Navigating the healthcare system: challenges for cancer patients in South Africa

by Comfort Maluleke, Senior Case Manager at Campaigning for Cancer, Executive Director for ASK Now Patient Services.

Navigating the healthcare system can be a daunting task for anyone, but for cancer patients, this challenge is often exacerbated by the physical, emotional, and financial burdens of their diagnosis. These challenges are even more pronounced in South Africa, where disparities between public and private systems mark the healthcare landscape. The complexity of medical schemes, the bureaucracy of public hospitals, and the uncertainty surrounding treatment plans can leave patients feeling overwhelmed and unsupported.

South Africa has a dual healthcare system, consisting of a well-developed private sector that caters for about 16% of the population, and an under-resourced public sector that serves the majority. According to the South African Medical Association (SAMA), there is a significant disparity in the quality of care between these two sectors. Public hospitals are often overcrowded, understaffed, and underfunded, leading to long waiting times and limited access to specialised care.

For cancer patients, these challenges are critical. The South African National Cancer Registry (NCR) from 2022 estimated that one in eight women and one in six men will be diagnosed with cancer in their lifetime. The burden of cancer is growing, with an estimated 100 000 new cases diagnosed annually. Despite this, access to timely and effective treatment remains a significant issue, particularly for those reliant on the public healthcare system.

The challenges of navigating healthcare

Cancer patients in South Africa face numerous obstacles when trying to access the care they need. These challenges include:

• Medical Scheme Limitations: Many patients with medical insurance find that their schemes only cover part of their treatment needs. Disputes over treatment plans and benefits are a common issue, leaving patients to navigate a complex appeal process to secure the coverage they are entitled to through the Council for Medical Schemes (CMS).
• Public Hospital Bureaucracy: For those reliant on public healthcare, the journey can be fraught with delays and administrative hurdles. Public hospital patients often face long waiting times for diagnosis and treatment, with some waiting months or even years to receive the care they need.
• Workplace Challenges: A cancer diagnosis can also lead to significant challenges in the workplace. Patients may face discrimination, lack of support, or difficulty in securing reasonable accommodations, which can add to the stress of managing their health.

Project ASK: empowering patients through advocacy

One of the biggest hurdles a patient has to overcome when facing these challenges is the feeling of isolation in the fight to access information. Patient advocacy groups are often the last stop or even get forgotten, leaving patients lost on their journey to recovery. Patients don’t have to fight these battles alone – there is help – they just need to ASK.

Project ASK provides free, accessible services designed to empower patients by guiding them through the complexities of the healthcare system and ensuring they receive the treatment and benefits they are entitled to. 

How Project ASK supports patients

• Access to Information: Knowledge is power, and Project ASK ensures that patients have access to the information they need to make informed decisions about their care. Through comprehensive databases and resources, Project ASK provides patients and caregivers with detailed information about their disease, treatment options, and patient rights.
• Support and Advocacy: Project ASK’s case managers work closely with patients to help them navigate the healthcare system. Whether it’s guiding them through the appeals process with their medical scheme, assisting with ex gratia funding applications, or addressing issues of unfair treatment in public hospitals, Project ASK is there to advocate for the patient’s rights.
• Emotional and Social Support: Recognising that cancer care extends beyond medical treatment, Project ASK connects patients and caregivers with support groups that offer emotional and social support. These groups play a vital role in improving the quality of life for patients during and after their treatment.

Since its inception, Project ASK has made a significant impact on the lives of cancer patients in South Africa. Through its advocacy efforts, Project ASK has helped countless patients secure the treatment and benefits they deserve, often making the difference between receiving timely, effective care and enduring unnecessary delays and denials.

As a senior case manager, I experience these changes daily when I assist patients and doctors to gain access to the treatment they have agreed upon. When the waters turn murky and patients start feeling lost on their journey to navigate care, they can find refuge in the resources available, whether it be for further education, emotional support, or even financial support.

Why support matters

Cancer is a life-altering diagnosis, and the journey through treatment can be overwhelming. However, with the right support, patients can navigate the healthcare maze and access the care they need to improve their outcomes. In my daily interactions with patients and doctors, I provide technical help in drafting letters of motivation to medical schemes to support treatment plans, prepare authorisation applications, and appeal declined treatment plans by medical schemes,

Whether it’s helping a patient navigate their medical scheme, securing life-saving treatment, or connecting them with vital support groups, I am fortunate to be part of Project ASK on its mission to empower cancer patients and ensure they receive the care and support they deserve.

Unfortunately, too many patients remain unaware of organisations that can help ease the burden of a cancer diagnosis by improving access to innovative care. 

Project ASK assists patients who are denied treatment or need additional support navigating treatment options and authorisations. While we have supported nearly 300 patients from 2021 to 2023, we have identified a greater need to educate patients about the various ways to access support. 

So, if you or someone you know are facing a cancer diagnosis, please remember: help is available, all you have to do is ASK.