South Africa orchestrated its response to the COVID-19 pandemic at the highest level of government, the Presidency. Despite the strong leadership, the pandemic highlighted weaknesses in the country’s health surveillance system, underscoring the need for an integrated approach to public health intelligence.[1] In response to these challenges, South Africa, in close collaboration with the World Health Organization (WHO), embarked on a mission to reinforce its disease surveillance and response capabilities. The comprehensive response included evaluating the existing surveillance infrastructure, developing a national Integrated Disease Surveillance and Response (IDSR) strategic plan, and establishing Public Health Emergency Operations Centers (PHEOCs). The impact of these initiatives is far-reaching. South Africa is now better prepared and equipped to identify, prevent, and respond to future health emergencies. By aligning various stakeholders and leveraging global expertise, South Africa has significantly enhanced its system's effectiveness in preventing and controlling communicable diseases, thereby ensuring the health and safety of its citizens.[2] These efforts align with the second goal of WHO’s thirteenth global program of work on protecting populations from health emergencies as well as the country priorities for pandemic prevention, preparedness, and response.

“An integrated national surveillance system will further facilitate monitoring of epidemiological characterisation of priority diseases and inform deployment of tailored public health interventions.”

- Dr Joseph Wamala, Emergency Preparedness and Response Coordinator, WHO South Africa

How did South Africa, with the support of WHO, achieve this?

In 2023, the 'Health Security Partnership to Strengthen Surveillance in Africa' (HSPA) initiative was launched by the WHO Hub for Pandemic and Epidemic Intelligence, in collaboration with the WHO Regional Office for Africa, the WHO Regional Office for the Eastern Mediterranean, the Africa Centres for Disease Control, and the Robert Koch Institute. The initiative aims to support six National Public Health Agencies in Africa in enhancing their capacities for disease surveillance and epidemic intelligence. [3]

Under the HSPA funding, WHO South Africa and the WHO Regional Office for Africa, in partnership with the South African National Department of Health (NDoH), conducted a thorough evaluation of the existing surveillance and response systems, capacities, and resources. This extensive evaluation gathered insights from 658 stakeholders, including health officials from various levels, facility staff, and community health workers, ensuring a comprehensive understanding of the existing infrastructure and required improvements.

The assessment revealed that South Africa’s high-level response enabled an early, evidence-based, whole-of-government approach, but also highlighted the need for a cohesive and unified surveillance system for effective, evidence-based decision-making. In response, a national Integrated Disease Surveillance and Response (IDSR) strategic plan was formulated, becoming the cornerstone of South Africa's new surveillance strategy. WHO assisted in this process by recruiting a consultant to support the NDoH and partners in developing the plan, and by providing logistical support. The plan, which focuses on enhancing surveillance for priority diseases, was developed through a multi-sectoral effort involving various health authorities and experts, including the National Ministry of Health, the National Institute for Communicable Diseases (NICD), the South Africa Medical Research Council, the South Africa Health Products Regulatory Authority, and Statistics South Africa.

“As recent assessments of the COVID-19 pandemic and cholera outbreak have recommended, South Africa has embarked on the strengthening of the national surveillance system using the IDSR strategy to optimise capacities for detection and response to emerging epidemic and pandemic prone diseases.”

- Dr Owen Kaluwa, WHO Representative in South Africa

To implement the strategic plan effectively, WHO and South African health authorities collaborated to tailor the IDSR guidelines, tools, and reporting mechanisms to suit the local context. A key aspect of this adaptation involved 133 representatives from the National Department of Health (NDoH) participating in the adoption and adaptation of guidelines and training modules. This effort led to the initiation of training programs that equipped 150 Master Trainers from both national and provincial levels to disseminate the IDSR framework further to subnational levels.[4]

^{Trainings were crucial to improve disease surveillance and response through integrated surveillance in South Africa.}
Photo credit: WHO South Africa

The upskilling of health professionals and the rollout of the IDSR strategy were augmented by the strategic development of national multi-hazard plans and contingency strategies, with the WHO providing crucial technical support. This proactive approach significantly enhanced South Africa's capacity to monitor, respond to, and prepare for diverse health threats.

A pivotal step in establishing this advanced surveillance system was the creation of Public Health Emergency Operations Centers (PHEOCs) throughout South Africa.[5] WHO played a vital role in this process by hiring a consultant who offered technical support in conducting baseline assessments for PHEOCs at both national and subnational levels, developing PHEOC plans, leading executive management training, assisting in the formulation of the PHEOC manual and guidelines, and facilitating the procurement of necessary equipment for the operationalization of the national PHEOC. WHO remains committed to continue working with government and partners to implement all these priorities that are critical for enhancing the national capacities for health emergency preparedness and health system resilience.