Strengthening South Africa’s COVID-19 preparedness and response: Building sub-national capacities and resilience through coordinated actions

The scale and magnitude of the COVID-19 crisis in South Africa far exceeded other nations in the WHO African Region. Over 3.5 million positive cases and more than 93 000 fatalities had been reported in South Africa alone by January 2022 - over 50% of the COVID-19 case load on the African continent.

South Africa reacted early to the COVID-19 pandemic by rapidly deploying a comprehensive public health response that, in the early phase, included nationwide lockdowns. This prevented many infections and provided a window of opportunity to ramp up capacity of the health system and save many lives. To build capacity across South Africa’s health system, WHO provided technical, strategic, and coordination expertise. As WHO placed an emphasis on transferring skills and capacity to the workforce at the national and subnational levels, South Africa’s ability to respond to health emergencies was strengthened in both the short-term and longer term.

How did South Africa do it, and how did the WHO Secretariat provide support to South Africa?

• Taking early preparedness measures - The WHO Country Office in South Africa commenced work on preparedness measures with the National Department of Health from January 2020, much earlier than the first case report on 5 March 2020. This enabled a rapid and comprehensive response at both national and subnational levels when the first COVID-19 case was confirmed.
• Rapidly providing technical expertise in accordance with an established framework – In March 2020, WHO repurposed its technical staff to support the response in accordance with the Emergency Response Framework (ERF). By end-2021, WHO had deployed 107 surge personnel both at the national level and in eight provinces to support the National Department of Health. This included international and local experts in coordination, epidemiology and surveillance, case management, infection prevention and control, operations and logistics, and risk communication. As provincial emergency preparedness and response capacity strengthened and overall population immunity increased with vaccinations and natural infections, the overall number of COVID-19 cases and deaths declined. WHO then scaled down its surge team and transitioned towards broader health system strengthening for health security and universal health coverage.
• Providing strategic support at the national level – In July 2020, when South Africa was ranked fifth globally in terms of cumulative cases, the President of South Africa requested technical support from WHO. WHO technical experts worked with the national Incident Management Team to synthesize global best practices and evidence to guide the COVID-19 response, provide technical support to the Office of Director General of the National Department of Health and strategic support to technical working groups of the Ministerial Advisory Committee, and conduct technical reviews of the national response strategy and plans (for example, vaccine introduction).
• Supporting response coordination – WHO undertook regular COVID-19 Intra-Action Reviews at the national and provincial levels. These identified key gaps and challenges and provided concrete action-oriented recommendations to improve planning, preparedness, and response. Four hundred fifty-six public and private healthcare facilities were assessed using WHO’s infection prevention and control assessment framework (IPCAF). This led to the development of a plan of action for strengthening infection prevention and control and case management. WHO technical experts provided advice to strengthen the Enhanced Incident Management System, National Response Plan, and National Resurgence Mitigation Plan. WHO technical experts developed, implemented, and monitored provincial and district resurgence plans and provided supportive supervision to districts.
• Comprehensive capacity building – WHO technical experts worked with public health partners at the provincial level to transfer skills and knowledge: WHO directly trained over 1 200 health professionals in infection prevention and control and case management, and 100 health promotion practitioners as COVID-19 champions on risk communication and community engagement; provided supportive supervision and on-the-job training in case investigation, immunization practices, safety surveillance, data collection tools, data audit, and quality control; and developed standard operating procedures for data management.
• Innovative models and tools – WHO embedded, supervised, and mentored five district epidemiologists into district teams in Free State Province to fill critical skill gaps in epidemiology and surveillance. The intervention successfully built capacity, and the National Department of Health and the National Institute of Communicable Disease are now working with WHO to expand the model to other provinces. WHO introduced the Data tool at national and subnational levels to strengthen contact tracing through digitalized data entry; 135 high performing computers with outbreak data management software and other information technology equipment were provided and staff of government health partners were trained on its use.

Photo Credit: © WHO South Africa 

Photo Caption: WHO South Africa Incident Manager offering opening remarks during the COVID-19 Intra-Action Review in Durban, KwaZulu-Natal Province, South Africa.

WHO support to strengthen the COVID-19 response in South Africa was well-received by the government. The Go.Data tool was a particular success. Accelerated data capture enabled the chains of COVID-19 transmission to be visualized, understood, and shared more quickly. More efficient team performance and improvements in data quality were critical to guiding an evidence-informed response.

Photo Credit: © WHO South Africa 

Photo Caption: The use of continuous positive airway pressure and high flow nasal oxygenation in COVID-19 patients during training in Mpumalanga Province, South Africa.