South African Private Sector Research Articles

A Quantitative Review of Un-licensed and Off-label Medicines Use in Children Aged 0-2 Years in the Private Sector in South Africa: Extent, Challenges, and Implications.

The global lack of suitable formulations for children leads to off-label and unlicensed medicine use, posing significant risks of adverse effects. Understanding this usage on a national level can help guide interventions for better formulations. This study aimed to measure the prevalence of off-label and unlicensed medicines among children in South Africa's private sector. The study used a point prevalence methodology to review medicine use in children aged 0-2 years enrolled in a selected pharmaceutical benefit management company in South Africa from January to June 2022. A sample size of 1055 prescriptions was calculated using a 90% confidence interval, 50% prevalence rate, and 5% error margin. A systematic random sampling approach selected every seventh entry from 91,973 total entries, resulting in a final sample size of 13,139. Data included patient age, number and characteristics of medicines, quantity, and indications. Descriptive statistics analysed and reported the prevalence of unlicensed and off-label medicine use. Among the 13,139 prescribed medicines, 40% (5,246) were off-label or unlicensed, and 60% (7,893) were on-label. Of the off-label/unlicensed medicines, 16.85% (2,214) were unlicensed, and 23.08% (3,032) were off-label. Methylprednisolone was the top off-label medicine, probiotics were the top unlicensed, and the ICD10 code Z76.9 was the top diagnosis. The study found that 40% of children aged 0-2 years were prescribed unlicensed or off-label medicines in South Africa's private healthcare sector between January and June 2022. This suggests a widespread practice of off-label or unlicensed prescriptions in paediatric treatment in the South African private sector.

Courier delivery of antiretroviral therapy: a cohort study of a South African private-sector HIV programme.

Courier delivery has become a popular antiretroviral therapy (ART) distribution method in some HIV care settings, yet data on ART courier delivery and how it relates to ART outcomes are scarce. We studied the differences in viral suppression rates between individuals from a South African private sector HIV programme receiving ART by courier delivery and those receiving ART through traditional retail dispensing. Individuals aged 15 years or older who were actively enrolled in the Aid for AIDS programme between January 2011 and July 2022 were eligible for the analysis. The outcome of interest was viral suppression defined as a viral load (VL) <400 copies per ml. We calculated adjusted odds ratios (OR) for the association between the ART distribution method and viral suppression, comparing those receiving refills through courier pharmacies versus retail dispensing at the time of the VL testing. We used generalized estimating equations to account for repeated VL testing of the same individual. The models were adjusted for age, sex, calendar year, ART regimen, history of mental illness and medical insurance scheme. We computed adjusted ORs for the calendar periods 2011-2013, 2014-2016, 2017-2019, 2020-2022 and overall. We extracted 442,619 VL measurements from 68,720 eligible individuals, 39,406 (57.3%) were women. The median number of VL measurements per individual was 6 (IQR 3-10). VL suppression was detected in 398,901 (90.1%) tests, and 185,701 (42.0%) of the tests were taken while the individual was receiving ART by courier delivery. Overall, courier delivery was associated with 5% higher odds of viral suppression than retail dispensing (adjusted OR 1.05, 95% CI 1.02-1.08). The strength and direction of this association varied by calendar period, with an adjusted OR of 1.37 (95% CI 1.27-1.48) in 2011-2013 and 1.02 (95% CI 0.97-1.07) in 2020-2022. Courier delivery of ART is a viable alternative to retail dispensing in the South African private sector, as it was associated with higher viral suppression until 2016 and similar suppression rates in recent years. Further research is needed to investigate the potential benefits and drawbacks of courier delivery of ART in both private and public healthcare settings.

Fostering organisational commitment: a resilience framework for private-sector organisations in South Africa.

Organisations worldwide encounter three significant and challenging issues related to talent management: intense competition for skilled employees, elevated rates of employee attrition, and the ongoing struggle to attract top-tier talent. This research focused on investigating the interconnected dynamics among factors associated with employee retention, including organisational commitment, job embeddedness, and hardiness, in conjunction with resilience-related behaviours such as resilience and career adaptability. A cross-sectional survey design was used to gather quantitative data from a convenience sample of employees within the private sector in South Africa (N = 293). The self-assessments of the participants were assessed using a range of well-established and validated instruments. Correlation and regression analyses, followed by structural equation modelling, were utilised to construct a resilience framework designed specifically for private sector organisations in South Africa. The results reveal significant associations between organisational commitment, job embeddedness, and hardiness (as retention-related attributes) and resilience and career adaptability (as resilience-related behavioural capacities). These relationships served as the basis for the development of a resilience framework for employees in South African private organisations. In South African private-sector organisations, talent retention is crucial due to a talent shortage. The study found that employees have a strong emotional attachment to their organisations, are highly aligned with their jobs and communities, and display resilience. Organisational commitment, job embeddedness, and hardiness are key factors in reducing turnover, forming an effective retention strategy. This research contributes to the development of a resilience framework for South African private sector organisations.

