Reflections on the health system response to COVID-19 in the Western Cape Province

Abstract

In the Western Cape Province, as elsewhere in the country, the COVID-19 crisis has required an intense multi-pronged response by the provincial Government. With the aim of encouraging wider reflection, this chapter presents our experiences, focusing specifically on surveillance and planning, the outbreak and health platform response including corporate support services, and leadership and governance. During the inter-wave periods, the Department of Health convened a series of facilitated conversations with staff to consider our responses and identify lessons that can inform our future strategy. The Western Cape COVID-19 response showed that government can be adroit and responsive to shocks. We drew on the pre-existing health system foundations of trusting relationships, collaboration and networking. The responses were also underpinned by decisive and distributed leadership and stewardship − mobilising a range of actors within, across and outside government around a common purpose; using routine information and evidence in continuously adapting to emergent conditions; and decentralised approaches that enabled local responsiveness. Responsive corporate support services (infrastructure provision, oxygen supply and staffing support) have been critical. Developing agile inter-disciplinary and cross-functional mechanisms for rapid decision-making, such as huddles, were instrumental. We also specifically sought to: address staff safety in all sectors; use digital technologies to do business differently; and develop a culture of learning and constant improvement. Areas for future improvement include strengthening community connectedness, managing ‘policy overload’ on frontline managers, and empowering middle management in their mediating role between frontline staff, the community and senior management. It is critical to strengthen the health system to manage both everyday challenges and extraordinary adverse events like COVID-19. Organisational muscle and resilience are built through collaborative relationships, flexibility and agility, and the ability to learn, improve and adapt.