The effects of coronavirus disease 2019 pandemic on the South African health system: A call to maintain essential health services

Abstract

South Africa had its first coronavirus disease 2019 (COVID-19) case on 06 March 2020 in an individual who travelled overseas. Since then, cases have constantly increased and the pandemic has taken a toll on the health system. This requires extra mobilisation of resources to curb the disease and overcome financial loses whilst providing social protection to the poor. Assessing the effects of COVID-19 on South African health system is critical to identify challenges and act timely to strike a balance between managing the emergency and maintaining essential health services. We applied the World Health Organization (WHO) health systems framework to assess the effects of COVID-19 on South African health system, and proposed solutions to address the gaps, with a focus on human immunodeficiency virus (HIV) and expanded programme on immunisation (EPI) programmes. The emergence of COVID-19 pandemic has direct impact on the health system, negatively affecting its functionality, as depletion of resources to curb the emergency is eminent. Diversion of health workforce, suspension of services, reduced health-seeking behaviour, unavailability of supplies, deterioration in data monitoring and funding crunches are some of the noted challenges. In such emergencies, the ability to deliver essential services is dependent on baseline capacity of health system. Our approach advocates for close collaboration between essential services and COVID-19 teams to identify priorities, restructure essential services to accommodate physical distancing, promote task shifting at primary level, optimise the use of mobile/web-based technologies for service delivery/training/monitoring and involve private sector and non-health departments to increase management capacity. Strategic responses thus planned can assist in mitigating the adverse effects of the pandemic whilst preventing morbidity and mortality from preventable diseases in the population.

Reported Barriers to Healthcare Access and Service Disruptions Caused by COVID-19 in Burkina Faso, Ethiopia, and Nigeria: A Telephone Survey

“…10,11 Considering the weak health systems and limited resources, the COVID-19 pandemic further burdened the healthcare system and worsened the availability and disparity of essential health services. [12][13][14] Subsequently, shortages of HCPs, a lack of guidelines regarding the continuation of non-COVID-19 services, and discouragement among HCPs because of the lack of equipment and materials have created challenging situations in many healthcare settings. 15 There are also consequences for sustaining health programs that are primarily donor-funded, such as those that prevent and treat malaria, HIV/AIDS, and tuberculosis.…”

Protective Behaviors and Secondary Harms Resulting From Nonpharmaceutical Interventions During the COVID-19 Epidemic in South Africa: Multisite, Prospective Longitudinal Study

“…The relaxation of lockdown regulations, which occurred even as the epidemic grew, reflected competing health and economic vulnerabilities and priorities as well as sustained popular pressures [ 13 - 15 ]. There was widespread concern that the lockdown was substantially affecting the national economy; individual household livelihoods; and access to education, health care, and medication [ 8 , 16 ]. Additionally, some expected the lockdown to be futile, since much of the population could neither maintain physical distancing nor implement NPIs due to household and community overcrowding and limited access to running water and sanitation [ 17 ].…”

Protective behaviours and secondary harms from non-pharmaceutical interventions during the COVID-19 epidemic in South Africa: a multisite prospective longitudinal study

“…Relaxation of lockdown regulations, even as the epidemic curved upwards, reflected competing health and economic vulnerabilities and priorities, alongside sustained popular pressure. Concern was widespread that the lockdown was substantially affecting the national economy and individual household livelihoods, as well as access to education, healthcare and medication [4, 9]. Additionally, some expected lockdown to be futile since much of the population could not maintain physical distancing or implement NPIs, due to household and community overcrowding and limited access to running water and sanitation [10].…”