Cancer surveillance gaps and data fragmentation in middle-income health systems: lessons from South Africa
1
Research and Implementation Science, Health Systems Trust, Durban, South Africa
2
Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal, Durban, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):A947
ABSTRACT
INTRODUCTION:
Cancer is an increasing contributor to morbidity and mortality globally, yet in many low- and middle-income countries, weak surveillance systems limit the ability to monitor trends, guide policy, and evaluate progress in cancer control. South Africa, with its dual health system and high burden of communicable and non-communicable diseases, provides a useful case study to examine how data limitations constrain effective cancer planning and equity-oriented responses.
METHODS:
This analysis synthesised cancer-related indicators from multiple data sources, including the National Cancer Registry, routine health information systems, national surveys, and international databases such as GLOBOCAN. Indicators were assessed for completeness, timeliness, population coverage, and alignment with service delivery, financing, and equity dimensions across provinces and population groups.
RESULTS:
While cancer incidence and mortality data are available from several sources, major surveillance gaps persist. National registry data are delayed and largely limited to pathology-confirmed diagnoses, excluding clinically or radiologically diagnosed cases, particularly in underserved settings. Routine health information systems capture service activity but lack comprehensive outcome and stage-at-diagnosis indicators. COVID-19-related disruptions further exposed system fragilities, with sharp declines in cancer diagnostics and uneven recovery across provinces. Significant inequities were observed between public and private sectors, across provinces, and among populations affected by HIV, undermining the accuracy of national cancer burden estimates and masking disparities in access to prevention, screening, and treatment.
CONCLUSIONS:
Effective cancer control requires integrated, timely, and equity-sensitive surveillance systems. South Africa’s experience highlights the need to strengthen cancer registries, expand reporting beyond pathology-based diagnoses, improve interoperability between routine and registry data, and embed cancer indicators within broader health system monitoring frameworks. These lessons are transferable to other middle-income countries seeking to strengthen cancer surveillance as part of universal health coverage and non-communicable disease strategies.
Cancer is an increasing contributor to morbidity and mortality globally, yet in many low- and middle-income countries, weak surveillance systems limit the ability to monitor trends, guide policy, and evaluate progress in cancer control. South Africa, with its dual health system and high burden of communicable and non-communicable diseases, provides a useful case study to examine how data limitations constrain effective cancer planning and equity-oriented responses.
METHODS:
This analysis synthesised cancer-related indicators from multiple data sources, including the National Cancer Registry, routine health information systems, national surveys, and international databases such as GLOBOCAN. Indicators were assessed for completeness, timeliness, population coverage, and alignment with service delivery, financing, and equity dimensions across provinces and population groups.
RESULTS:
While cancer incidence and mortality data are available from several sources, major surveillance gaps persist. National registry data are delayed and largely limited to pathology-confirmed diagnoses, excluding clinically or radiologically diagnosed cases, particularly in underserved settings. Routine health information systems capture service activity but lack comprehensive outcome and stage-at-diagnosis indicators. COVID-19-related disruptions further exposed system fragilities, with sharp declines in cancer diagnostics and uneven recovery across provinces. Significant inequities were observed between public and private sectors, across provinces, and among populations affected by HIV, undermining the accuracy of national cancer burden estimates and masking disparities in access to prevention, screening, and treatment.
CONCLUSIONS:
Effective cancer control requires integrated, timely, and equity-sensitive surveillance systems. South Africa’s experience highlights the need to strengthen cancer registries, expand reporting beyond pathology-based diagnoses, improve interoperability between routine and registry data, and embed cancer indicators within broader health system monitoring frameworks. These lessons are transferable to other middle-income countries seeking to strengthen cancer surveillance as part of universal health coverage and non-communicable disease strategies.
| eISSN: | 2654-1459 |
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