While cancer is a global health concern, the burden of cancer is disproportionately felt in low-and middle-income countries (LMICs), where the majority of new cancer cases 3 and 70% of cancer deaths occur. 1 The persistence of infectious diseases as a major public health concern for LMICs has led to a substantial proportion of health spending going to infectious diseases. It is also true that donor funding in LMICs tends to be oriented towards communicable rather than non-communicable diseases (NCDs). The lack of both domestic and donor funding 4,5 has led to poor access to cancer prevention, screening and diagnostic services (which leads to late-stage diagnosis and poorer health outcomes), as well as low levels of access to quality cancer treatment in many LMICs. 3 As an NCD, cancer forms part of the quadruple disease burden faced by South Africa. 6 It is also a leading cause of mortality in the country, accounting for 10% of national deaths. 6 These high rates of cancer mortality can, in part, be explained by the inequities that exist in access to cancer prevention, screening, diagnosis and treatment that lead to poorer health outcomes. 7 The most commonly diagnosed cancers in South African women are breast, cervical, basal cell carcinoma, squamous cell carcinoma and colorectal cancer, while the most commonly diagnosed cancers in men are prostate, basal cell carcinoma, squamous cell carcinoma, colorectal and lung cancers. 8 The National Cancer Strategic Framework (NCSF): 2017-2022, 7 developed by the South African Background: The incidence of cancer is on the rise in South Africa and globally. However, literature on the current and expected future burden of cancer in the country is lacking.Aim: To develop a model that forecasts the incidence of five of the most commonly diagnosed cancers in South Africa. The model aims to estimate the true underlying burden of cancer, as opposed to diagnosed cases only.Setting: South Africa. Methods: Age-specific incidence rates for each cancer are forecasted for the period 2019-2030, based on a combination of public and private sector cohort data. It is assumed that historical trends in changes in the incidence rate of cancer will continue over the forecasting period. Forecasted incidence rates are applied to population forecasts to find the total number of incident cancer cases for the relevant year. Results:The incidence of all cancers included in this research is increasing over time, with the total number of cases just less than doubling between 2019 and 2030 (from approximately 62 000 to 121 000 incident cases). This is a result of increases in the agespecific incidence rate of cancer, as well as the growth and ageing of the South African population. Conclusion:Results confirm that cancer is a major and growing public health problem in South Africa. This highlights the need for increases in resources available for cancer services, as well as rapid implementation of cancer prevention strategies, to reduce the number of future cancer cases, and thereby reduce the burden o...
In the context of the current COVID-19 pandemic, congested public health facilities pose a health risk to patients with chronic conditions such as non-communicable diseases (NCDs), HIV/AIDS and tuberculosis (TB). Recent medical research articles and reports indicate that patients with chronic conditions have relatively high mortality when infected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). [1][2][3] During the various alert levels of the COVID-19 lockdown, some chronic patients did not risk going to clinics for collection of their usual medications, and adherence levels dropped substantially. [4] In addition, transport options were limited, and up to 11% of patients on chronic medication in cities, and 25% from informal settlements, struggled to access care. [5]
IntroductionInternational calls for universal health coverage (UHC) have led many countries to implement health sector reforms, however, since the 2008 global recession, economic growth has slowed in many lower-income and middle-income countries. In a renewed interest in public financial management (PFM), international organisations have emphasised the importance of giving spending control to those responsible for healthcare. However, centralisation is a common response when there is a need to cut expenditure due to a reduced budget; yet failure to decentralise often hampers the achievement of important goals. This paper examines the effect of centralising financial decision-making on the functioning of the South African health system.MethodsWe used a case study design with an ethnographic approach. Primary data collection was conducted through participant-observation and semistructured interviews, over 1 year. Member checking was conducted.ResultsNew management implemented centralisation due to a reduced budget, a history of financial mismanagement, the punitive regulatory environment financial managers face, and their fear of poor audit outcomes. The reform, together with an authoritarian management style to ensure compliance, created a large power distance between financial and clinical managers. District managers felt that there was poor communication about the reform and that decision-making was opaque. This lowered commitment to the reform, even for those who thought it was necessary. It also reduced communal action, creating an individualistic environment. The authoritarian management style, and the impact of centralisation on service delivery, negatively affected planning and decision making, impairing organisational functioning.ConclusionAs public health systems become even more financially constrained, recognising how PFM reforms can influence organisational culture, and how the negative effects can be mitigated, is of international importance. We highlight the importance of a participatory culture that encourages shared decision making and coproduction, particularly as countries grapple with how to achieve UHC with limited funds.
IntroductionEffective public financial management (PFM) ensures public health funds are used to deliver services in the best way possible. Given the global call for universal health coverage, and concerns about the management of public funds in many low-income and middle-income countries, PFM has become an important area of research. South Africa has a robust PFM framework, that is generally adhered to, and yet financial outcomes have remained poor. In this paper, we describe how a South African provincial department of health tried to strengthen its PFM processes by deploying finance managers into service delivery units, involving service delivery managers in the monthly finance meeting, using a weekly committee to review expenditure requests and starting a weekly managers’ ‘touch-base’ meeting. We assess whether these strategies strengthened collaboration and trust and how this impacted on PFM.MethodThis research used a case study design with ethnographic methods. Semi-structured interviews (n=30) were conducted with participant observations. Thematic analysis was used to identify emergent themes and collaborative public management theory was then used to frame the findings. The authors used reflexive methods, and member checking was conducted.ResultsThe deployment of staff and touch-base meeting illustrated the potential of multidisciplinary teams when members share power, and the importance of impartial leadership when trying to achieve consensus on how to prioritise resource use. However, the service delivery and finance managers did not manage to collaborate in the monthly finance meeting to develop realistic budgets, or to reprioritise expenditure when required. The resulting mistrust threatened to derail the other strategies, highlighting how critical trust is for collaboration.ConclusionEffective PFM requires authentic collaboration between service delivery and finance managers; formal processes alone will not achieve this. We recommend more opportunities for ‘boundary crossing’, embedding finance managers in service delivery units and impartial effective leadership.
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