29 South Africa is lagging behind peers across Africa in responding to these highly costeffective priorities in terms of policy and implementation. 4. Cancer management: The intended cooperative but decentralised health system created by the National Health Act No. 63 of 2003, as amended, has not been able to achieve uniformity or equity in the delivery of cancer health services. The Medical Schemes Act 131 of 1998 offers little benet. As a Cancer Alliance report has shown, even those who can afford private medical aid are often not guaranteed quality cancer treatment due to imposed limits on cost and/or invoking Prescribed Minimum Benets (PMBs) that outline what medical aid schemes will cover. Despite the existence of the Medicines and Related Substance Control Amendment Act No. 90 of 1997 and the Patents Act 57 of 1978, as amended, the affordability of cancer medicines remains out of reach for most patients. The 24 Medicine Case study report has shown that the cost of some cancer medicines in South Africa are more than double the price of, for example, the same in India. This is due to our country s weak patent systems, including: poor patentability criteria, easy granting of patents, unnecessary issuance of secondary licences, and limited mechanisms to challenge patents before they are granted. In addition to state-of-the-art cancer prevention and treatment, social and employment protections for patients and their families/caregivers are essential. The Employment Equity Act 55 of 1998 and Labour Relations Act 66 of 1995 delineate these protections for patients who are unable to work due to their disease and its treatment. However, unlike in many other countries, cancer patients do not meet the criteria for persons with recognised disabilities, and hence do not receive the same protections. 5. Palliative care: the management of advanced and terminal cancer diagnoses necessitates cross-cutting palliative care for all South Africans. Home-based and hospital care with multi-disciplinary teams and access to opiates and other pain management modalities are essential. Supportive medicines are also part of Appendix 3 of the Global Action Plan in NCDs and embedded in the 2014 resolution Strengthening of palliative care as a component of comprehensive care throughout the life course (WHA67.19) The National Policy Framework and Strategy on Palliative Care remains unimplemented across the provinces. 6. Research: Despite budgetary constraints, a recent bibliometric analysis of cancer research outputs across Africa identied the high research output of South Africa compared to most other African countries. These research investments should be harnessed further to improve the evidence base for local cancer prevention and control mechanisms. Implementation research could include studies on health outcomes, quality of life and costeffectiveness as dened in the 2017 resolution, Cancer prevention and control in the context of an integrated approach (WHA 70.12) and should be a key component of a national cancer control plan. National Cancer Acts: six country lessons Table 1 presents a comparison of how the UK, the USA, Japan, Kenya, the Philippines and Chile have each dealt with standard setting for prevention, treatment and control as well as expanded social, nancial and employment protections through their NCAs. These experiences offer critical lessons for South Africa. UROLOGY, URO-ONCOLOGY AND SEXOLOGY UPDATE
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