Podcast: COVID-19 in South Africa - “Invest in trusting relationships”

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Welcome to episode three of Policy in Pandemics, a podcast where we are speaking to leaders and policy makers around the workd about the policy challenges of Covid-19.

Having looked at the crisis in Albania and Pakistan in episodes one and two, this week we shift our focus to South Africa, specifically the Western Cape province which is home to Cape Town and is the current epicentre of the crisis in the country. Our guest is Beth Engelbrecht, who was due to retire as Head of the Health Department for Western Cape in March, but has stayed on to help lead and coordinate the response to Covid-19.

In the discussion we focus on the public health dimensions of Covid-19 response, but explore the particular challenges of the response in the South Africa context. Aside from the complexities of the virus itself, the response has had to take account of massive economic inequalities, the challenges of social distancing on public transport and in townships, large vulnerable populations with TB and HIV, and the ever present social and economic legacies of Apartheid.

We hear about the race to get the health system ready for the virus’ onslaught; about overcoming resistance to behavour change; about the social hardships of lockdown in townships like Khayelitsha; the difficulty in moving resources and budgets to fund the response; and the need to protect health workers who are on the front line.

Beth’s insights are fascinating. Among the most fascinating are her comments about dispersed leadership, and the importance of the existing health and social ‘infrastructure’ that has helped South Africa manage the enormous challenges above. As she explains, ‘dispersed leadership’ means that everyone involved in the response is expected to exercise leadership at their level. It is an alternative to traditonal government ‘command and control’ which makes people in the system fearful to experiment. Dispersed leadership gives people at every level freedom to work in terms, make mistakes, learn and adapt. This echoes important lessons and writing from the Ebola epidemic and on this crisis.

On the health and social infrastructure, we learn that South Africa’s extensive experience with communicable diseases like measles, diptheria, Congo fever and others has created a wide network and system of community health specialists and outbreak response teams who have powerful and deep relationships in communities. These have been reinforced by volunteers from universities and NGO community health workers. This know-how has helped South Africa been more agile and effective in its response.

At the end, Beth provides her parting advice for other public health leaders: prepare well. Make sure your data is good. Set up “a network of teams that are connected”, who can coordinate and work together and make decisions. Above all, invest in trusting relationships.

Here is the full version of 'No Pata Pata' mentioned in the podcast: