Since 2014, the multi-country DREAMS programme has aimed to prevent HIV acquisition among highly vulnerable adolescent girls and young women through a multi-dimensional and comprehensive intervention. TB HIV Care ─ a DREAMS implementing partner in South Africa ─ adapted the programme to address local needs, developing an innovative component to positively influence mental health outcomes and further protect adolescent girls and young women from HIV infection. This paper details the integration of TB HIV Care’s mental health component into the programme, and argues that this approach offers a model and lessons for the adoption of better mental health services within the Primary Health Care system. Adolescent girls and young women aged 10─24 years were recruited in five districts with high HIV prevalence in the Eastern Cape and KwaZulu-Natal, where TB HIV Care implements the DREAMS programme. Once enrolled in age-appropriate educational sessions, each participant received comprehensive mental health risk screening by trained psychosocial support workers. TB HIV Care’s specially developed electronic risk-reduction screening tool incorporates aspects of Pfizer’s patient health questionnaire; the general anxiety disorder form; the alcohol use disorders identification test, and the drug use disorders identification test, and is used to identify mental health concerns and substance use disorders. This screening system enables the mental health risk profile of clients to be identified for their prompt referral to appropriate treatment services. Between October 2022 and May 2024, 145 605 participating adolescent girls and young women underwent mental health screening. While most participants were in a low-risk mental health category, over 5 000 were in need of first-line counselling; 934 required higher-level support, and 506 moderate- to high-risk cases needed in-depth support. TB HIV Care implemented its mental health treatment cascade with these clients, with encouraging results. This paper provides lessons for the government in addressing weaknesses and gaps in existing mental health services, not only for adolescent girls and young women, but also for the broader population. Such approaches should be better integrated into the Primary Health Care system to reduce the impact of mental health disorders on young people.
The Western Cape Department of Health and Wellness has responded to increasing mental health service pressures by developing an expanded psychosocial rehabilitation framework. Initiated in 2023, this framework aims to address the needs of individuals with mental disorders while also promoting mental well-being across the broader population. Central to this approach is the concept of occupational justice, which upholds the right of every individual, regardless of socio-economic status, disability, or other barriers, to engage in meaningful activities that support mental health and social inclusion. The aim of this paper is to outline the process employed by the Department to develop this framework and to illustrate the benefits of framing mental health around the principles of occupational justice. Consultative workshops were held with health workers from across the care continuum to identify service gaps and opportunities for expanding psychosocial rehabilitation services. Thematic analysis of the feedback informed the development of the expanded framework, with occupational justice positioned as a core protective factor for mental health and well-being. A bouquet of psychosocial interventions was developed, consisting of five key components: (1) building community resilience by promoting equitable access to basic services through a multi-sectoral response; (2) psychosocial support to promote mental health and prevent decline among those who are healthy or at risk; (3) psychosocial care and rehabilitation for individuals with diagnosed mental disorders to support optimal functioning and community re-integration; (4) palliative psychosocial support for clients and families to enhance quality of life; and (5) employee resilience through access to support services and training for healthcare staff. The framework recognises mental health as a continuum and promotes differentiated levels of psychosocial support tailored to an individual’s needs through inter-disciplinary and multi-sectoral collaboration. This expanded framework redefines psychosocial interventions in the Western Cape by situating occupational justice at its core. It recognises psychosocial support as part of a continuum of care and emphasises the role of multi-sectoral and inter-disciplinary stakeholders as change agents collaborating to strengthen rehabilitation and support services, and to promote overall societal well-being.
