Table 2. Selected South African legal and policy frameworks that support cancer prevention and control.

	Year enacted	Provisions
Legal mechanisms
Bill of Rights, Chapter 2, South African Constitution [31]	1996	Defines human rights, including socioeconomic entitlements, principles of dignity and equality and the need for societal redress post-apartheid. Section 11 guarantees everyone the right to life. Section 27 outlines the right to access health care services, including reproductive health care, as well as emergency medical treatment, which cannot be limited. Other sections address the social determinants of health and special populations (e.g.: housing, environment, food and children).
National Health Act 61, as amended [32]	2003; 2013	‘Provides a framework for a structured uniform health system in [South Africa] taking into account the obligations imposed by the Constitution and other laws on the national, provincial and local governments with regard to health’. In a federalist system, this Act regulates the provision of health care services for public and private sectors as well as delegations to the nine provinces. Establishes The Office of Health Standards Compliance as an independent body to ensure that both public and private health establishments in South Africa comply with the required health standards.
Medicines and Related Substances Act 101, as amended [33]	1965	Regulates the manufacturing and importation of pharmaceuticals and medical devices, including pricing of same. Establishes the South African Health Products Regulatory Authority which reports to the Minister of Health.
Patents Act 57, as amended [34]	1978	Regulates patent registration and provides for voluntary and compulsory licensing through a legal process.
Medical Schemes Act 131 [35]	1998	Consolidates previous legislation concerning the health insurance industry. Establishes the Council for Medical Schemes as a juristic person to regulate, control and coordinate certain activities of the 76 different not-for-profit medical schemes, to protect the interests of members of medical schemes. It also outlines prescribed minimum benefits for 271 specific conditions, including ‘treatable’ solid organ and systemic or non-solid organ cancers (such as leukaemia and lymphoma).
Labour Relations Act 66 [36]	1995	Governs labour practices and non-discrimination in the workplace; regulates the organisational rights of trade unions, including facilitating collective bargaining; regulates the right to strike; promotes employee participation in decision-making; establishes the Commission for Conciliation, Mediation and Arbitration for independent alternative dispute resolution services as well as the Labour Court and the Labour Appeal Court to decide matters arising from the Act. Establishes grounds for incapacity due to ill health or injury, to safeguard against unfair dismissal in the workplace when sick.
Environmental Management Act 107 [37]	1998	Recognises that many inhabitants of South Africa live in an environment that is harmful to their health and well-being; regulates exposure to toxic substances in the environment, including the promotion of community participation in affected areas.
National Liquor Act 59 [38]	2003	Regulates the alcohol industry and the sale of alcohol.
Tobacco Products Control Amendment Act 63 [39]	2008	Prohibits smoking in public places and regulates the production, importation, advertisement, packaging and labelling of tobacco products; prohibits the sale of tobacco products to minors
Regulation no. 380 of the National Health Act no. 61 of 2003: National Cancer Registration Regulation [40]	2011	Formally establishes the National Cancer Registry (NCR) for cancer surveillance, with a compulsory legal requirement for every health care worker, in both public and private sectors, to report confirmed cancer cases to the NCR. Aligns public health reporting of cancer to international standards; and, mandates the NCR to shift from pathology-based surveillance to establish population-based cancer registries for the country [41].
National Public Health Institute of South Africa (NAPHISA) Act 1 of 2020 [42]	This bill has been signed by the President however, it has not yet been enacted.	The Act establishes a National Public Health Institute to coordinate disease prevention, control and surveillance, which could include cancer. It also ‘provide[s] for specialised public health services, public health interventions, training and research directed towards the major health challenges affecting the population of the Republic’.
NHI Bill [B11-2019] [43]	Passed the National Assembly in June 2023, the Bill is pending concurrence in the National Council of Provinces	Parliament passed this law to extend UHC to all South Africans through the establishment of a single funding pool. Details of this new regime must still be worked out and are hotly contested.
Cancer-specific policies
Cervical Cancer Prevention and Control Policy [44]	1998, updated in 2017	Introduces mass HPV vaccination through a school-based program for girls prior to the initiation of sexual activity for primary prevention of cervical cancer; introduces evidence-based secondary prevention screening in the public sector at primary care level with PAP smears/cytology augmented by HPV DNA-based screening where resources permit; provides additional screening benefits for women living with Human immunodeficiency virus/Acquired immunodeficiency syndrome (HIV/AIDS). This policy is fully integrated into primary health care (PHC) service delivery, and budgeted for by provinces. Related treatment services are referred to treatment centres at tertiary level within provinces.
Breast Cancer Prevention and Control Policy [45]	Approved in 2017	Lays out 22 objectives to promote public awareness and access to early breast cancer detection, diagnosis, appropriate treatment and palliative care services; establishes specialised ‘units’ in tertiary care centres in the public sector for timely diagnosis and treatment of breast cancer to improve survival outcomes. However, these services are not integrated into primary levels of care across the provinces and no budgets are allocated for services within primary and secondary levels of care.