Nomantu Nkomo-Ralehoko is the MEC for Health and Wellness in Gauteng. (Photo: GautengHealth/X)News & Features
17th September 2025 | Ufrieda Ho
Activists say the Gauteng Department of Health’s late appeal to a court judgment that compels it to act on cancer treatment backlogs is raising more questions about what the department believes it stands to lose from not doing as the courts have ruled.
There are growing concerns and questions about why the Gauteng Department of Health is hellbent on legal appeals rather than compliance to two court orders that direct the department to clear cancer treatment and services backlogs in the province.
Last week, the department filed a late appeal against an August 20 court order that instructs it to comply with an earlier court order from March 27.
In the March 27 ruling, arising from a case brought by the Cancer Alliance, the South Gauteng High Court in Johannesburg found the health department’s failure to deliver critical cancer treatment to patients in the province unconstitutional and unlawful. At a 2022 count, there were 3 000 patients on a waiting list to receive treatment. The Cancer Alliance turned to the courts in 2024 when it said its demands and protests came up against continued inaction and non-communication by the department.
It also came after the department failed to spend a R784 million allocation granted by the provincial Treasury in 2023 to reduce the treatment backlog by outsourcing services to the private sector over a three-year period.
In the March ruling, the court instructed the department to take immediate action, including diverting patients to private facilities; to provide radiation oncology services to all patients on a backlog list, to update the backlog list within 45 days, submit a detailed progress report on efforts to deliver treatment, and to present a long-term plan for ongoing cancer treatment services within three months.
MUST READ| The Gauteng Department of Health has suffered another loss in the courts earlier this month over it’s obligation to provide cancer treatments. Spotlight assesses the legal situation and what it means for people waiting for life-saving treatment.
www.spotlightnsp.co.za/2025/08/28/w…— Spotlight (@spotlightnsp.bsky.social) August 28, 2025 at 12:59 PM
Instead of complying, the health department decided to appeal the ruling at the very end of the deadline period.
This then led to counter legal action by the Cancer Alliance, represented by SECTION27 (see disclosure at the end of this article), to ask for the March ruling to be made immediately enforceable, not suspended till an outcome in the Supreme Court of Appeal. This resulted in the 20 August ruling in favour of the Cancer Alliance, handed down by Judge Evette Dippenaar (we previously reported on that ruling here).
The August court win for the Cancer Alliance was welcomed by activists and opposition politicians as a much-needed push to get the ball rolling to get treatment to patients, to properly assess the level of the cancer treatment crisis in the province and to compel the department to set out its ongoing plans to get treatment and to report back to the courts.
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But with this latest legal detour, the matter is now back on appeal with the High Court, with the department seeking to have the 20 August ruling overturned. The matter will be heard by a full bench of three judges with a date set for the end of the first week of October. Should the court again find against the department, they will have no further legal recourse until the matter is heard by the Supreme Court of Appeal – no date has yet been set for that hearing.
The ongoing legal wrangle has come at significant costs for taxpayers. The department has lost two challenges in court and have had to pay Cancer Alliance’s costs in both cases. The department is represented by senior and junior counsel as well as two attorneys.
Growing concerns
There are growing concerns from activists and opposition politicians that the department is unwilling to comply with the March court order because it may expose a dire picture of patient deaths as a result of the department’s failure to provide services as per its constitutional mandate.
“They are stalling because providing the original list [of patients and backlogs] will show how many people died because they did not get radiation treatment within the 90-day period after chemotherapy or surgery. I suspect there have been more deaths than in the Life Esidimeni tragedy,” said Democratic Alliance shadow health MEC Jack Bloom.
Taxpayer funds are being used for expensive legal fees, he suggested, because Gauteng Health MEC Nomantu Nkomo-Ralehoko is “trying to protect her reputation” and is evading the personal costs order against herself, the head of department of health, and the CEOs of Charlotte Maxeke and Steve Biko hospitals.