Thirty-day unplanned reoperation following spinal surgery: how does the South African private sector measure up?

Thirty-day unplanned reoperation following spinal surgery: how does the South African private sector measure up?

The barriers and facilitators to initiation of telephone-assisted bystander cardiopulmonary resuscitation for patients experiencing out-of-hospital cardiac arrest in a private emergency dispatch centre in South Africa

BackgroundThe incidence of cardiovascular diseases, and with it out-of-hospital cardiac arrest (OHCA), is on the increase in low- to middle-income countries (LMICs), like South Africa. Interventions such as mass public cardiopulmonary resuscitation (CPR) training campaigns and public access defibrillators are expensive and out of reach for many LMICs. Telephone-assisted CPR (tCPR) is a cost-effective, scalable alternative. This study explored the barriers and facilitators to tCPR uptake in OHCA in a private South African emergency dispatch centre. MethodsThis qualitative study applied inductive dominant content analysis to emergency call recordings of OHCA cases into a private emergency dispatch centre. Calls were analysed to the latent level to identify barriers and facilitators. Cases were sampled randomly, until data saturation. ResultsSaturation occurred after the analysis of 25 recordings. A further three recordings were analysed to confirm saturation of the facilitators; yielding a final sample size of 28 calls. Overall, t-CPR was offered in 23 (82.1%) cases, but only initiated in 8 (34.8%) of these calls. Five barriers (“Poor Communication”; “Lack of Support”; “Caller Hesitance or Uncertainty;” “Emotionality”; and “Practical Barriers”) and three facilitators (“Caller Willingness”; “Support” and “CPR in Progress”) were extracted. ConclusionNumerous barriers limit the initiation of tCPR in the South African private sector EMS. It is crucial to address these barriers and leverage the facilitators in order to improve tCPR uptake. This study highlights the importance of using specific language techniques and developing tailored tCPR algorithms to overcome these barriers, which is underpinned by standardised training of call-takers.

A cross-sectional study on factors influencing patient participation in undergraduate medical education in a public and private hospital in Johannesburg, South Africa

BackgroundThe active involvement of patients in medical education is a common practice globally. Despite this, there is a global paucity of data on patients’ views on their role in medical education. As such this study aimed to identify factors that influence patient participation in undergraduate medical education in public and private hospitals in Johannesburg.MethodsA cross-sectional study was conducted, using a 23-question, self-designed, paper questionnaire to collect data on patients’ perceptions of student involvement in their care – with regard to consent, confidentiality, ethics, and patient preferences. Participants were recruited on a voluntary basis in the Departments of Medicine, Surgery, and Gynaecology, at selected hospital sites. Fisher’s Exact and Chi-Square statistical tests were used where appropriate.ResultsTwo hundred and one adult patients, comprised of 150 public sector patients and 51 private sector patients, completed the questionnaire. One hundred and sixty-nine patients (84,1%) were willing to participate in undergraduate medical education and no notable difference between these sectors was demonstrated (p = 0,41). The results further demonstrated that the main factors influencing patient participation in undergraduate medical education across both sectors were (1) the presence of a supervising professional, (2) the perceived degree of invasiveness of a procedure, and (3) the perceived expertise of the student. In addition, data across other key themes such as consent, confidentiality, ethics, and patient preferences and perceptions were elucidated.ConclusionsThis study demonstrates that the majority of inpatients across the public and private sectors are willing to participate in undergraduate medical education to facilitate the development of healthcare professionals. It also demonstrated that most patients have a positive experience. However, more measures of quality informed consent need to be instituted to optimise the current role of the South African public health sector, whilst facilitating the development of a similar role for the South African private sector in future clinical education. In addition, further research is necessary to evaluate these findings in a South African context.

Response to 'A critical analysis of Discovery Health's claims-based risk adjustment of mortality rates in South African private sector hospitals' by Rodseth et al.