Globally, severe mental health conditions contribute significantly to the burden of disease. In South Africa, there is a considerable treatment gap in the recovery of persons with severe mental health conditions. These persons are mostly treated on an in-patient basis in specialised psychiatric hospitals with limited access to community-based recovery-orientated services. Given the international drive to transform mental health services and reduce the treatment gap, especially in low- and middle-income countries, it is pertinent to understand how recovery from severe mental health conditions is conceptualised from multiple stakeholder perspectives, including those with lived experience of the condition. This qualitative descriptive study explores how diverse stakeholders understand recovery from severe mental health conditions, identifying possibilities for intersectoral collaboration. Seventeen purposively selected service providers from health services and non-profit organisations, four mental health service users, and three of their caregivers in Cape Town participated in the study. Data collected using semi-structured interviews, focus groups and visual participatory methods were thematically analysed. Three themes identifying opportunities to implement intersectoral collaboration emerged: barriers to personal recovery; finding meaningful participation; and affirming agency. Health service providers primarily focused on medication adherence and symptom reduction in health settings. In contrast, mental health service users and their caregivers suggested that their recovery was facilitated by long-term relational support from a range of service providers, including non-profit mental health organisations. Additionally, mental health service users valued access to interventions outside health settings, promoting meaningful engagement in their living, learning, working and socialising environments. Intersecting contextual, socio-economic, cultural, and spiritual factors beyond the health sector influence recovery. Appropriate services for severe mental health conditions are multi-dimensional and treatment considerations should accommodate this complexity.
This paper describes the components of the Perinatal Mental Health Project’s Maternal Support Service model, highlighting adaptions made over time to address real-world challenges and opportunities. Each component of the service model and its refinements are described. This includes: (1) collaboration with maternity staff; (2) mental health promotion, prevention and service preparedness; (3) initial screening of women with a locally validated, ultra-brief tool; (4) engagement, assessment and triage sessions; (5) on-site psychotherapeutic and social support interventions based on levels of need; (6) collaborations with other providers for holistic case management; (7) monitoring and evaluation, and (8) prioritisation of staff wellbeing and supervision. Monitoring and evaluation data were collected to describe care pathways. Data for 2024 are provided. Over time, we made several modifications to the service design to optimise uptake, relevance, efficiencies, and quality of care. In 2024, 3 059 women attended the unit for antenatal care. Maternity staff referred 450 of these women to the Maternal Support Service for further assessment, based on their mental health screening results and/or being part of a pre-defined target group. Mental health counsellors conducted 415 sessions for engagement, assessment and triage. Psychotherapy and social support were offered to 392 women, of whom 348 accepted. A total of 275 new service users were seen, with a mean of 3.4, a median of 3, and a mode of 2 therapy sessions. Of these women, 29%, 37% and 34% required low-, medium-, and high-intensity care, respectively. A postnatal follow-up assessment was completed for 69 women, with 37% reporting complete improvement, and 23% reporting partial resolution of their presenting problems, across all problem categories. The model provides a promising example for the planning, organisation and integration of maternal mental health services at primary care level.
Mental health conditions are a leading cause of disability in South Africa. Yet, resources allocated to their prevention, treatment and rehabilitation are low and centralised, disproportionately disadvantaging rural and lower socio-economic communities. The high treatment gap and poor quality of care further fuels stigma and discrimination. The National Mental Health Policy Framework and Strategic Plan 2023─2030 seeks to address this by integrating mental health into general care and providing quality care as close as possible to the places where people live and work. Achieving this within the current resource constraints requires innovative, culturally appropriate, collaborative and novel service delivery solutions. This paper outlines a model for and the key experiences of implementing a collaborative, multi-faceted, multi-disciplinary mental health outreach service in predominantly rural, geographically vast, northern KwaZulu-Natal. By sharing this approach and reflecting on challenges and lessons learnt, the aim is to support similar initiatives, advance implementation of the Framework and Strategic Plan, and improve access to quality mental health care in under-served rural communities. An adapted, collaborative care model for specialist outreach services provides a pragmatic solution to the challenges of delivering quality mental healthcare services to rural and under-served communities. The outreach service should be flexible, grounded in strong relationships among specialists, district staff, and intersectoral partners, and extend beyond clinical service delivery to include input on clinical governance, infrastructure development, and facilitation of referral pathways.
