Recovering from COVID lockdowns: Routine public sector PHC services in South Africa, 2019 - 2021.

BACKGROUND: In a previous article on the impact of COVID-19, the authors compared access to routine health services between 2019 and 2020. While differential by province, a number of services provided, as reflected in the District Health Information System (DHIS), were significantly affected by the pandemic. In this article we explore the extent to which the third and fourth waves affected routine services. OBJECTIVES: To assess the extent to which waves 3 and 4 of the COVID-19 pandemic affected routine health services in South Africa, and whether there was any recovery in 2021. METHODS: Data routinely collected via the DHIS in 2019, 2020 and 2021 were analysed to assess the impact of the COVID-19 pandemic and extent of recovery. RESULTS: While there was recovery in some indicators, such as number of children immunised and HIV tests, in many other areas, including primary healthcare visits, the 2019 numbers have yet to be reached - suggesting a slow recovery and continuing impact of the pandemic. CONCLUSIONS: The COVID-19 pandemic continued to affect routine health services in 2021 in a number of areas. There are signs of recovery to 2019 levels in some of the health indicators. However, the impact indicators of maternal and neonatal mortality continued to worsen in 2021, and if interventions are not urgently implemented, the country is unlikely to meet the Sustainable Development Goals targets.

The impact of climate change on maternal and child health

It can be argued that there are three colliding pandemics that are currently affecting the planet and its people: COVID-19, global inequities and climate change. Regrettably, these are all the result of human action or inaction and are preventable. The United Nations Conference of the Parties (COP26), held in November 2021 in Glasgow, addressed some of these issues.1 Prince Charles called this meeting the 'last chance saloon to save the planet.' The main objective of COP26 was to reduce global heating and limit global warming to the target maximum temperature of 1.5-degree Celsius above pre-industrial levels. According to the National Aeronautics and Space Administration (NASA), since the late 19th century, the earth surface temperature rose by 1.18 degrees Celsius, caused by increased carbon dioxide and other emissions into the atmosphere, with the years 2016 and 2020 being tied as the warmest years on record.2 However, many, including a group of scientists called 'Scientist Rebellion' were not convinced that COP26 would make any difference to the warming of the planet.3 President of COP26, Alok Sharma admitted that the objective of the conference was not reached but remained cautiously optimistic: "We can now say with credibility that we have kept 1.5 degrees alive. But its pulse is weak and it will only survive if we keep our promises and translate commitments into rapid action".

Foreword: Preparedness and response to SARS-CoV-2 in South Africa Foreword

The World Health Organization's (WHO) China Country Office was informed of cases of pneumonia of unknown cause detected in Wuhan City, Hubei Province of China on the 31st of December 2019. On 7 January 2020, the causative pathogen was identified as the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) and on 11th of March 2020, the WHO declared a global pandemic. This paper serves as an introduction to a series of research articles which consider South Africa's preparedness and response to SARS-CoV-2.

Governing a pandemic: A case study of South Africa?s coordination and management structures used to respond to the COVID-19 pandemic

During a public health emergency, coordination and management are essential for ensuring timeous, decisive, and harmonised leadership. In this paper, the governance structures utilised in South Africa (SA) during the COVID-19 pandemic are recorded and the key strengths and weaknesses of response in the country are discussed. A qualitative methodology is used for the case study and comprises insights from stakeholders who were at the forefront of SA???s response as well as from documentation that was used to guide the response. Structured, transparent, science-based and agile coordination and management systems are necessary to gain the public???s trust during a public health emergency. This case study contributes to the literature on governing a pandemic and shares lessons learned from the COVID-19 response. The lessons learned by the stakeholders within the SA governance structures can be leveraged in future public health emergencies within SA and other low-and middle-income countries.

Recovery and transforming the South African health system

The COVID-19 pandemic has devastated lives and livelihoods globally and in South Africa (SA). The SA government has been lauded for its swift response to the pandemic, in March 2020 and subsequently. Many routinely provided health services were severely disrupted and there is an urgent need to recover to 2019 levels at least. In this paper, the lessons from the COVID-19 response are discussed and proposals for transformation of the SA health system are considered.

