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The number of COVID-19 cases and deaths in South Africa has increased exponentially in the past 12 months. As of July 2020, the country had 168,000 cases of COVID-19 and 2,844 deaths. A year later, in early July 2021, there were more than two million confirmed cases and more than 61,000 deaths. These numbers are just a glimpse of the kind of pressure South Africa’s healthcare system is under. On the one hand, the country needs to dramatically increase the number of frontline health workers. And on the other hand, there is not enough money, according to the acting Minister of Health, Mmamoloko Kubayi, to employ medical interns, or even additional medical staff. Laetitia Rispel chaired the ministerial working group responsible for developing the National Strategy for Human Resources for Health to 2030. She spoke to Ina Skosana of The Conversation Africa about the country’s response to COVID-19.
How is South Africa coping with the current wave?
The country is not doing it. I think the third wave could have been avoided. A lot of attention has been paid to the immunization program. While vaccination is important, you cannot view the vaccination program in isolation from the overall response to the pandemic.
Things could have been done differently.
First, the government declared COVID-19 a national disaster in March 2020. It was an opportunity for the national health ministry to provide strong leadership for the entire health system. But the national department has either remained silent or played a supporting role in the pandemic response in all nine provinces. As a result, the response to COVID-19 has varied across the country. In a crisis like the pandemic, you need strong central leadership and management.
Second, there has been a lot of attention on the ability of hospitals to cope. The first step in any public health response must be prevention. Preventing new infections and community transmission, and containing the pandemic protects health systems from being overwhelmed or on the verge of collapse.
By the time hospitals are inundated with people who need to be hospitalized, it is almost too late. Gauteng is the epicenter of the current wave. The province’s early warning system showed an increasing number of weeks before the outbreak. Yet very little has been done to contain these infections or prevent a rapid increase.
Civil society and ordinary members of the community have not been sufficiently involved.
There is some degree of fatigue associated with COVID-19. But many people still don’t understand why non-pharmaceutical interventions – social distancing, hand washing, wearing masks – are important.
What are your biggest concerns?
There is chronic underinvestment in health workers – the pandemic has revealed and amplified it. This is evident in the shortages reported, especially for the critically ill who need to be admitted.
You can have as many hospital beds as you want. But if you don’t have the qualified staff to care for the patients, then people will not receive quality care at all.
There has also been a failure to address the concerns and fears of frontline health workers. I don’t think there has been enough attention to the psychosocial and emotional impact of the pandemic on these workers. The potential consequences are physical and mental exhaustion, stress, anxiety and burnout. This could lead to medical errors, decreased productivity, increased absenteeism and higher turnover, thus creating a vicious cycle.
What has worked?
There are areas of innovation that we need to recognize. For example, the government and the South Africans were able to raise significant financial resources in a relatively short period of time. Digital innovation included the COVID-19 alert app, the early warning system for hot spots or clusters of infections, and the ability to get daily updates on COVID-related infections and deaths. -19.
One of the positive aspects has been the “whole-of-government” approach and the intergovernmental structures that have been put in place. These have allowed different government departments and entities to work together rather than silos.
The other thing we need to recognize is visible political leadership. There was very decisive leadership from the president in the early stages of the pandemic.
Hospital and district directors, as well as frontline staff, saved the day. They went above and beyond the call of duty. For example, nurses and primary care physicians had creative ways of maintaining communication with family members who were not allowed to visit patients. There was a new public appreciation for nurses and primary care physicians.
I think that the institutionalization of public health measures is an incredible achievement. Wearing masks, hand washing and disinfection were adopted quite quickly. Compliance and enforcement, however, remain key issues.
What should be done?
The first thing is to strengthen and stabilize leadership and management. If people are in acting positions, they are less likely to take risks and make tough decisions. Considering the speed at which the pandemic is developing, it is important to have early decision making.
The second thing is to engage and involve ordinary people. This can be done through existing community structures. South Africa can build on the experience of managing the HIV epidemic to gain public buy-in. People need to understand that only by working together can we prevent new infections, contain the spread of infections, save lives and protect our future.
The third point is the importance of investing in the health workforce. Without health workers, it is not possible to fight a pandemic or have a functioning health system.
Finally, it is important to act on the data generated by the information systems. What is the point of investing in health information systems when you do not respond to the message? The government must take swift action at the first sign of hot spots and not wait for infections to spread.
Laetitia Rispel receives funding from the National Research Foundation as part of her South African research chair.
By Laetitia Rispel, Professor of Public Health and DST / NRF Research Chair, University of the Witwatersrand
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