28 • Finally, as evidenced in other countries, an NCA would provide leveragability for coordination and coherence as well as accountability for the delivery of cancer prevention and control mechanisms across all nine provinces of South Africa. South Africa’s commitment to provide equitable cancer care services South Africa has a duty to uphold certain legal obligations having ratied both international and regional instruments that compel the country to respect, protect, promote and full the human right to health. South Africa has ratied the African Charter on Human and Peoples Rights and is a signatory to the International Covenant on Economic, Social and Cultural Rights (ICESCR). Both frameworks recognise the right of everyone to the enjoyment of the highest attainable standard of physical and mental health and place a duty on states parties to realise that right progressively. The CESCR Committee further dened the right to health in General Comment No. 14 (GC 14) in 2000, which is used globally to assess and guide governments legal obligations to attain the right to health. Currently, South Africa is also striving to meet the Sustainable Development Goals (SDGs), notably SDG 3.4 which aims to reduce premature mortality from NCDs by one-third through prevention and treatment as well as promote mental health and well-being ; and SDG 3.8 which seeks to achieve universal health coverage (UHC), including nancial risk protection, access to quality essential health care services and access to safe, effective, quality and affordable essential medicines and vaccines for all. In 2017, many countries including South Africa made a commitment to invest further in cancer control as a public health priority, through the adoption of the World Health Assembly (WHA) Resolution 70.12 on Cancer Prevention and Control, by adopting an integrated approach. This requires states to monitor and address inequalities that impact access to safe, affordable and highquality cancer-related health services by responding to six priority areas: governance; prevention; early detection; management; palliative care; surveillance and research. Current gaps of the six priority areas in South Africa 1. Cancer policy framework and governance: South Africa lacks a national cancer prevention and control plan, as well as a coordinating body to set, implement and nance strategic decisions. The National Cancer Strategic Framework for South Africa 2017-2022 remains largely unimplemented and has been extended with one year. The Cervical Cancer Prevention and Control Policy 2017 (updated from the previous 1998 policy) continues to experience challenges, as cytology-based screening programmes at primary care level and subsequent referral pathways for treatment at higher levels of care are still being implemented across the different provinces. The Breast Cancer Prevention and Control Policy of 2017 is ineffective due to the lack of implementation at the provincial level. Importantly, these policies were developed to set minimum standards of care with little or no attention to eliminating health care inequities. The National Strategic Plan for the Prevention and Control of Non-Communicable Diseases 2022-2027 prioritises the prevention and early initiation of treatment for diabetes and hypertension, but not cancer. Broader frameworks like the National Development Plan and the Medium-Term Strategic Framework (2019-2024) provide limited attention to noncommunicable diseases (NCDs) compared to communicable diseases, like HIV, AIDS and TB. 2. Cancer prevention: Similar to NCDs, cancer risk factors include tobacco use, alcohol consumption, physical inactivity, unhealthy diets (linked to overweight and obesity) and exposures to environmental and occupational hazards. South Africa has taken steps in this regard through legislation and regulations on tobacco, alcohol and obesogenic diets. However, these measures have been insufcient in tackling the NCD crisis and adequately mitigating cancer risks, due to weak provisions and poor implementation. 3. Early detection: Appendix 3 of the WHO Global Action Plan on NCDs 2013-2030 identies early detection programmes linked with timely diagnostic work-up and comprehensive cancer treatment for cancers of the breast, cervix, colorectum, prostate, head and neck (including oral cancers) and childhood cancers. There are also associated global initiatives adopted through WHA mandates for childhood cancer (2019), cervical cancer elimination (2020) and breast cancer (2021). UROLOGY, URO-ONCOLOGY AND SEXOLOGY UPDATE
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