South Africa has accounted for well over half of all COVID-19 cases and deaths in the WHO African region. Soon after the first case of COVID-19 was confirmed on 5 March 2020, the President of South Africa declared a state of national disaster on 15 March, enacting a series of stringent public health and social measures. All WHO South Africa staff were immediately repurposed for COVID-19 incident management. In line with the vision of WHO-AFRO Transformation Agenda and the WHO General Programme of Work 2019-2023 of bringing impact on the ground, the WCO team was swiftly deployed to the COVID-19 response. When the first wave of the pandemic in South Africa peaked in July 2020, the Department of Health requested WHO’s additional technical support towards the response. With coordination from the global, regional, and country levels of the Organization, by August 2020, 27 international experts, 12 locally recruited experts, and 19 WHO Country Office (WCO) staff comprising the surge teams were stationed in eight of nine provinces and at the national level. Human resources were managed efficiently as experts were assigned according to the specific needs of each province across areas including coordination; risk communication and community engagement; epidemiology and surveillance, data and information management; infection prevention and control; case management; and operations support.

Among many deliverables, the WHO Team was tasked with a review of the COVID-19 response. One national-level and eight provincial reviews were conducted using the WHO Intra Action Reviews (IAR) methodology in collaboration with the National Department of Health (NDoH), Incident Management Team (IMT), and Provincial Departments of Health.  The IAR provided an opportunity for the officials engaged in COVID-19 response to review and reflect what worked well (or not) and why. A number of good practices were identified: whole-of-government response with clear, strong leadership from the NDoH; coherent evidence-based response strategy; synergistic partnership with the private sector; and the rapid scale-up of laboratory capacity with widespread community screening and testing. However, discussions also revealed that the IMTs were fragmented and operated in silos and that critical pillars, such as the continuity of essential health services were overlooked in the provincial-level IMT. Further, there was a disconnect between national and provincial IMTs in planning and implementation of key interventions.

These reviews culminated into activities and action-oriented recommendations for implementation by different stakeholders. More concretely, the IAR informed the development of national and province-specific resurgence plans with support from the NDoH and WHO. These resurgence plans enabled a better coordinated response at both provincial and district levels during the second wave of the pandemic (November 2020–January 2021), and contributed in shortening the duration of second wave despite the higher number of cases and deaths.  Furthermore, the IAR resulted in the inclusion of continuity of essential health services as a key priority within provinces. Several long-term recommendations were also made from the national and provincial IAR that aimed to strengthen the health system capacity in public health surveillance and data management. Other recommendations on the Infection Prevention and Control Programme and the human resources management (particularly for field epidemiologists) for implementation of the International Health Regulations continues to contribute to improved health security in South Africa.

The IAR and its impact truly highlighted the importance of open and structured review as well as sound monitoring and evaluation practices. As exemplified in the case of South Africa, an evidence-informed introspection has allowed for a more thoughtful, efficient, and comprehensive response to the pandemic and is an exceptional example of broader WHO goals to work towards a more effective and efficient Organization in supporting countries.

Photo caption: WHO supporting Intra Action Review in the Eastern Cape province of South Africa.

Photo credit: WHO