ArticlePloS one2021
Innovations, contestations and fragilities of the health system response to COVID-19 in the Gauteng Province of South Africa.
Article in PloS one, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed, 20 citations in OpenAlex.
- Perspectives of senior health managers on COVID-19 response and challenges, lessons learned and opportunities against future outbreaks in Gauteng province, South Africa.BMC health services research · 2026Article
- Article
- Factors influencing uptake of COVID-19 diagnostics in Sub-Saharan Africa: a rapid scoping review.PloS one · 2025Article
- Article
- Article
- [Analysis of the institutional capabilities of the Guatemalan Ministry of Health: democratic constraint, defunding, reforms, and model of care].Cadernos de saude publica · 2024Article
- Preparedness, impacts, and responses of public health emergencies towards health security: qualitative synthesis of evidence.Archives of public health = Archives belges de sante publique · 2023Article
- Impacts of Covid-19 on mental health service provision in the Western Cape, South Africa: The MASC study.PloS one · 2023Article
- When uncertainty becomes the norm: The Chris Hani Baragwanath Academic Hospital's Speech Therapy and Audiology Department's response to the COVID-19 pandemic.The South African journal of communication disorders = Die Suid-Afrikaanse tydskrif vir Kommunikasieafwykings · 2022Review
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Authors and funding
4 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundGauteng province, with 26.3% of South Africa's population, is the commercial and industrial powerhouse of the country. During the first epidemic wave in 2020, Gauteng accounted for 32.0% of South Africa's reported COVID-19 cases.
aimThe aim of this study was to describe the health system response to the COVID-19 pandemic during the first epidemic wave in Gauteng province and to explore the perspectives of key informants on the provincial response. MATERIAL AND
methodsUsing an adapted Pandemic Emergency Response Conceptual Framework, this was a qualitative case study design consisting of 36 key informant interviews and a document analysis. We used thematic analysis to identify themes and sub-themes from the qualitative data.
resultsOur case study found that Gauteng developed an innovative, multi-sectoral and comprehensive provincial COVID-19 response that aimed to address the dual challenge of saving lives and the economy. However, the interviews revealed multiple perspectives, experiences, contestations and contradictions in the pandemic response. The COVID-19 pandemic exposed and amplified the fragilities of existing systems, reflected in the corruption on personal protective equipment, poor data quality and inappropriate decisions on self-standing field hospitals. Rooted in a chronic under-investment and insufficient focus on the health workforce, the response failed to take into account or deal with their fears, and to incorporate strategies for psychosocial support, and safe working environments. The single-minded focus on COVID-19 exacerbated these fragilities, resulting in a de facto health system lockdown and reported collateral damage. The key informants identified missed opportunities to invest in primary health care, partner with communities and to include the private health sector in the pandemic response.
conclusionGauteng province should build on the innovations of the multi-sectoral response to the COVID-19 pandemic, while addressing the contested areas and health system fragilities.
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