When the Covid-19 outbreak reached several regions of the world early last year, healthcare personnel were lauded for their "heroic" actions in combating the virus on the front lines, risking their own lives.
However, according to a new local study conducted in Gauteng, while healthcare workers may have received praise from various parts of society, they did not receive this admiration from health bureaucrats and politicians, instead feeling underappreciated and sidelined when it came to the Covid-19 response.
Interviews with front-line healthcare workers, senior managers, academics, unions, and the private sector revealed tensions in intergovernmental relations and problems caused by a hierarchical, top-down approach that ignored the views of healthcare workers and hospital managers in a first study to investigate the Covid-19 health system response at a provincial level.
The absence of contract negotiation, as well as views of rigidity and a highly centralised approach that resulted in confusion or duplication of tasks, were mentioned by many in the private health sector.
According to Wits University researchers, poor intergovernmental ties and tensions during the initial wave of the pandemic led in illogical laws and standards that hampered the Covid-19 response's implementation at both the clinic and hospital levels.
While many survey participants were grateful for the increased funds, digital innovations, and staff appointments provided as part of the Covid-19 response, many were worried about the lack of attention paid to the health workforce.
"Doctors are burned out," one of the doctors questioned for the study stated. "Nothing you do is truly recognized, morale is low, and there is minimal support... it is a really demanding emotional experience."
"Some healthcare personnel contracted Covid-19 and died as a result. "We could have paid a bit more attention to front-line health workers," a clinic manager said, adding that this included providing private transportation to healthcare staff to reduce the spread of illnesses. The healthcare personnel bemoaned the lack of front-line employee participation in the pandemic response.
"We should have been included in negotiations about how oxygen will be given to the [Covid-19] tent, and that is an issue," said a physician from one of Gauteng's key hospitals. "Sometimes you run out of oxygen during resuscitation," he said.
While Gauteng's novel Covid-19 approach, which attempted to save both lives and money by producing provincial modeling during the first wave, was praised, the analysis highlighted disagreements regarding the modeling method, resulting in an overestimation of Covid-19 cases. Later provincial choices, such as the building of field hospitals, were impacted by these projections. The epidemic not only revealed and magnified health-care system flaws, but it also "reflected in corruption on personal protective equipment, poor data quality, and improper judgments on self-standing field hospitals," according to researchers.
Participants stated that corruption is completely avoidable, and that "existing system deficiencies, combined with a lack of checks and balances, formed the ideal environment for corruption."
"They said that the alleged corruption was caused by a combination of centralised procurement, a lack of transparency, a lack of accountability, a failure to prioritize society benefit over self-interest, and a failure to recognize dangers."
Prof Laetitia Rispel, the lead researcher, stated that the Covid-19 epidemic has emphasized the significance of enhancing the country's crisis management system, including increased surveillance that can respond quickly and efficiently.
However, the rapid reaction to a pandemic may be distinguished from the long-term improvement of Gauteng's healthcare system.
"While solid systems are crucial, altering the culture of the organization is as critical." "Investing in people, challenging dysfunctional or weak management, encouraging employee agency and accountability, and rewarding ethical and professional behaviour will all be necessary," she added.
"By investing in and engaging with communities, civil society, and other stakeholders from the ground up, we can develop connections, assure ownership of solutions, and lessen opposition to change..."
Apart from poor intergovernmental relations, which resulted in fragmented communication and weak messaging between national, provincial, and local government, another major flaw of the Covid-19 health response in Gauteng was the damage caused by the virtual shutdown of the public healthcare system for essential health services such as HIV and tuberculosis, as well as maternal and child health, which resulted in unnecessary deaths.
There was a 25—50 percent decline in children's immunizations as a result of a halt in child health services there, according to the report, posing a danger of additional virus outbreaks such as measles.
But the widespread claims of corruption in the purchase of personal protective equipment had proved considerably more destructive (PPE). The PPE corruption incident, according to those questioned for the research, was a terrible event "that obscured the successes and strengths of the Covid-19 response in the province."
-Timeslives
