully specified evaluation methodology.[20][3][24]

Costing & Financing

The framework identifies sustainable financing as a strategic goal and recognises that cancer services are underfunded, while high treatment costs, medicine prices and inadequate public financing restrict equitable access, particularly for uninsured people and the large population dependent on public health services.[10][18][5][22]

• Complete detailed costing for optimal cancer prevention and control services and use revised expenditure estimates, verified data and validated caseloads to inform phased facility improvements.[22]
• Increase funding incrementally through phased implementation of the National Cancer Plan to address unmet demand, treatment backlogs and additional demand associated with improved awareness, screening and diagnosis.[22]
• Develop funding and service-delivery models as an implementation indicator for sustainable financing.[5]
• Protect specified provincial Goods and Services budget components during tight economic conditions, including medicines, medical supplies, laboratory and blood services, equipment, maintenance, vaccines and antiretroviral medicines.[25][26]
• Plan provincial packages of care that account for staffing, equipment, medicines, consumables, transport and laboratory requirements at each level of the health system.[19]
• Maintain functional equipment, medicines, devices and supply chains, while addressing financing constraints, medicine prices, patents, generic registration, procurement and distribution inefficiencies.[18]
• Apply treatment guidelines that consider cost-effectiveness, affordability, practice implications and containment of public-health costs.[18]
• Consider transparent public-private partnerships, transversal equipment contracts, leasing arrangements, community-supported patient transport and research grants to expand public-sector capacity, subject to clear agreements and cost analysis.[15][13][5][22]
• Allocate adequate financial resources to sustain palliative care and reduce out-of-pocket barriers that can delay or prevent survivors’ access to care, including screening.[20][19]

The framework does not provide monetary budget allocations, quantified funding gaps, financing shares, cost estimates or numerical economic assumptions in the supplied material.[5][22][25]