Abstract
Background: The South African Constitution affords everyone the right to access healthcare services, but in children the care must ensure survival. Aim: This study aimed to determine whether there was access to equitable paediatric oncology services for the management of neuroblastoma in South Africa. Setting: Paediatric oncology services in South Africa between 2000 to 2014. Methods: A literature review was carried out, focussing on access to healthcare in South Africa for children with neuroblastoma. Services were classified in accordance with the International Society of Paediatric Oncology resource settings for neuroblastoma diagnosis. Supplementary data from a retrospective study of the management of neuroblastoma in South Africa were evaluated. Results: The neuroblastoma care services in South Africa were not uniformly resourced and accessible across the provinces. Two provinces (2/9 provinces) had excellent healthcare services that included access to transplant facilities, whilst three (3/9 provinces) had no services. Traveling distances to healthcare services pose major challenges, whilst number of medical staff providing oncology care were unequally distributed. The Constitution did not define basic healthcare for children, nor did the National Cancer Control plan acknowledge childhood cancer as a defined entity without provision until 2022. Conclusion: Children diagnosed with neuroblastoma do not have equitable access to healthcare as stated in the South African Constitution. The case of neuroblastoma highlights the inequitable access to childhood care as a whole in South Africa. As the health of children is a national priority, it is therefore necessary to sensitise policymakers to the needs of children with cancer.
Highlights
When the Republic of South Africa ratified the United Nations (UN) Convention on the Rights of the Child in 1995 and subsequently enshrined children’s rights to health care in 1996 in its Constitution, the country committed to provide children with equitable health care.[1]
Based on the South African Children’s Cancer study group’s retrospective study of the management and outcomes of NB between 2000 and 2014, we evaluated the burden of three prognostic factors, age at diagnosis, stage and risk stratification, associated with NB in each province of South Africa
We evaluated the human resources and paediatric oncology services during this period by comparing the provincial paediatric oncology services that manage children diagnosed with NB
Summary
When the Republic of South Africa ratified the United Nations (UN) Convention on the Rights of the Child in 1995 and subsequently enshrined children’s rights to health care in 1996 in its Constitution, the country committed to provide children with equitable health care.[1]. The South African Constitution states that the state should take reasonable action to comply with the provision of health care.[2,3] It does not fully define the nature of the healthcare services beyond emergency medical care and basic health services, which may be interpreted as primary health care or preventative health care.[4] Section 28 of the Bill of Rights stipulates that children have a right to basic nutrition, shelter, basic healthcare services and social services.[2] The Constitution protects the right to life, and as oncological diseases are life-threatening, oncological health care should be defined as an essential healthcare service.[2] The government should provide health care in accordance with its available resources but may not allocate a disproportionate share of the budget to one sector of health care, and thereby create shortages for other healthcare services.[4] To be able to prioritise healthcare services, major public health needs should be identified for state funding.[3] http://www.sajo.org.za. The South African Constitution affords everyone the right to access healthcare services, but in children the care must ensure survival
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