The numbers of COVID-19 cases and deaths in South Africa have increased exponentially over the past 12 months. At the beginning of July 2020 the country had 168 000 cases of COVID-19 and 2 844 deaths. A year later, at the start of July 2021, there were over two million confirmed cases and more than 61 000 deaths. These numbers are only a snapshot of the kind of pressure South Africa’s healthcare system is under. On the one hand, the country needs to drastically increase the number of frontline health workers. And on the other hand, there’s not enough money, according to acting health minister Mmamoloko Kubayi, to employ medical interns, or even extra medical staff. Laetitia Rispel chaired the ministerial task team responsible for the development of the 2030 National Human Resources for Health Strategy. She spoke to The Conversation Africa’s Ina Skosana about the country’s COVID-19 response.
How is South Africa coping with the current wave?
The country is not coping. I think the third wave could have been avoided. There’s been a lot of focus on the vaccination programme. Although vaccination is important, you can’t look at the vaccination programme in isolation from the overall response to the pandemic.
Things could have been done differently.
First of all, the government declared COVID-19 a national disaster in March 2020. That was an opportunity for the National Department of Health to provide strong leadership for the entire health system. But the national department has either remained quiet, or played a supportive role to the pandemic response in the nine provinces. Consequently, the COVID-19 response has varied across the country. In a crisis like the pandemic, you need strong central leadership and management.
Second, there’s been a lot of attention on the ability of hospitals to cope. The first step of any public health response must be prevention. Preventing new infections and community transmission, and containing the pandemic protects health systems from being overwhelmed or getting close to collapse.
By the time hospitals are overwhelmed by people who need admission, it is almost too late. Gauteng is the epicentre of the current surge. The province’s early warning system showed increasing numbers weeks ahead of the surge. Yet very little was done to contain those infections, or prevent a rapid increase.
There has been insufficient involvement of civil society and ordinary community members.
There’s a certain degree of COVID-19 fatigue. 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’s a chronic under-investment in the health workforce – the pandemic has exposed and amplified this. This is apparent in the reported shortages especially to deal with the people who are seriously ill and need to be admitted.
You can have as many hospital beds as you want. But if you don’t have the skilled staff to look after patients, then people won’t receive quality care or care at all.
There’s also been a failure to deal with the concerns and fears of frontline health workers. I don’t think there’s been sufficient 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, lower productivity, increased absenteeism and higher turnover, thus creating a vicious cycle.
What’s been working?
There are areas of innovation that we should recognise. For example government and South Africans were able to put together, at relatively short notice, significant financial resources. Digital innovation included the COVID-19 Alert App, the early warning system of hotspots or clusters of infections and the ability to get daily updates on COVID-19 infections and deaths.
One of the positive aspects was the “whole-of-government” approach and inter-governmental structures that were set up. These enabled different government departments and entities to work together, rather than in silos.
The other thing we have to acknowledge is the visible political leadership. There was very decisive leadership from the president at the early stages of the pandemic.
Hospital and district managers, as well as frontline staff, rescued the day. They went way beyond the call of duty. For instance, frontline nurses and doctors had creative ways of keeping communication going with family members who were not allowed to visit patients. There was a newfound public appreciation for frontline nurses and doctors.
I think the institutionalisation of public health measures is an amazing achievement. Wearing masks, handwashing and sanitising were adopted quite quickly. Compliance and enforcement, however, are still key issues.
What should be done?
The first thing is to strengthen and stabilise leadership and management. If people are in acting positions they are less likely to take risks and make tough decisions. Given the speed with which the pandemic is growing, it’s important to have rapid decision-making.
The second thing is to engage with 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 get public buy-in. People must understand that it’s only through working together that we’ll be able to prevent new infections, contain the spread of infections, and save lives and protect our future.
The third point is the importance of investment in the health workforce. Without health workers it’s not possible to fight a pandemic, or have a functional health system.
Finally, it’s important to act on the data generated by information systems. What is the point of investing in health information systems when you don’t respond to the message? The government needs to take swift action at the first signs of hotspots and not wait for infections to spread.