Abstract
Gauteng province, with 26.3% of South Africa's population, is the commercial and industrial powerhouse of the country. During the first epidemic wave in 2020, Gauteng accounted for 32.0% of South Africa's reported COVID-19 cases. The aim of this study was to describe the health system response to the COVID-19 pandemic during the first epidemic wave in Gauteng province and to explore the perspectives of key informants on the provincial response. Using an adapted Pandemic Emergency Response Conceptual Framework, this was a qualitative case study design consisting of 36 key informant interviews and a document analysis. We used thematic analysis to identify themes and sub-themes from the qualitative data. Our case study found that Gauteng developed an innovative, multi-sectoral and comprehensive provincial COVID-19 response that aimed to address the dual challenge of saving lives and the economy. However, the interviews revealed multiple perspectives, experiences, contestations and contradictions in the pandemic response. The COVID-19 pandemic exposed and amplified the fragilities of existing systems, reflected in the corruption on personal protective equipment, poor data quality and inappropriate decisions on self-standing field hospitals. Rooted in a chronic under-investment and insufficient focus on the health workforce, the response failed to take into account or deal with their fears, and to incorporate strategies for psychosocial support, and safe working environments. The single-minded focus on COVID-19 exacerbated these fragilities, resulting in a de facto health system lockdown and reported collateral damage. The key informants identified missed opportunities to invest in primary health care, partner with communities and to include the private health sector in the pandemic response. Gauteng province should build on the innovations of the multi-sectoral response to the COVID-19 pandemic, while addressing the contested areas and health system fragilities.
Highlights
The devastation of the Coronavirus disease 2019 (COVID-19) pandemic is reflected in close to 5 million deaths by 26 October 2021 [1]
Our case study found that Gauteng developed an innovative, multi-sectoral and comprehensive provincial COVID-19 response that aimed to address the dual challenge of saving lives and the economy
Rooted in a chronic under-investment and insufficient focus on the health workforce, the response failed to take into account or deal with their fears, and to incorporate strategies for psychosocial support, and safe working environments
Summary
The devastation of the Coronavirus disease 2019 (COVID-19) pandemic is reflected in close to 5 million deaths by 26 October 2021 [1]. Several factors have influenced country-specific innovations and responses to the COVID-19 pandemic. These include political leadership, legislative controls, previous experience of respiratory diseases, existing disaster or pandemic management plans, national health systems, and technology [3,4,5,6]. The variations in country-level responses resulted in differential impact of the pandemic during the first epidemic wave, further shaped by diverse political, social, cultural, economic and health system contexts, the timing and range of government policies, quality of information systems, and the relative trade-offs between population health and the economic impact of interventions [6]. During the first epidemic wave in 2020, Gauteng accounted for 32.0% of South Africa’s reported COVID-19 cases
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