Response to 'A critical analysis of Discovery Health's claims-based risk adjustment of mortality rates in South African private sector hospitals' by Rodseth et al.

Understanding the impact of the COVID‑19 pandemic on healthcare services for adults during three waves of COVID‑19 infections: A South African private sector experience.

Since the onset of the COVID‑19 pandemic, healthcare resources have been repurposed to focus on COVID‑19. Resource reallocation and restrictions to movement that affected general access to care may have inadvertently resulted in undue disruptions in the continuum of care for patients requiring non-COVID‑19 healthcare services. To describe the change in pattern of health service use in the South African (SA) private sector. We conducted a retrospective study of a nationwide cohort of privately insured individuals. An analysis of claims data was performed for non-COVID‑19 related healthcare services provided from April 2020 to December 2020 (year 1 of COVID‑19) and April 2021 to December 2021 (year 2 of COVID‑19) relative to the same period in 2019 prior to the COVID‑19 pandemic in SA. Over and above plotting the monthly trends, we tested for statistical significance of the changes using a Wilcoxon test given the non-normality of all the outcomes. Between April and December 2020, relative to the same period in 2021, and also relative to the same period in 2019, we found a 31.9% (p<0.01) and a 16.6% (p<0.01) reduction in emergency room visits, respectively; a 35.9% (p<0.01) and 20.5% (p<0.01) reduction in medical hospital admissions; a 27.4% (p=0.01) and 13.0% (p=0.03) reduction in surgical hospital admissions; a 14.5% (p<0.01) and 4.1% (p=0.16) reduction in face-to-face general practitioner consultations for chronic members; a 24.9% (p=0.06) and 5.2% (p=0.54) reduction in mammography for female members; a 23.4% (p=0.03) and 10.8% (p=0.09) reduction in Pap smear screenings for female members; a 16.5% (p=0.08) and 12.1% (p=0.27) reduction in colorectal cancer registrations and an 18.2% (p=0.08) and 8.9% (p=0.07) decrease in all oncology diagnoses. Uptake of telehealth services throughout the healthcare delivery system increased by 5 708% in 2020 compared with 2019, and 36.1% for 2021 compared with 2020. A significant reduction in emergency room visits, hospital admissions and utilisation of primary care services was observedsince the start of the pandemic. Further research is required to understand if there are long-term consequences of delayed care. An increase in the use of digital consultations was observed. Research on their acceptability and effectiveness may open new modalities of care, which may have cost- and time-saving benefits.

IDF2022-1220 The impact of a diabetes shared value programme on quality and outcomes, in the South African private sector

IDF2022-1220 The impact of a diabetes shared value programme on quality and outcomes, in the South African private sector

Massive Open Online Courses adoption model for corporate training in the South African private sector

Massive Open Online Courses adoption model for corporate training in the South African private sector

A critical analysis of Discovery Health’s claims-based risk adjustment of mortality rates in South African private sector hospitals

In 2019, Discovery Health published a risk adjustment model to determine standardised mortality rates across South African private hospital systems, with the aim of contributing towards quality improvement in the private healthcare sector. However, the model suffers from limitations due to its design and its reliance on administrative data. The publication's aim of facilitating transparency is unfortunately undermined by shortcomings in reporting. When designing a risk prediction model, patient-proximate variables with a sound theoretical or proven association with the outcome of interest should be used. The addition of key condition-specific clinical data points at the time of hospital admission will dramatically improve model performance. Performance could be further improved by using summary risk prediction scores such as the EUROSCORE II for coronary artery bypass graft surgery or the GRACE risk score for acute coronary syndrome. In general, model reporting should conform to published reporting standards, and attempts should be made to test model validity by using sensitivity analyses. In particular, the limitations of machine learning prediction models should be understood, and these models should be appropriately developed, evaluated and reported.

Diagnosis and treatment of opioid-related disorders in a South African private sector medical insurance scheme: A cohort study.