This paper synthesises the latest evidence on child and adolescent mental health in South Africa, arguing that early investments therein are essential for breaking the inter-generational cycle of violence, poverty, discrimination, and mental ill-health, and identifying opportunities for intervention and systems-strengthening both within and outside the healthcare system. The paper draws on a range of evidence to explore the epidemiology of child and adolescent mental disorder and its social determinants. It emphasises the need to support children and families across the continuum from prevention and early intervention through to specialised mental health services, and examines how to enhance the use of schools and health facilities to support children and families. Fifty per cent of mental disorders have their onset before the age of 14, so it is vital to intervene early in the life-course to promote optimal mental health. An estimated 17% of South Africa’s children have a diagnosable and treatable mental disorder, yet only one in 10 are able to access care, with specialist child and adolescent mental health services being concentrated in a handful of urban centres. Therefore, innovative approaches, such as the Western Cape’s child and adolescent mental health service-strengthening project, are required to bring services and support closer to home. Outreach, training and task-shifting have the potential to build the capacity of frontline workers at primary care level and should be rendered with a child- and family-centred approach, including adult services, to focus attention on the vulnerability and care needs of children of parents with mental disorders. It is also essential to strengthen support for children and families through improving access to social assistance, parenting programmes and health-promoting schools.
This paper presents a current review of South Africa’s mental healthcare research and system progress, by: (1) mapping out the type, scope and focus of research studies that have been undertaken, and (2) drawing conclusions from those studies on the progress made towards reforms in developing a people-centred mental health system. An integrative review with thematic analysis guided by the World Health Organization Framework on Integrated, People-centred Health Services was employed. A total of 126 papers over a period of 13 years were included for final analysis. A relatively large proportion of papers used qualitative methodologies, followed by secondary document analysis, the majority of papers being descriptive. Most papers focused on all mental health conditions, followed by common mental conditions such as depression, anxiety and substance use disorder. While progress emerged in the reorientation of the model of care, and in co-ordinating services, substantial gaps remain in terms of strengthening governance and accountability, as well as in empowering and engaging people. Creating an enabling environment was exemplified by the introduction of two cycles of the National Mental Health Policy Framework and Strategic Plan, although implementation of the policy remains suboptimal. The review mirrors findings from an earlier review, and key barriers remain in terms of insufficient resources and governance structures to adequately support community-based, people-centred services, the under-detection of common mental conditions, limited culturally congruent services, stigma, and a lack of intersectoral collaboration.
Between 2012 and 2014, the Klipfontein/Mitchells Plain sub-structure in Cape Town piloted an initiative to train community health workers through a one-year Higher Certificate in Disability Practice, creating a new cadre of mid-level health workers referred to as rehabilitation care workers. These workers were trained to provide basic rehabilitation and disability-inclusion services for people with mental, neurological and substance use disorders across the lifespan. This paper explores the role of rehabilitation care workers in advancing disability-inclusive development and community-based rehabilitation to support universal health coverage in primary-level mental health services. Rehabilitation therapists developed and supervised home- and community-based recovery-orientated care programmes for rehabilitation care workers, using a task-sharing model. Based on the pilot’s success, local health service management adopted a health systems strengthening approach, adjusting human resource policies to support community-based rehabilitation services including psychosocial care. This pilot was a collaborative effort between the Western Cape Department of Health and Wellness and local universities to develop the curriculum and train an initial cohort of 33 community health workers. Supervised rehabilitation care worker teams improved access to intersectoral health services in line with community-based rehabilitation principles. The initiative disrupted the ‘revolving door’ phenomenon through individual case management, group interventions, and population-level mental health promotion and prevention efforts. Rehabilitation care workers play a critical role in bridging the mental healthcare gap and strengthening the care continuum between primary and community-based services. The Klipfontein/Mitchells Plain sub-structure pilot demonstrates how adaptive human resource and service planning can support disability inclusion and reinforce district health systems. The ongoing creation of rehabilitation care worker and rehabilitation therapist posts focusing on mental, neurological and substance use disorders is gradually expanding to other sub-structures in the region.
