In 2014 we set out with the vision of an equitable and sustainable breast cancer policy for all. This policy was approved in April and was officially launched in East London on Friday. This is indeed an achievement! This means that our advocacy pays off.
Even though the policy was approved – the policy is by far not complete as there are still gaps in the policy. The decision was to focus on Phase 1 to ensure that the treatment aspects are in place before focusing on the community awareness and clinical breast examination as well as the supportive care and palliative care aspects. Other gaps are the provisioning of lymphoedema and prosthetic services. We need to make sure that these aspects get the attention that they require in the future.
The policy will be implemented first in five treatment centres: Groote Schuur in Western Cape, Helen Joseph/Charlotte Maxeke in Gauteng, Frere and Livingstone in Eastern Cape and Universitas in Bloemfontein. All of these were selected as they are already in line with the breast policy.
You may also be aware of the Tobeka Daki Trastuzumab Access Campaign. Trastuzumab is included in the policy and subsequently added to the Essential Medicines List. This in itself is also a win as there was quite a resistance from the EML Committee to add traztuzumab due to cost. This has opened the case for trastuzumab to be included as a PMB for private sector clients. There are already some patients that are approaching their respective funders.
Access to trastuzumab in the public sector in particular depends on the successful completion of negotiations for an acceptable price, as explained in the BDLive story (here as “fair use”).
The reality of this is that at this stage there is only one company – Roche – that has a registered drug. Mylan and Amgen are both busy with clinical trials. Mylan has already applied to register their product, however their product is still under review by the FDA and our our MCC still need to get their systems in place for the approval of biosimilars. If the Department of Health want to procure this drug then they must follow the tender route and that would mean that only Roche would effectively be able to tender and these tenders last for two years. The reality is further that even though it is part if the policy, the provinces are responsible for the implementation of the policy and therefor provide the budget for the drug. Some of the treatment centres have already indicated that they would not have the budget for trastuzumab irrespective of price. It would therefor seem as of our advocacy effort will have to take on these access issues as well at a later stage.
For your information the updated cervical cancer policy 2017 is at http://www.health.gov.za/index.php/shortcodes/2015-03-29-10-42-47/2015-04-30-08-18-10/2015-04-30-08-24-27?download=2299:cervical-cancer-policy-2017. The main changes in this policy is
- Taking cognisance of new technologies namely Liquid Based Cytology
- Test and treat on site at the health facilities
- Guidelines for a full continuum of care
It is worthwhile that organisations also study the content of this policy as the global movement is to focus on women’s health.
The Palliative Care Policy is not yet available