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By Cheryl Kahla

Content Strategist


Covid-19’s effect on health system punished poor the hardest

South Africa can't just 'move on' from Covid-19 without absorbing valuable lessons.


The Rural Health Advocacy Project (RHAP) on Monday released a report highlighting the inequities in South Africa’s current health system and how it was impacted by the Covid-19 pandemic.

The ‘Health System Strengthening Post-Covid-19’ report reveals the effect the response to Covid-19 had on other essential health services.

Covid-19 impact in SA

Strengthening health system post-Covid

RHAP director Russell Rensburg said the “report demonstrates, despite many successful collaborations, the response to Covid-19 was inequitable and the burden of the pandemic was disproportionately borne by the poor”.

Rensburg said rebuilding the health system provides an opportunity “to strengthen primary care with a particular focus on diagnostic availability, more proactive vaccine roll-outs, and improved governance”.

Some of the negative effects include the decline of childhood immunisation across all provinces, as well as testing for HIV and TB.

HIV and TB testing in SA

RHAP found that HIV and Tuberculosis (TB) testing declined during the pandemic and has not yet returned to normal in 2022.

Moreover, the decline in testing “has significant implications for treatment initiation, linkage to care
and reducing transmission of these infectious diseases”, the report states.

South Africa had a robust HIV and TB testing infrastructure before the pandemic, backed by large investments and extensive research.

The health system had enough resources and personnel to easily weather the pandemic, however, people were reluctant to visit facilities for fear of being exposed to Covid.

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Decline in childhood immunisations

Another impact of the Covid-19 pandemic was the decline in the number of fully-immunised children in seven out of SA’s nine provinces.

As per the research done by RHAP, the largest declines were recorded in the Northern Cape, Eastern Cape and Mpumalanga, “which are considered to be rural provinces”.

“This decline in childhood immunisations was especially notable in lockdown periods. It is possible that vaccine hesitancy around the COVID-19 vaccine may have an effect on childhood immunisations as well.”

Advancements and innovations

The outcome wasn’t all negative. RHAP said the report “also highlights the many innovations that came out of this health crisis”.

Going forward, these innovations could be used to improve health system resilience, and these lessons will assist in strengthening South Africa’s health system.

Drive-through testing sites and mobile units

Some of these innovations include drive-through testing sites in SA, which minimises contact between healthcare workers and the public.

However, only those who could afford private testing (and who had access to a vehicle) could utilise these services – it would most like be inaccessible to the majority of South Africans.

Meanwhile, mobile testing units “demonstrated substantially decreased testing turnaround times (TAT) compared to central laboratories, when using rapid testing technology”.

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Covid-19 mobile apps

The COVID-Connect app also enable South Africans to access health checks and other information pertaining to test alert.

That said, not everyone has a smartphone and the cost of data and airtime – coupled with the public’s general mistrust with how privacy is protected – limited the app’s usage.

RHAP recommendations

In order to overcome these disruptions, the RHAP recommends agile and adaptive governance.

This would include developing “a variety of response strategies prior to a public health emergency to allow for greater adaptability in emergency response”.

Government should also “plan for contingencies based on the lessons learnt from Covid-19 to ensure pandemic preparedness and a resilient health system”.

The report also highlights recommendations pertaining to medical technologies, the health workforce, and service delivery.

The research “included a literature review and data analysis”, and includes an analysis of Covid-19 data from 1 March 2020 to 25 June 2022.

The report can be viewed here in its entirety.