South Africa faces a complex and intersecting burden of communicable, non-communicable, maternal, child, injury, and mental health conditions, all within a context of profound socio-economic and environmental inequities. This paper consolidates recent nationally representative and routine data to characterise population health status, service performance, mental health data assets, and cross-cutting system gaps. It places a strengthened emphasis on mental health surveillance and its integration into broader health system monitoring. The most recent publicly available national surveys, routine health information, modelled estimates, administrative financing and human resource datasets, mental health policy indicator frameworks, and longitudinal cohort platforms were synthesised. The strengths and limitations of indicators, as well as equity patterns across provinces and priority populations, were also appraised. Mental health data assets are expanding, with improvements in the routine indicator set and the inclusion of mental health metrics in longitudinal cohorts. However, significant gaps remain in community-level data capture, disaggregation by age, gender, and geography, standardisation of indicators, and governance structures. These limitations hinder the full integration of mental health into national health surveillance. Service performance data reveal uneven access to mental health services, workforce shortages in specialised cadres, and limited financing. Provincial disparities in mental health infrastructure and reporting exacerbate inequities in care and outcomes. Accelerating progress requires integrated, equity-orientated strategies: strengthening mental health information governance; closing gaps in the HIV/TB care cascade; improving the quality of maternal, newborn and child preventive services; rebalancing workforce and financing allocations; and addressing upstream socio-environmental determinants.
This paper investigates the critical shortage of mental health human resources in South Africa, exacerbated by longstanding socio-economic challenges and the COVID-19 pandemic. It assesses the current state of mental health human resources and proposes evidence-based recommendations aligned with national and international policy developments. An extensive review of scientific literature, national policies, and reports from multi-lateral bodies was conducted. The research was informed by three round-table consultation workshops held in 2021, attended by stakeholders working in national mental health and HIV response. Additional insights were drawn from engagements by the Foundation for Professional Development project staff with various stakeholders, including government departments, and provincial- and district-level staff. The South African healthcare system’s mental health sector faces significant challenges, including a severe shortage of specialised mental healthcare providers. The ratio of psychiatrists and psychologists to the population is critically low, especially in rural areas. Implementation of recent policy reforms, such as the National Mental Health Policy Framework and Strategic Plan 2023─2030, is hindered by insufficient human resources. Urgent action is required to address South Africa’s mental health human resources crisis. Recommendations include lifting restrictions on private-sector training of mental health professionals, optimising task-shifting, and embracing technological solutions like telemedicine. Addressing this crisis not only upholds the human right to health, but also mitigates economic losses due to reduced productivity from untreated mental health conditions.
This study explores the factors underlying the prioritisation of adolescent and youth mental health policy in South Africa, or lack thereof, from the perspective of health policy actors and youth advocates. In-depth interviews were conducted with 34 key informants including researchers, civil society and government policy actors and a focus group with seven youth advocates, aged 18─24 years. Data were analysed thematically drawing on an adapted version of a policy prioritisation framework. The analysis revealed several barriers to prioritisation, including: a lack of policy community cohesion, inadequate leadership, insufficient collaboration with adolescents and young people and those with lived experience, evidence gaps, a fragmented policy landscape, and a lack of simple, scalable solutions. However, a number of opportunities were also identified: dedicated and passionate actors, new evidence, and contextual factors which have raised public awareness and provided opportunities for change, such as COVID-19 and the introduction of National Health Insurance. Adolescent and youth mental health has not received the political attention necessary to ensure that action is taken to enhance and protect the mental health of young South Africans. More purposeful efforts to unite the adolescent mental health community and coordinate research, advocacy, policy and implementation efforts are needed to address these challenges. This research provides insight into the current state of adolescent and youth mental health policy in South Africa and potential actions to strengthen adolescent mental health policy development and implementation.
