Priority setting for oncology in South Africa using a burden of disease approach

Abstract

Objectives To forecast the provincial supply of oncologists in South Africa through 2030 using a health need–based approach grounded in disability-adjusted life years (DALYs), and to identify shortfalls under scenarios aimed at reducing human resources for health (HRH) inequities as highlighted in Disease Control Priorities, Volume 3 (DCP-3). Study design A retrospective forecasting study employing DALY-driven demand projections for oncology services in each of South Africa's nine provinces, with scenario analyses evaluating horizontal equity in HRH distribution. Methods Age-standardized provincial DALYs for cancer were obtained from the Institute for Health Metrics and Evaluation Global Burden of Disease (IHME GBD) estimates via the Global Health Data Exchange (GHDx). Mid-year population estimates for 2018 were sourced from Statistics South Africa. Using these metrics, we calculated DALY load per oncologist and projected oncologist requirements for 2020, 2025, and 2030. Results Under the best guess scenario, South Africa faces a shortfall of 47 oncologists in 2020, increasing to 97 by 2025 and 148 by 2030. The optimistic scenario yields national deficits of 77 (2020), 126 (2025), and 175 (2030). In the aspirational scenario, shortfalls climb to 138 (2020), 184 (2025), and 230 (2030). Conclusions The Workforce Projection Model offers a replicable framework for low- and middle-income countries to assess oncology workforce needs, optimize HRH allocation, and plan capacity development to enhance equitable access to cancer care