The World Health Organization Country Office for South Africa, in partnership with the National Department of Health (NDoH) and Clinton Health Access Initiative, organized a policy workshop on Strengthening Health Systems Resilience Towards Universal Health Coverage on 19^th  and 20^th May 2022 in Cape Town. The workshop brought together the high-level health sector leadership including the Director General of Health, Heads of the Departments and senior leadership from national level as well as all the nine provinces of the country.

With three distinctive objectives, the workshop (i) provided a space for senior managers of the public health system to reflect on the last two years of the COVID-19 pandemic, (ii) helped to explore key issues that the health sector needs to focus on to strengthen the resilience of the health systems, and (iii) enabled to look at the governance, leadership and management aspects that are required to implement Universal Health Coverage (UHC) and National Health Insurance (NHI).

As South African health moves to the next phase of COVID-19 pandemic with the scaling up of COVID-19 vaccinations and the gradual easing of restrictions, the mainstreaming of COVID-19 into day-to-day lives and health systems becomes pertinent. The workshop provided the opportunity to pause, reflect, and collectively strategize for building back better. The workshop also allowed to bring the national and provincial health leadership together physically for the first time in over two years where they could discuss key strategic interventions to strengthen the health sector, reprioritize national health goals and build back more resilient people-centered health systems.

Dr Sandile Buthelezi, Director General for National Department of Health, in his opening remarks said that “the past two years have tested the resolve of health systems and health leadership. We have lost many health workers and there have been over 100,000 deaths in general public, when one life lost is too much. Despite all the adversities and not being fully prepared in the beginning, we have persevered. However, we need to be better prepared for the next waves of COVID-19 and pandemics and the time is now to build stronger, more resilient health systems.”.

Dr Owen Kaluwa, WHO Representative to South Africa congratulated the national leadership and noted that “the national team and provincial Heads of Departments of Health led from the forefront even when there was little knowledge or information available about the novel coronavirus and the disease. WHO teams worked closely with the provincial and national teams throughout the COVID-19 response. We will continue the support, albeit WHO is repositioning its support in this new phase of pandemic, based on the lessons learnt over past two years and the resource availability.”

In the opening session the participants of the workshop reflected on their experience over the past two years including their personal stories of loss and grief, anxiety, and sacrifices. It came out very clearly that the health systems were caught ill prepared to deal with pandemic of such enormity. The access to essential health services suffered and the quality of services plummeted as the country dealt with COVID-19. Key challenges while addressing the pandemic included vacancies in critical posts, archaic organogram that did not include dedicated structures for emergency, major burden of back-to-back meetings and reporting requirements, policies and rigid procurement rules even during emergencies, and at times strained relationships between national and provincial teams. 

Among the external impeding factors political opportunism, pressures from unions and environment of general mistrust were mentioned. However there have been exemplary practices of courage, teamwork and humanity, the innovations in rapidly changing context and effective partnerships. The national Department of Health and the provincial Heads of Departments highly appreciated the technical support of the WHO and being there as a credible partner since the beginning of the pandemic when resources and knowledge about the pandemic response were scarce.

WHO led the session on Resetting South Africa’s Health System on road to recovery from COVID-19, where the framework for resetting the health systems and its four components were discussed at length. The Framework entails four components: 1) Recalibration; 2) Mitigation; 3) Integration; and 4) Recovery.

The group discussions entailed deliberations to take forward the WHO framework and coming up with ideas and practical steps for strengthening health systems resilience and accelerating progress towards UHC in South Africa. Several key ideas emerged including 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 communication with public and reprioritization of health initiatives such as the National Health Insurance that have been put on hold due to the COVID-19 pandemic.

The Director General of the Department of Health, the Heads of Department of all provinces and the participants highly appreciated the rich discussions and ideas that emanated out of the UHC policy workshop. The participants agreed to continue deliberation and actions to take forward some of the key outcomes in the coming weeks and months. WHO reiterated its commitment to work with the national and provincial departments of health to support the country in building back more resilient health systems and accelerate progress towards Universal Health Coverage in this new phase.