The use of opioids is increasing globally, but data from low- and middle-income countries on opioid-related mental and behavioural disorders (hereafter referred to as opioid-related disorders) are scarce. This study examines the incidence of opioid-related disorders, opioid agonist use, and excess mortality among persons with opioid-related disorders in South Africa's private healthcare sector. We analysed longitudinal data of beneficiaries (≥ 11 years) of a South African medical insurance scheme using reimbursement claims from Jan 1, 2011, to Jul 1, 2020. Beneficiaries were classified as having an opioid-related disorder if they received an opioid agonist (buprenorphine or methadone) or an ICD-10 diagnosis for harmful opioid use (F11.1), opioid dependence or withdrawal (F11.2-4), or an unspecified or other opioid-related disorder (F11.0, F11.5-9). We calculated adjusted hazard ratios (aHR) for factors associated with opioid-related disorders, estimated the cumulative incidence of opioid agonist use after receiving an ICD-10 diagnosis for opioid dependence or withdrawal, and examined excess mortality among beneficiaries with opioid-related disorders. Of 1,251,458 beneficiaries, 1286 (0.1%) had opioid-related disorders. Between 2011 and 2020, the incidence of opioid-related disorders increased by 12% (95% CI 9%-15%) per year. Men, young adults in their twenties, and beneficiaries with co-morbid mental health or other substance use disorders were at increased risk of opioid-related disorders. The cumulative incidence of opioid agonist use among beneficiaries who received an ICD-10 diagnosis for opioid dependence or withdrawal was 18.0% (95% CI 14.0-22.4) 3 years after diagnosis. After adjusting for age, sex, year, medical insurance coverage, and population group, opioid-related disorders were associated with an increased risk of mortality (aHR 2.28, 95% CI 1.84-2.82). Opioid-related disorders were associated with a 7.8-year shorter life expectancy. The incidence of people diagnosed with or treated for an opioid-related disorder in the private sector is increasing rapidly. People with opioid-related disorders are a vulnerable population with substantial psychiatric comorbidity who often die prematurely. Evidence-based management of opioid-related disorders is urgently needed to improve the health outcomes of people with opioid-related disorders.

Training, guideline access and knowledge of antiretroviral interactions: Is the South African private sector being left behind?

South Africa (SA) has the largest antiretroviral therapy programme in the world. While the majority of the country accesses healthcare in the public sector, 15.2% access private healthcare. In 2019, dolutegravir was introduced as first-line treatment for HIV. Dolutegravir has clinically significant interactions with numerous commonly used medicines, e.g. rifampicin and cation-containing medicines such as calcium and iron. They require dosage adjustments, detailed in public and private HIV guidelines. To describe SA healthcare workers' guideline access, training and knowledge of dolutegravir's interactions, focusing on differences between the public and private sectors. A cross-sectional, descriptive study was done using an online survey of healthcare workers in the field of HIV in SA, conducted by the National HIV and TB Healthcare Worker Hotline. Convenience sampling was used, with electronic dissemination to users of the hotline and by relevant HIV-focused organisations. Simple descriptive statistics and statistical analyses were used. A total of 1 939 surveys were analysed, with 22% from the private sector. Training on the dolutegravir guidelines was received by significantly fewer healthcare workers in the private sector v. the public sector: 42.4% (95% confidence interval (CI) 37 - 48) v. 67.5% (95% CI I 65 - 70), respectively. Significantly fewer healthcare workers in the private sector had access to the guidelines (63.8%; 95% CI 59 - 69 v. 78.8%; 95% CI 77 - 81). When asked if they were aware that dolutegravir has interactions, just over half (56.9%) of healthcare workers in the private sector responded 'yes', 24.6% responded 'no' and 18.5% did not answer. Of those who were aware that dolutegravir has interactions, 48.9% knew that dolutegravir interacts with calcium, 44.6% with iron and 82.0% with rifampicin. Private sector knowledge of dosing changes was lower for all interacting drugs, with the difference only significant for calcium and iron. Private sector healthcare workers reported significantly lower levels of counselling on dolutegravir use in all appropriate situations. Private sector healthcare worker access to HIV training and guidelines requires attention. In a high-burden HIV setting such as SA, it is vital that healthcare workers across all professions, in both the public and private sector, know how to adjust antiretroviral dosing due to clinically significant interactions. Without these adjustments, there is a risk of treatment failure, increased mother-to-child transmission and morbidity and mortality.