Mental health promotion and prevention programmes are a promising approach to addressing adolescent mental health, but little work has been done to integrate mental health into existing adolescent health programmes. Grassroot Soccer, with extensive experience in delivering sport-based adolescent sexual and reproductive health and rights programmes, has begun integrating mental health into its initiatives, re-designing, piloting, and assessing two evidence-based programmes in Alexandra, South Africa. This paper documents the process of adapting programme curricula and providing training on the new content; presents preliminary results from programme monitoring data; and shares challenges faced and addressed by Grassroot Soccer. The mental health integration process entailed stakeholder consultations, a participatory design workshop with young people, pre-testing, and programme refinement. Grassroot Soccer used a pragmatic mixed-methods approach, including programme monitoring data such as participant reach and retention, pre- and post-intervention questionnaires, and one focus group discussion with coaches (n = 8). Quantitative data were analysed using descriptive statistics, and key themes were documented through reports and memos. Co-design with partners and young people clarified challenges facing adolescents, and review of the existing programme curriculum highlighted opportunities for mental health integration. Programme monitoring data showed early promise in enhancing adolescent mental health and sexual and reproductive health and rights knowledge. Facilitators highlighted the need for clear referral processes for adolescent participants requiring additional support, and emphasised the importance of supporting their own mental health. Additional insights include using supplemental print magazines to reinforce key topics, formalising facilitator mental health support, and further work on mental health measurement in integrated programmes. Grassroot Soccer experiences demonstrate that integrated mental health and sexual and reproductive health and rights programmes can be feasibly delivered by young adult facilitators to address both domains. The authors recommend that government and programme stakeholders explore methods for integrating mental health content into existing programmes.
Mental health is increasingly recognised as a key component of national development and health equity, yet investment remains insufficient. This paper presents the South African Mental Health Investment Case, which aims to inform policy and financing decisions, particularly within the National Health Insurance framework, by estimating the costs, implementation requirements, and potential returns of scaling-up mental health services. The Mental Health Investment Case was developed in two phases. Phase 1 involved a national costing analysis to estimate current spending and identify inefficiencies and gaps. Phase 2 employed a structured Delphi process and stakeholder consultations to prioritise a package of clinical and programmatic interventions, which were then costed using a bottom-up modelling approach. Projected returns on investment were calculated based on productivity gains and avoided illness and mortality. Modelling indicates that scaling up cost-effective interventions, particularly for common mental disorders, can significantly increase coverage, yield high returns, and reduce treatment costs over time. Stakeholders highlighted implementation barriers, including fragmented governance, lack of dedicated financing, and weak intersectoral collaboration. Recommendations include dedicated provincial mental health directorates, formalised multi-sectoral co-ordination platforms, strengthened monitoring and evaluation systems, and a phased implementation plan aligned with fiscal realities. The Mental Health Investment Case provides an evidence-informed roadmap for strengthening mental health systems in South Africa. It expands the investment case by incorporating efficiency, equity and rights-based arguments. The findings support the development of tailored implementation guidelines, prioritised benefit entitlements under NHI, and dedicated budgeting mechanisms such as conditional grants. Sustained advocacy, inter-departmental collaboration, and robust data systems will be essential to ensure delivery of equitable and effective mental health care.
This paper reflects on the accessibility and use of psychotropic medicines in the resource-constrained South African public health sector. Current legislation, policies and processes supporting uninterrupted access to affordable psychotropic medicines of assured quality, safety and efficacy, by the South African population that is dependent on the public health sector, were reviewed and reflected on. Public-sector medicine procurement data obtained from the National Surveillance Centre were analysed, using defined daily dose per 100 000 uninsured population per day per province for the calendar years 2019─2023. The application of evidence-based medicine review processes has supported access to essential psychotropic medicines for a range of mental disorders at all service levels. The Standard Treatment Guidelines recommend that medicines be used in conjunction with psychosocial interventions, and provide guidance on monitoring of chronic treatment in people with severe mental illness at primary-care level. Access may be limited by prescriber restrictions: apart from anti-epileptic medicines, psychotropic medicines are listed as Schedule 5 or 6 and cannot be prescribed by Primary Health Care nurses or clinical associates. Provincial procurement data suggest that there is inequitable access to psychotropic medicines, with marked disparities in expenditure on psychotropic medicines between provinces. Medicine accessibility may be constrained by affordability, supply-chain challenges, restrictive legislation, prescriber availability, and pragmatic implementation. However, patient-linked data are not routinely available, which prevents national monitoring of case-mix and medicine utilisation at the prescriber or patient level. Furthermore, apart from attempted suicide, national mental health indicators do not include person-centred outcomes, thus limiting capacity to evaluate the effectiveness of current care. Access to psychotropic medicines on the national Essential Medicines List for a range of mental disorders varies between provinces. While multiple factors may affect access, differing human resources for mental health and supply-chain issues should be examined. Outcome-based routine monitoring is recommended to inform quality improvement efforts.
