Public health surveillance perspectives from provincial COVID-19 experiences, South Africa 2021.

Previous pandemics, recent outbreaks, and imminent public health events are a clarion call for functional public health surveillance systems that timeously detect public health events, guide interventions, and inform public health policy. We reviewed the Eastern Cape Provincial coronavirus disease 2019 (COVID-19) surveillance approach to determine best practices and opportunities to strengthen public health surveillance. We conducted a document review of COVID-19 surveillance reports, tools and guidelines prepared between March 2020 and November 2021. Iterative content and thematic analysis were applied to identify strengths and shortcomings of provincial COVID-19 surveillance. Strengths and shortcomings of the provincial COVID-19 surveillance process, and human, technical, and technological resources for surveillance were described. The existence of local surveillance networks, local availability of national-level surveillance guidelines, the ability to describe and track COVID-19 epidemiology, and provincial access to a national, web-based centralised COVID-19 surveillance data system were strengths identified. Shortcomings included poor data quality, data disharmony between sub-national reporting levels, under-resourced surveillance capacity at district level, and suboptimal use of the routine surveillance system for COVID-19 surveillance. The review determined the need for a web-based, integrated surveillance system that was agile in meeting evolving surveillance needs and accessible at all health reporting levels for response and decision-making. Contribution: The review identified opportunities to advance the existing routine public health surveillance system and improve public health surveillance and response. This qualitative review articulates local knowledge that should be translated into strategies and actions to bolster public health preparedness.