CANCER: What Are We Really Up Against?
"The measure of a society is how it treats those who cannot fight for themselves".
In South Africa, every 60 minutes ten people receive a diagnosis that overturns their world. More than half will not complete treatment, not because their cancer is invincible, but because the system meant to fight it is ineffective and under-resourced.
In 2019, roughly 85 000 South Africans were diagnosed and 44 000 died. By 2025, Gauteng alone faces a death toll that mirrors a national crisis, more than 56 000 cancer-related fatalities in recent years, accounting for nearly one-quarter of all premature deaths from non-communicable diseases (NCR / WHO).
Experts warn that without a coordinated national strategy, cancer incidence could double within the next decade, driven by ageing populations, lifestyle risks, and fragile health infrastructure.
The Broken Promise
The State's commitment to cancer care has never been louder in speeches, yet never weaker in execution. Since 2019, the Department of Health has unveiled ambitious oncology-infrastructure programmes — from turnkey radiotherapy and nuclear-medicine facilities to technologically advanced treatment centres in Gauteng, Limpopo, Mpumalanga, KwaZulu-Natal, and the Eastern Cape — yet many remain incomplete, delayed, or mired in litigation.
In Gauteng, the Chris Hani Baragwanath Academic Hospital (CHBAH) and Dr George Mukhari Academic Hospital (DGMAH) oncology-facility projects have been bogged down by procedural disputes, unlawful payment suspensions, and protracted subcontractor litigation. Whilst the main contractor lawfully terminated a non-performing subcontractor and obtained High Court confirmation to proceed with completion, the Gauteng Department of Health has remained silent on the contractor's formal request to retract termination letters.
At the same time, the Department faces mounting political pressure from the Premier's Office, following the suspension of the Head of Department and multiple senior officials under investigation — including the dismissal of the cancer-project director. Amid this administrative turmoil, the Department has offered no correspondence or response, showing no indication of willingness to resume or complete the project.
In Mpumalanga, the Rob Ferrera Hospital Oncology Turnkey Project — intended as the province's first SAHPRA-compliant radiotherapy unit — remains in early design development. Enabling works are stalled pending National Treasury's roll-over approval, and although the project was first announced in 2021 with commissioning targeted for 2024, completion is now projected for late 2026, delayed by procurement reviews and professional-team realignment.
In KwaZulu-Natal, the Ngwelezane Hospital Oncology Turnkey Facility, part of the province's cancer-response plan, has faced its own turbulence. Although site surveys and geotechnical assessments were concluded by late 2024, the tender-award process was suspended in 2025 amid bid-adjudication challenges and allegations of irregular scoring. The provincial health department has since confirmed a tender re-evaluation, pushing ground-breaking to early 2026.
Across provinces, the pattern repeats: grand plans without grounding. Projects meant to bring cancer care closer to rural and township populations are trapped in bureaucracy. Instead of accelerating construction, departments are locked in audits, investigations, and litigation. The public — once promised world-class oncology centres — now looks upon empty foundations.
A Department on Crutches
From 2019 to 2025, the Gauteng Department of Health has resembled a patient in chronic relapse with five MECs, three HODs, and a carousel of CFO suspensions, each change erasing institutional memory and paralysing delivery.
The Department has spent more time in disciplinary hearings than expanding oncology services. Projects that should have been completed within 24 months have stretched beyond 36, and hundreds of millions in procurement allocations remain pending under investigation.
Public-private partnerships designed to accelerate access are paralysed by mistrust, whilst organisations such as CANSA Alliance and PinkDrive continue to issue warnings that echo unanswered.
"What Heartless Act Is This?"
In March 2025, the Gauteng High Court declared the oncology backlog unconstitutional, ordering immediate treatment. The Department appealed, drawing public outrage:
"What heartless act is this? Fix your house and stop pointing fingers. Sies man! Playing with people's lives".
By August 2025, another ruling held officials personally liable for costs, citing "irreversible and permanent harm" from treatment delays. Appeals continue and so do the deaths.
The Final Diagnosis
The cure is not elusive. It lies in accountability, continuity, and depoliticised governance. South Africa has the technical capacity and clinical expertise to build world-class oncology centres. What's missing is political will and ethical stewardship. Cancer cannot wait for paperwork;
"It demands precision in leadership equal to precision in medicine".
Cancer has become a mirror reflecting not only the frailty of the human body but the fragility of our institutions. Yes, there are initiatives to expand early screening, timely diagnosis, treatment access, oncology drug supply, and rehabilitation support, yet these efforts remain uneven and insufficient to complement the patient experience.
Until prevention, treatment, and dignity are delivered seamlessly, the promise of universal health care remains unfulfilled.
If South Africa Cannot Heal Its Governance, It Cannot Treat Its Patients Efficiently
Somewhere in Gauteng tonight, a mother will receive her diagnosis. The oncologist will explain treatment at a facility that should have been operational two years ago, in a unit that was promised but never delivered, at a centre trapped in litigation. What legacy are we building for her? For the ten diagnosed every hour? For the 56,000 who will die this year?
We pride ourselves on constitutional rights that guarantee healthcare, yet rights without infrastructure are merely elegant lies.
The technical capacity exists. The clinical expertise is present. The budget has been allocated. Everything required to build comprehensive cancer care is available—everything except the one ingredient that cannot be procured or tendered: political will anchored in ethical stewardship.
Future generations will judge us not by the oncology centres we planned, but by the ones we completed. Not by the speeches we delivered, but by the patients we treated. Not by the investigations we launched, but by the accountability we enforced.
Because incomplete projects claim complete lives. Administrative delays produce medical fatalities. And every foundation that remains unfinished is a future that will never be lived.
The choice has always been ours. The capacity has always existed. The only question remaining is whether we'll act before regret becomes the only treatment we can offer.