In addition to contributing to Objective 3 of the 2023─2030 National Mental Health Policy Framework and Strategic Plan regarding strengthening of research and surveillance, this paper aims to better inform resource allocation and assess capacity shortfalls by addressing Objectives 1 and 2 for building capacity and strengthening mental health services, utilising available electronic health records to develop a dashboard for monitoring mental health-related admissions in the Western Cape. Aimed at facility managers and mental health stakeholders, this dashboard facilitates contextual awareness of mental health-admission trends when identifying areas of need. The provincial health data centre collates electronic health records from public health facilities across the Western Cape, encompassing admissions to psychiatric wards, ICD-10 coded diagnoses, and medication dispensations. A daily updated dataset of all information relating to admissions to mental health wards is created from these sources. The admission-level data are enhanced to include metrics around inter-facility patient journeys such as length of stay, bed-occupancy rates, or re-admission rates. This dataset is visualised through a Microsoft PowerBI dashboard environment, enabling simple identification and observation of mental health admission trends by aggregating data for specialised population groups, geographical areas, and facility- or province-level metrics. With admission data from 26 284 mental health-related admissions to 40 Western Cape hospitals during 2023, the dashboard allows for province-level surveillance, filterable to individual facilities. Additional pages display detailed metrics for specialist facilities, specific population groups, self-harm, and substance abuse. The dashboard has received positive feedback from facility managers and features regularly in provincial health surveillance meetings. Intersectional collaboration with mental health service providers has been maintained to facilitate dashboard updates and expansions for areas of need. This tool has proved invaluable for monitoring and comparing facility performance and service utilisation over time, understanding interactions between mental health services, and most importantly, identifying areas of need. Additionally, the dashboard may serve as a tool to inform resource allocation to overburdened facilities.
Aim A better understanding of the scope of the National Cancer Strategic Framework (NCSF) could lead to improvements aiding the framework’s ultimate objective of reducing the burden of cancer. Accordingly, this report evaluates whether the 2017-2022 NCSF adequately addressed issues related to childhood cancer treatment, in particular paediatric oncology medicines. Methods To identify determinants of current access to childhood oncology medicines in South Africa, in-depth interviews were conducted with 29 stakeholders in South Africa’s public and private healthcare sectors. Key health system stakeholders included policy makers and regulators, medical insurance scheme informants, medicine suppliers, healthcare providers and civil society stakeholders. Identified barriers were categorised according to the components of the pharmaceutical value chain, and combined with a health systems approach to acknowledge the linkages of medicines with other building blocks of the health system. Identified barriers were then compared to the limitations and interventions as discussed in the 2017-2022 NCSF to identify areas for improvement in the framework. Findings Three recurrent gaps in the NCSF in relation to childhood cancers were identified, representing a range of issues throughout the pharmaceutical value chain: 1) childhood cancers are neglected compared to adult cancers, in both the policy arena and the organisation of healthcare services; 2) there are particular challenges for childhood cancers due to their rarity, thus requiring targeted interventions (e.g., regulatory incentives, tailored pricing solutions, and customised evidence requirements by decision-making bodies); and 3) children must be accompanied by a caregiver during treatment, causing several social and financial issues for their families. Conclusions There is a pressing need for a strategic cancer plan that makes proper provisions for children. Such an endeavour must commence with acknowledging the areas in which childhood cancers are different from adult cancers, and which demand targeted intervention in an update of the NCSF.
