Perspectives of senior health managers on COVID-19 response and challenges, lessons learned and opportunities against future outbreaks in Gauteng province, South Africa.

backgroundThis study explores senior health managers' perspectives on COVID-19 response and challenges, lessons learned, and opportunities in Gauteng, one of the most affected provinces in South Africa, and further presents recommendations for health systems strengthening, preparedness, and effective response against future infectious outbreaks or pandemics.

methodUsing a qualitative exploratory study, online in-depth interviews were conducted with purposively selected senior managers from the Gauteng Department of Health (GDoH) who were at the forefront of managing the pandemic. Recordings were transcribed verbatim, and saturation was reached with thirteen interviewees (n = 13). Thematic and inductive analyses were performed in NVivo 10 and reported following the Consolidated Criteria for Reporting Qualitative Research (COREQ).

resultsThe findings are presented in four main themes, namely: GDoH's response to the COVID-19 pandemic, COVID-19-related challenges, lessons learned and opportunities from COVID-19, and participants' recommendations on dealing with future pandemics. The managers' perspectives suggest that GDoH's response to COVID-19 was comprehensive, multi-sectoral, and effective through public awareness, the War Room/nerve Centre that managed the response, resources mobilization like the recruitment of additional nurses and doctors, and vaccination. The challenges included the adverse effects of "long-COVID" and mental health, demised health workers, corruption and embezzlement of COVID-19 funds, high cost of living, and gender-based violence associated with COVID-19. The lessons learned included the importance of technology, surveillance, and data analytics during crises, improved hygiene-like hand washing, to mitigate infection transmission, and the urgency to build resilient health systems. The pandemic also highlighted the need for inclusive and collaborative public-private partnerships in the National Health Insurance (NHI) implementation. Participants' recommendations for dealing with future outbreaks included improvements in ICT, the need for social media regulation, working remotely, pandemic incentives for health workers, improved and accountable leadership, addressing corruption and the need for further COVID-19 research.

conclusionAccording to the health managers interviewed in this study, the GDoH response to COVID-19 appeared to be resilient, comprehensive, multi-sectoral and effective despite the challenges emanating from the pandemic. Although the pandemic harmed the health system, lessons were learned with opportunities for leveraging the impact of future outbreaks, particularly as South Africa is in the process of providing universal health coverage, pronounced through the NHI. CLINICAL

trial registrationNot applicable.