Bloom, who has been pushing for the axing of Nkomo-Ralehoko, said “she presides over a failing department plagued by scandals and financial mismanagement”. He asked for a response on this matter from Premier Panyaza Lesufi in the Gauteng Legislature last week. Lesufi’s response was that he would “await the outcome of a mediation process between the department and the Cancer Alliance”.
Lesufi also said that he has asked for a calculation of costs on the ongoing court case and added that he did not want to “waste money on court cases that should rather be used to provide hospital treatment”.
Responding to this, Bloom said: “This matter should never have ended up in court in the first place. The department should have worked with cancer interest NGOs from the start, but they are arrogant and incompetent.”
Partnering with private sector
While the department did not answer Spotlight’s questions, they did send us an address that Nkomo-Ralehoko delivered in the Gauteng legislature on 25 August. She said in that address that her department has partnered with “several private radiotherapy units to expand access to care and reduce treatment delays”. As of 25 August, she said 563 patients were actively receiving radiation oncology care through these partnerships and more than 1 000 patients had already successfully completed their treatment.
Nkomo-Ralehoko added that in the past four years they had “replaced all radiation therapy equipment at Charlotte Maxeke Johannesburg Academic Hospital and Steve Biko Academic Hospital with state-of-the-art linac (linear accelerator) machines valued at more than R600 million”.
She added: “We have also replaced brachytherapy machines and CT scan machines for [treatment] planning purposes.”
‘Incomplete and incorrect’
However, Salomé Meyer of the Cancer Alliance said the picture being painted by the MEC was “incomplete and incorrect” and did not reflect realities at hospital level.
“What the MEC is saying about equipment is incorrect – the equipment she is referring to was procured before 2021. Also, all the equipment, bar one machine at Steve Biko, was bought with money from the National Tertiary Services Grant, so the money comes from the Oncology Conditional Grant from Treasury, which is managed by the National Department of Health, not the province. So the question is what have they been doing with the money set aside by Gauteng Treasury?”
Meyer said that “new” waiting list patients are being channelled to the private sector for treatment, but backlog list patients are treated at Charlotte Maxeke Hospital where treatment cannot be successfully carried out because of the unresolved equipment and staffing issues. She called the situation “baffling”.
Commenting on having to head to court again on this issue, attorney Khanyisa Mapipa, head of health rights at SECTION27, said: “The Gauteng Department of Health still maintains its open opposition against cancer patients’ plea for cancer treatment. This despite two court orders now that have stated that the Gauteng Department of Health is obligated to provide urgent radiation oncology services to backlog list patients and to report on their progress in this regard to the court.”
Many people with cancer in Gauteng have not been able to access the treatment and care they need. Though activists and the provincial government are at odds about what should, or should have been, done about it, nobody is denying that there is a problem.
www.spotlightnsp.co.za/2025/06/25/a…
— Spotlight (@spotlightnsp.bsky.social) June 25, 2025 at 9:41 AM
“To date, we have no idea how many people have been affected or have died from the Gauteng Department of Health’s failure in this matter,” she said. “It takes a department that is completely removed from its constitutional duties to resist a court order that simply requires it to do its job.”
The Cancer Alliance will challenge the lateness of the department’s application to appeal the August 20 ruling and will argue that the department has not been prejudiced in being compelled to act.
“Our interpretation was that they ought to have filed their appeal the very next week following the judgment but they didn’t. The rule is set up this way to allow the matter to be disposed of as quickly as possible. Remaining in limbo even for three weeks prejudiced both parties but especially the party who is required to comply, unless of course, there is no prejudice in complying,” said Mapipa.
Disclosure: SECTION27 was involved in the court proceedings described in this article. Spotlight is published by SECTION27, but is editorially independent – an independence that the editors guard jealously. The Spotlight editors gave special attention to maintaining this editorial firewall in the production of this story.