Unequal, undiversified and underrepresented: women on the backburner in local decision making in South Africa’s local government

The object of research: Firstly, the study highlights that women are still underrepresented in local government at the district level in leadership positions remaining on the backburner as decision makers. Secondly, the study examines the notion of patriarchy and male dominance that results in the marginalization and exclusion of women in municipal decision making. The study contributes to the current body of knowledge through identifying the challenges that prevent the equal representation of women as decision makers in local government.&#x0D; Investigated problem: South Africa has been consistently praised for its advcancement in drafting a progressive constitution and legislation that provides for gender equality. Despite the progressive achievements, women remain underrepresented at the municipal level, as South Africa has not attained the target of 50/50 equal representation as far as women mayors, women are more likely to be underemployed in comparison to men; women do not receive the same and/or fair remuneration in comparison to their male counterpart and women are not able to progress as fast as men in their careers once in local government structures , into leadership role that grant women equal access to become decision makers alike their male counterpart. The reasons for the low proportion of women to men in leadership is attributed to intersecting oppressions that women remain confronted with and can be seen to be connected to historical patriarchal norms and institutional values, which excludes and marginalizes women and institutional culture is stronger than the process of changing this culture.&#x0D; The main scientific results: The findings of the study suggest that women are lagging behind in decision making. Secondly, organizational structures that are attributed to the presence of dominant behaviours in the workplace can be seen to be linked to patriarchy and male dominance exclude and marginalize women. Thirdly, women’s representation within South Africa at the municipal ward and PR levels is on a downward spiral, when comparing the 2021 electoral results to previous electoral results in 2016. Notably, there is a lack of practicality of women's status in local government, policy enacted such as the Women Empowerment and Gender Equality Bill contains the key element that failure to comply with the Constitution justifies punitive action against the defaulting unit. This includes local councils and executive officers. Clause 11 requires 50 percent representation of women. Highlighting instances of failure to comply, with no punitive actions taken. South African women are passive recipients of male-dominated decision making in local government.&#x0D; The area of practical use of the research results: South African public and private sector institutions. Any persons connected to gender justice within society

Unequal Remunerations in the South African Private Sector

Abstract South Africa has passed various laws such as the Employment Equity Act 55 of 1998 to address discriminatory practices in the workplace. These discriminatory practices include the unequal pay between males and females performing work of equal value. Payment of unequal remunerations is prevalent in the South African private sector, and it is exacerbated by the preferential treatment enjoyed by white employees compared to employees in other race groups. White groups and black males dominate higher positions in the private sector and their remunerations are often higher than those of black female employees in similar positions. This is so because the private sector engages in the gender wage gap to the detriment of suitably black South African females who are both underrepresented at managerial levels and paid less than their male counterparts. This paper examined various transformative remuneration interventions and their effectiveness in ensuring remuneration equality regardless of gender. The paper examined those practical challenges that further hinder the achievement of income equalities in the private sector. The paper asserted that there should be consequences such as termination of State contracts for companies that deliberately engage in the payment of unequal remunerations between male and female employees. This paper adopted a qualitative research methodology. The data for this paper were sourced from the desk research, Acts, court decisions and international conventions dealing with income inequalities in South Africa. The paper concluded that companies need to strategise, track and measure income disparities and address the gender wage gap to promote equity and fairness in the workplace.

The Fourth Industrial Revolution (4IR) in the South African Private Sector: The Initiative is Right, but the Timing is wrong

The era of life-long employment is probably coming to an end for many people in South Africa due to technological developments. This will affect the population which keeps on growing. The 4IR will affect the employed citizens through loss of jobs. The first, second, and third revolutions cut jobs and created new jobs and new industries, especially in developed countries. The Fourth Industrial Revolution reduces jobs due to the introduction of technological facilities in the work environment. Naturally, revolutions are disruptive, as the 4IR holds all the powers to create whole new industries or sectors while completely destroying others. In destroying other sectors, people are being retrenched because their services are no longer necessarily required. Individuals will always need emotional and personified interactions with other humans, which robots can never replace. Technology may be ready, but that does not mean all South African individuals are ready for such developments. This paper aims to highlight the impact of the 4IR in the private sector and its effect on unemployment and retrenchment in South Africa. The paper is purely theoretical, as it relied heavily on secondary data such as articles, books, and newspapers. Nevertheless, proposed recommendations were guided by the findings of the study.