Teenage births and pregnancies in South Africa, 2017 - 2021 - a reflection of a troubled country: Analysis of public sector data

Articles on teenage pregnancies have been proliferating in both the popular press and the medical media. We analysed data available in the public sector database, the District Health Information System, from 2017 to 2021. During this time, the number of births to young teenagers aged 10 - 14 years increased by 48.7% (from a baseline of 2 726, which is very high by developed-country standards) and the birth rate per 1 000 girls in this age category increased from 1.1 to 1.5. These increases occurred year on year in most provinces. In adolescent girls aged 15 - 19, the number of births increased by 17.9% (from a baseline of 114 329) and the birth rate per 1 000 girls in this age category increased from 49.6 to 55.6. These increases also occurred year on year in a continuous upward trend as well as in all provinces, but at different rates. Generally, rates were higher in the more rural provinces such as Limpopo, Mpumalanga and Eastern Cape than in more urban provinces such as Gauteng and Western Cape. The increases during the past 2 years were particularly large and may be due to disruption of health and school services with decreased access to these as a result of COVID-19. These metrics pose serious questions to society in general and especially to the health, education and social sectors, as they reflect socioeconomic circumstances (e.g. sexual and gender-based violence, economic security of families, school attendance) as well as inadequate health education, life skills and access to health services.

What's to know and what's to be done-implementing and monitoring STI and HIV programmes

With decades of experience implementing STI and HIV programmes globally what do we know and what are we still learning? Implementation science is a relatively new approach to understanding what facilitates rapid implementation and the barriers to implementation. With a rising tide of some STIs and need to eliminate HIV as a public health threat, this presentation will focus on experiences of a national programme manager implementing STI, HIV and other programmes in an upper middle-income country - South Africa. Looking ahead does the COVID-19 pandemic provide us with opportunities to do things differently - and if yes, what can they be.

Impact of COVID-19 on routine primary healthcare services in South Africa.

BACKGROUND: The COVID-19 pandemic and responses by governments, including lockdowns, have had various consequences for lives and livelihoods. South Africa (SA) was one of the countries that implemented severely restrictive lockdowns to reduce transmission and limit the number of patients requiring hospitalisation. These interventions have had mixed consequences for routine health services. OBJECTIVES: To assess the impact of COVID-19 and restrictions imposed to limit viral transmission on routine health services in SA. METHODS: Data routinely collected via the District Health Information System in 2019 and 2020 were analysed to assess the impact of the COVID-19 pandemic. RESULTS: Access to public health services between March 2020 and December 2020 was limited in all provinces. However, this was not linear, i.e. not all services in all provinces were similarly affected. Services most severely affected were antenatal visits before 20 weeks, access to contraceptives, and HIV and TB testing. The impact on outcomes was also noticeable, with a measurable effect on maternal and neonatal mortality. CONCLUSIONS: The responses to the COVID-19 pandemic, including different levels of lockdowns, the limitation of health services, lack of staff as a result of COVID-19 infection, and fear and stigma, resulted in a reduction in access to routine health services. However, the picture varies by type of service, province and district, with some faring worse than others. It is important to ensure that routine services are not significantly affected during future COVID-19 waves. This will require careful planning on the part of service providers and optimal communication with patients and communities.

What did we learn from South Africa's first-ever tuberculosis prevalence survey?

The World Health Organization (WHO) has urged countries to conduct tuberculosis (TB) prevalence surveys to better understand the burden of TB and to enable the WHO to conduct global estimates. Until the report from the first-ever prevalence survey in South Africa (SA), the country had to rely on WHO estimates. The recently published report on the SA TB prevalence survey provides important estimates of the burden of TB disease as well as information on health-seeking behaviour. This review notes the key findings of the 2018 prevalence survey. The high prevalence of TB in SA continues to be a major cause for concern, and calls for a significantly improved response to reach the End TB targets set by the WHO.