Background: Access to radiotherapy services is critical for effective cancer treatment, yet patients in sub-Saharan Africa face numerous barriers to accessing these services. The region is experiencing a significant increase in cancer cases, with a more than 85% increase in cancer cases reported in the past decade, highlighting the critical role of radiotherapy in enhancing patient prognosis. This systematic review aims to explore the barriers to radiotherapy access in sub-Saharan Africa. The barriers explored will be used to inform the development of the framework to improve access to radiotherapy in the Gauteng provinces, South Africa. Methods: A systematic search of electronic databases was conducted to identify relevant studies published between January 2013 and December 2023. Studies reporting on barriers to radiotherapy access in SSA were included and put into four categories of barriers: health system factors, patient sociodemographic factors, patient factors, and provider factors. Data were synthesised using thematic analysis. Results: This review identifies geographical, financial, cultural, logistical, and systemic barriers to radiotherapy access in sub-Saharan Africa, including limited infrastructure, long travel distances, and inequitable distribution of services. Systemic barriers, including policy gaps and governance issues, also contribute to the inequitable distribution of radiotherapy services in the region. Conclusions: This systematic review highlights the diverse array of barriers to radiotherapy access in sub-Saharan Africa and emphasises the urgent need for targeted interventions to address these challenges.

Background: Timely access to radiotherapy is crucial for optimal cancer treatment outcomes, as delays in receiving treatment can lead to disease progression and decreased chances of survival. Healthcare systems need to prioritise efficient scheduling and coordination of radiotherapy services to ensure patients receive timely care. This study aims to quantitatively analyse the key time intervals in the cancer care continuum, specifically from diagnosis to the start of radiotherapy treatment in Gauteng. Methods: Data from 800 patients treated between January and December 2023 were analysed using a retrospective analysis of patient records from the two public radiotherapy centres in Gauteng Province, one in Johannesburg and the other in Pretoria, focusing on key time intervals in the cancer care continuum. The durations from diagnosis to the commencement of radiotherapy were analysed. Results: The mean duration of the first consultation was 8.32 months, highlighting significant delays in accessing specialised care. This finding is further supported by the average time until a Computed Tomography (CT) simulation, which was 13.38 months, highlighting a considerable delay in treatment planning. Conclusion: This study highlights systemic delays in the Gauteng radiotherapy pathway, highlighting the need for optimisation of referral processes, resource constraints, and strategies to improve cancer care.

Simulation is becoming increasingly popular in clinical education due to a shortage of resources. The Virtual Environment for Radiotherapy Training (VERT) assists students in developing their skills by providing realistic simulations of clinical radiation oncology treatments. It has also been used to help students around the world learn how to evaluate treatment plans. The aim of this research is to evaluate version 5 of the VERT as a radiation therapy teaching tool for evaluating 3D treatment plans compared with treatment planning software tools in a limited resource setting. A quantitative design using an adapted online questionnaire was used for the study. All students registered for a bachelor's degree in a radiation therapy programme at the university's Department of Medical Imaging and Radiation Sciences were invited to a 90 min treatment planning session to evaluate two plans. First to fourth year students were evenly divided among eight groups. Four groups used the ECLIPSE TPS software (Varian Medical Systems, Palo Alto), and the other four groups used VERT version 5.0 (Virtual Ltd, Hull) to evaluate the same plans. This study demonstrated that VERT version 5.0 has the potential to improve the training of radiation therapy students in environments with limited resources as a plan evaluation tool alongside the treatment planning software tools. All respondents found the session useful, with 55% of students indicating that the session was extremely useful. Insights into the value of VERT as a teaching tool could contribute to improving training efficacy in contexts with resource limitations that are present in many clinical settings.

Radiotherapy, a critical component of cancer treatment, faces significant challenges in Gauteng, South Africa. These disparities hinder the achievement of Sustainable Development Goal 3, primarily due to systemic issues, socioeconomic barriers, and limitations within the health system. This article presents the House framework, designed to enhance access to radiotherapy services by integrating the WHO Health Systems framework with the dimensions of access proposed by Penchansky and Thomas. The framework is visually represented as a house, with Policy & Governance as the foundation, WHO building blocks as pillars, and Equitable Cancer Care and Improved Outcomes as the roof. A mixed-methods approach was utilized, combining quantitative data from radiotherapy facilities and qualitative insights from healthcare professionals to identify barriers and potential solutions. Findings indicate significant disparities in resource distribution and accessibility between public and private institutions, compounded by socioeconomic factors like transport costs and lack of awareness. The article discusses innovative proposed framework using the 5As of access as potential solutions. The House framework serves as a valuable tool for policymakers and healthcare providers aiming to improve radiotherapy access and promote equitable cancer care in Gauteng, ultimately working towards reducing disparities in cancer outcomes.

Background: Management of radiography departments requires skilled and competent managers. This task becomes complex if there is no management development and collaborative performance monitoring. Aim: The study aimed to explore and describe the radiography managers’ perceptions regarding management training and skills required. Setting: The research was conducted in public health institutions of Gauteng, South Africa. Methods: Qualitative, exploratory and descriptive approach was adopted, and a purposive sampling method was used to select twenty-three (23) managers from the radiography departments; however, data saturation guided the sample size. Data were collected through online focus group discussions (FGDs). Ethical approval was obtained through Departmental Research Committee (DRC) of Medical Imaging and Radiation Sciences (MIRS) department, Higher Degrees Committee (HDC), Research Ethics Committee and Gauteng Department of Health Research Committees. Data trustworthiness was obtained through member checking, data verification and an independent coder to verify the accuracy of the data. Thematic data analysis method was used to analyse the data. Results: Five themes emerged from the thematic analysis and centred on: difficulties in transitioning into management, lack of management support, the need for postgraduate management qualification, coaching and mentoring and required skills for radiography managers. Conclusion: Public health institutions continuously face transitions in service delivery frameworks. This requires competent and skilled radiography managers to survive in this environment. The study revealed that new managers experience difficulties and require management support to succeed in their roles. Contribution: Awareness of managers developmental needs relative to the real-life dynamics of radiography management in Gauteng public health environment.

Background: Radiotherapy is a critical component of effective cancer treatment, yet access remains limited in many low- and middle-income countries, including South Africa. This study explores structural quality indicators influencing radiotherapy access in Gauteng province, a region with a dual public–private healthcare system. Methods: A concurrent triangulation mixed-methods approach using a descriptive cross-sectional study was employed; for the quantitative phase, data from public and private radiotherapy facilities was analysed, and for the qualitative phase, insights were obtained from interviews with the heads of departments and members of three multidisciplinary professions in radiation oncology, namely radiation oncologists, radiation therapists, and medical physicists. Results: Findings reveal stark disparities in radiotherapy access. Gauteng province has only two major public radiotherapy facilities serving a large population, while multiple private facilities exist. The data indicate substantial differences in resource distribution, equipment accessibility, and personnel levels between public and private institutions. Bureaucratic inefficiencies, personnel shortages, and operational limitations in the public sector have surfaced as significant barriers to prompt equitable access to radiotherapy. This research shows the urgent need for focused strategies to address these systemic issues in order to improve access to radiation treatment in Gauteng province. The study’s findings will inform the development of a comprehensive framework to enhance radiotherapy access and contribute to more equitable cancer care delivery in South Africa.