Aim Commercial determinants, encompassing marketing strategies, corporate social responsibility, and lobbying, significantly contribute to avoidable cancer deaths globally. In South Africa, 30-50% of cancers are preventable, but SA focuses mainly on tobacco control, ignoring major causes of cancer such as alcohol, obesity, and ultra-processed foods. This paper highlights the role of these commercial determinants in contributing to cancer in SA. It outlines strategies and barriers in addressing these determinants. Approach While conventional approaches focus on individual responsibility relating to risk factors like tobacco, alcohol, and unhealthy diets, the role of industries in promoting these risk factors remains inadequately addressed. The paper explores the marketing and non-marketing methods employed by industries, such as tobacco, alcohol, and ultra-processed products, to maximise profits while neglecting public health consequences. Findings The article sheds light on industry tactics, including strategic partnerships, sponsorship, and diversionary narratives during crises, aimed at safeguarding profits. It emphasises the less-explored realm of non-marketing strategies, such as political lobbying, industry-funded research, and the ‘revolving door’ phenomenon where industry insiders become policymakers. Conclusions The article advocates for a paradigm shift in cancer prevention policies, urging the government to implement a comprehensive suite of measures that include increased taxation on harmful products, strict restrictions on marketing, enhanced product labelling, and eliminating conflict of interest in health research and policies. Addressing the commercial determinants necessitates not only recognising their impact but also adopting a multi-level governance approach that prioritises public health over corporate profits. The paper concludes by emphasising the urgency of recognising the links between alcohol, food regulation, and cancer prevention. The overarching goal is to shift power relations, fostering governance for the collective good and ensuring equitable access to preventive measures, especially for vulnerable populations.
Aim This case study reports on a series of multi-stakeholder dialogues on challenges to access to oncology medicines in both the public and private sectors. Methods Key stakeholders, identified from various points in the pharmaceutical supply chain, were invited to attend a series of virtual discussion sessions to address specific medicines access challenges to the provision of cancer care in South Africa. For each session, a case scenario, based on a real world situation/event was presented for discussion, and viable solutions and areas requiring further research or legislative changes were identified. Topics covered in these discussions included registration pathways and obstacles; limitations of current medicine pricing policies; alternate reimbursement models; funders’ initiatives to ensure access to oncology medicines; and essential medicine selection and procurement in the public sector. Findings The key issues raised in the discussions included: non-transparency in the approval and pricing of unregistered medicines accessed in terms of section 21 of the Medicines and Related Substances Act of 1965 (as amended); commercial decisions related to the small market for oncology medicines in South Africa; inequities between public and private sector access; alternate forms of price negotiation in the private sector; the restrictions imposed by the single exit price model; and the role of co-payments for those medicines not included as prescribed minimum benefits. Conclusions There is a clear need for a forum where all stakeholders and actors in this field can engage in discussions to find solutions to the oncology medicines access conundrum, including the development of legislative amendments.
Aim Breast cancer is the most prevalent cancer in South African females, making up 27.1% of all histologically diagnosed cancers in 2020. Although genetic technology and awareness of genetic counselling have improved, genetic counselling services in South Africa remain largely inaccessible. Clinical genetic services are only formally available in four South African provinces and few outreach programmes exist for small towns and cities. Until 2019, genetic counselling services were unavailable in the North West province; however, since then, genetic counsellors from the National Health Laboratory Service and the University of the Witwatersrand have provided genetic counselling services to patients at the Breast Clinic at Potchefstroom Hospital regularly each year. Method The aim of this pilot study was to perform a retrospective file review and report on the implementation and outcomes of the genetic counselling service at the Breast Clinic at Potchefstroom Hospital, from its inception in 2019, until November 2022. Fifty-two patients attended a genetic counselling consultation during that period. Results The majority of patients (83.7%) were diagnosed with an invasive ductal carcinoma, and 57.7% of the patients had a family history of cancer. A total of 62.8% of patients had a histologic grade 3 tumour. A total of 25.5% (12/47) of patients tested positive for a pathogenic variant in BRCA1 or BRCA2. A total of 45 at-risk first-degree relatives were identified who could benefit from predictive testing. Conclusions This study highlights the benefit of offering clinical genetics services through outreach clinics. Being able to offer this service is not only beneficial for the management of the affected individuals, but also for their at-risk relatives. The initiative serves as a positive example of how limited resources can be extended to benefit patients.
