On the 19th and 20th of May 2022 in Cape Town, the World Health Organization Country Office for South Africa, in collaboration with the National Department of Health (NDoH) and the Clinton Health Access Initiative, hosted a policy workshop on Strengthening Health Systems Resilience Towards Universal Health Coverage.
The event brought together high-level health sector leaders from around the country, including the Director General of Health, Department Heads, and senior leadership from all nine provinces.
The workshop (i) provided a space for senior public health officials to reflect on the last two years of the COVID-19 pandemic, (ii) assisted in the exploration of key issues that the health sector needs to focus on to strengthen the resilience of health systems, and (iii) enabled an examination of the governance, leadership, and management aspects required to implement Universal Health Coverage (UHC) and National Health Insurance (NHI) (NHI).
With the scaling up of COVID-19 vaccinations and the gradual loosening of restrictions, the mainstreaming of COVID-19 into day-to-day life and health systems becomes increasingly important in South African health. The session provided an opportunity to pause, reflect, and brainstorm together on how to rebuild better.
For the first time in over two years, the workshop allowed national and provincial health leaders to meet in person to explore critical strategic actions to improve the health sector, reprioritize national health goals, and rebuild more resilient people-centered health systems.
“The previous two years have challenged the resolve of health systems and health leadership,” said Dr Sandile Buthelezi, Director General of the National Department of Health, in his opening remarks. Many health personnel have died, and over 100,000 people have died in the general population, when even one life lost is too much.
We have persevered despite all of the challenges and the fact that we were not fully prepared at the start. However, we must be better prepared for future COVID-19 outbreaks and pandemics, and the time to establish stronger, more robust health systems is now.”
Dr. Owen Kaluwa, WHO Representative in South Africa, praised the national leadership, saying, “Even when there was little knowledge or information available regarding the novel coronavirus and the disease, the national team and provincial Heads of Departments of Health led from the front.”
Throughout the COVID-19 response, WHO teams collaborated closely with provincial and national teams. We will continue to provide assistance, however WHO is repositioning its assistance in this new phase of the pandemic, based on lessons learned over the previous two years and available resources.”
The workshop participants reflected on their experiences over the previous two years, including personal stories of loss and sadness, worry, and sacrifices, in the opening session.
As the country dealt with COVID-19, access to essential health services was hampered, and the quality of services deteriorated. Vacancies in critical positions, an archaic organogram that lacked dedicated emergency structures, a significant burden of back-to-back meetings and reporting requirements, policies and rigid procurement rules even during emergencies, and strained relationships between national and provincial teams were among the key challenges faced during the pandemic response.
Political opportunism, union pressures, and a general climate of mistrust were mentioned as external impediments.
There have, however, been examples of bravery, teamwork, and humanity, as well as innovations in a rapidly changing environment and effective partnerships. The WHO’s technical assistance and presence as a credible partner since the beginning of the pandemic, when resources and knowledge about the pandemic response were scarce, was greatly appreciated by the national Department of Health and provincial Heads of Departments.
The framework for resetting the health systems and its four components were reviewed in depth during the session on Resetting South Africa’s Health System on the Road to Recovery from COVID-19, which was led by WHO. The Framework is made up of four parts: Recalibration, mitigation, integration, and recovery are the four steps.
The group talks included considerations on how to go forward with the WHO framework, as well as ideas and practical initiatives for increasing health system resilience and speeding up progress toward UHC in South Africa.
Building adaptable health systems, fostering collaborative governance and leadership, institutionalizing the capacities and structures for emergency preparedness and response, strengthening health workforces, building agile service delivery models, establishing integrated information systems, strengthening public communication, and reprioritizing health initiatives such as the National Health Insurance, which have been put on hold, are just a few of the key ideas that emerged.
The Director General of the Department of Health, the Heads of Department from all provinces, and the participants all expressed their gratitude for the rich conversations and ideas generated by the UHC policy workshop.
In the following weeks and months, the participants decided to continue conversation and activities to move some of the important results forward. In this new phase, WHO reiterated its commitment to cooperate with national and provincial health ministries to assist the country in rebuilding more resilient health systems and accelerating progress toward Universal Health Coverage.
WHO values its long-standing engagement with South Africa’s National Department of Health and recognizes the country’s broad and impactful work with non-state actors.
WHO gratefully welcomes the substantial support it received through the UHC Partnership from the European Union-Africa, the Caribbean, and the Pacific, as well as the financing provided by the Isle of Man Government, which enabled this important workshop to take place.