Devil's in the detail: how to assess transformation of the South African private sector

Devil's in the detail: how to assess transformation of the South African private sector

Assessing the prices and affordability of oncology medicines for three common cancers within the private sector of South Africa

BackgroundPrices of cancer medicines are a major contributor to the cost of treatment for cancer patients and the comparison of these cost needs to be assessed.ObjectivesTo assess the prices of cancer medicines for the three most common cancers ((breast, prostate and colorectal) in the private healthcare sector of South Africa.MethodsThe methodology was adapted from the World Health Organization (WHO)/ Health Action International (HAI) methodology for measuring medicine prices. The Single Exit Price (SEP) variations between product types of the same medicine between the highest- and lowest-priced product and between Originator Brand (OB) and its Lowest Priced Generic (LPG) of the same medicine brand was compared, as of March 2020. The affordability of those medicines for cancer usage based on treatment affordability in relation to the daily wage of the unskilled Lowest-Paid Government Worker (LPGW) was also determined. Also, a comparison of the proportion of the population below the poverty line (PL) before (Ipre) and after (Ipost) procurement of the cancer medicines was determined.ResultsSEP Price differences ranged from 25.46 to 97.33% between highest- and lowest-priced products and a price variation of 72.09% more for the OB than the LPG medicine, except for one LPG that was more expensive than the OB. Affordability calculations showed that All OB treatments for all three cancers (breast, prostate and colorectal), except for paclitaxel 300 mg (0.2 days wage) and Fluorouracil (Fluroblastin) 500 mg (0.3 days wage) costs respectively were more than 1 day’s wage, with patients diagnosed with colorectal cancer needing 32.5 days wages in order to afford a standard course of treatment for a month.ConclusionThere was a considerable variation in the price of different brands of cancer medicines available in the South African private sector.

Untangling discrimination in the private sector workplace in South Africa: Paving the way for Black African women progression to managerial positions

Black African women in South Africa are poorly represented at managerial levels in the South African private sector since the advent of democracy. Their exclusion at these occupational levels persists despite the Employment Equity Act 55 of 1998 (EEA) requiring that the private sector must ensure that all occupational levels are equitably represented and reflects the demographics of South Africa. The South African private sector demonstrates its lack of commitment to proliferating black African women into managerial positions by deliberately engaging in race-based recruitment and failing to develop and promote suitably qualified women into managerial positions. As such, the private sector is failing to create upward mobility for black African women to break the glass ceiling. The EEA requires the private sector to apply affirmative action measures in order to achieve equity in the workplace. It is submitted that since 1998, the private sector has been provided with an opportunity to set it own targets in order to achieve equity. However, 22 years later, black African women are still excluded in key managerial positions. However, the EEA does not specifically impose penalties if the private sector fails to achieve the set targets.This approach has failed to increase the representation of black women in managerial positions. However, the EEA does not specifically impose penalties if the private sector fails to achieve the set targets. Whilst this approach seeks to afford the private sector importunity to set its own target, this approach has failed to increase the representation of black women in managerial positions. Employing black African women in managerial levels enhances their skills and increases their prospects to promotions and assuming further leadership roles in the private sector. This paper seeks to show that the progression of black African women requires South Africa to adopt a quota system without flexibility that will result in the private sector being compelled to appoint suitably qualified black African women in managerial levels.

Colorectal cancer liver metastases : management and five-year survival in a South African patient cohort

Background Approximately 25% of patients with colorectal cancer (CRC) will be diagnosed with CRC liver metastases (CRCLM) during the course of their disease. No data regarding CRCLM presentation, management and survival outcomes has been published from either the private or public health care sectors in South Africa. This study aimed to address this deficit, reporting on a private sector cohort. Methods A retrospective review of a private health care funder's database from 1 January 2008 to 31 December 2015 was performed. ICD-10 diagnosis codes were used to identify CRC and CRCLM. Procedure codes assigned to hospital admissions were used to identify the type of surgical treatment. Chemotherapy was identified by the WHO Anatomical Therapeutic Chemical classification system of medicines. Treatment patterns were assessed and five-year overall survival (OS) was calculated. Survival was estimated using the Kaplan-Meier method, and Cox proportional-hazards regression was used for between group survival comparisons. Results Six hundred and one (601) of 3 412 patients presenting with CRC (17.6%) were diagnosed with CRCLM at presentation or during the follow-up period. Sixty patients with CRCLM (10.0%) underwent resection of the primary CRC and liver resection for metastases, 281 (46.8%) underwent CRC resection only, 180 (30%) received chemotherapy only, and 47 (7.8%) received no treatment. Five-year OS for these groups were 57.3%, 15.6%, 9.8% and 0% respectively. Conclusion Five-year OS of the various CRCLM treatment pathways in a South African private sector population compares to results published in international series. However, a smaller proportion of patients with CRCLM underwent liver resection, compared to international studies.