Sitting in the sun outside Winnie Mandela clinic in Thembisa in mid-August, a group of community care workers carefully packed gloves, face shields and hand sanitizer away in their bags. Some pulled out medical-grade masks from a full month’s supply and put them on for the very first time since the Covid-19 pandemic hit South Africa’s shores six months ago. Until this moment they’d been wearing whatever they could find. They received the personal protective equipment (PPE) thanks to a massive and multi-faceted civil society initiative called Masked Heroes, and their relief at finally having supplies was palpable.
The 35 healthcare workers represented one group of thousands around the country — community health and emergency service workers, child and youth care workers; social workers and social auxiliary workers; food and relief workers — responsible for looking after the most vulnerable in South African society. With little support, most also found themselves ill-equipped to deal with the enormity of providing essential care during the pandemic.
Esther Ngubeni, a healthcare worker for over a decade, said that when the number of Covid cases began to rise, she had had to choose between her patients in Kempton Park, a four-taxi commute from home, and the safety of her 12-year-old son. The risks of being exposed to Covid-19 without a mask and gloves were simply too high: Ngubeni decided to limit her work to the confines of her local clinic. Even there, her ability to provide care was stunted by the ongoing lack of PPE.
That changed with the roll-out of the Masked Heroes campaign.
“This PPE is going to help us assist even the people who walk into the clinic,” said Ngubeni. “Often you’ll find that some of them are really sick and in urgent need of medical care, but they aren’t allowed into the clinic because they don’t have masks. So, now we are able to supply them with ours so they can access the help they need,” she said.
“Ezi zixhobo zizakunceda kwa aba bantu baze kwanompilo, ngoba kumaxhesha amaninzi kungena abantu abagula kakhulu nabadinga uhoyo olukhawulezileyo,” utshilo uNgubeni. “Kodwa ngenxa yokuba bengenazo izikhuseli-buso abavunyelwa ukuba bangene kwanompilo. Ngoko sizakutsho sikwazi ukubanceda sibanike kwezi zethu ukuze bafumane uncedo abaludingayo.”
In April, President Cyril Ramaphosa announced a R500-billion relief fund to ameliorate the devastating effects of the Covid-19 pandemic on both society and the economy. As the number of positive cases began to tick up, roughly R50-billion of that fund was earmarked for emergency medical relief, PPE procurement, and distribution. But long-standing members of civil society had already seen the writing on the wall.
“As Covid approached, we looked at the national priorities we felt wouldn’t be on anyone else’s radar,” said David Harrison, the CEO of the DG Murray Trust, a public innovator committed to “developing South Africa’s potential through strategic investment.” Before the pandemic, the foundation was predominantly focused on early childhood development and societal inclusivity, but quickly adapted its considerable systems and community networks to anticipate the inevitable gaps in service delivery and meet them head on.
Access to vital information in local languages about Covid-19 was an obvious need. So was access to the internet, particularly for learners who would soon be unable to attend school, said Harrison.
But the more complicated and pressing needs quickly became the provision of food to an increasingly hungry nation, as well as PPE and psychosocial support for the estimated 120 000 community care workers around the country. With supplies of masks stretched thin by global demand, Harrison’s team predicted that community care workers would be at the bottom of the recipient list. Within weeks they were proven correct.
“We knew it was likely that the PPE would go to the public sector and that no one was thinking about the NGO sector, despite the crucial role it plays” said Harrison. “We decided to take a bottom-up approach… That’s how the Masked Heroes programme was born.” he said.
As far as Harrison was concerned, it wasn’t just about PPE — it was about protecting community care workers. That means ensuring access to localised information in different languages, mental health services, as well as platforms for care workers to share their experiences, and be recognised for their efforts. “We wanted to set a precedent for how to manage Covid-19 and other disasters going forward,” he said.
But even a civil society veteran like Harrison couldn’t have anticipated the scale of the challenges in attempting this worthy cause that he and his team — and the country — were about to encounter.
Facing the Wave
Walking into a brand new job at DGMT just two weeks before lockdown, Sinazo Nkwelo suddenly found herself in the role of project manager of the Masked Heroes campaign. It was quickly becoming a massively ambitious and multi-pronged national project. She got straight to work.
First and foremost, the campaign required a team with a diverse skill set. Those working on the communications and awareness campaigns segments of the programme got things off the ground quickly. But the PPE procurement portion got stuck in the increasingly politicised Covid response arena almost immediately. Instead of fast-tracking innovation and capacitating local businesses to manufacture and distribute PPE, government turned to its usual tender procurement system, without tailoring it to respond to the extraordinary disaster. This was quickly flooded with politically connected and massively inflated contracts, with fragmented engagement with Chinese authorities instead of the government setting up a bi-lateral agreement that would assure quality goods and fair pricing.
“Government is preoccupied with B-BBEE, not distribution,” said Nkwelo. “What you end up essentially creating is not local production capacity, but a middle-man sector that’s simply importing PPE from China and charging [the taxpayer] a massive premium,” she said.
“When you procure from China you have to be strict about quality control specifications so the PPE doesn’t get held up going through a second certification process when it reaches South Africa. A lot of it was getting turned around and sent back, or worse, dumped in our landfills.”
In applying for funding and PPE procurement rights from the Solidarity Fund — a public-private partnership between government and business to provide Covid-related relief — DGMT quickly learnt that the process would be hamstrung by similar issues, as Business4South Africa (B4SA) sought to operate within the procurement framework of government. After two months the health worker masks, gloves and gowns ordered by DGMT had failed to materialise, and the organisation decided to procure PPE independently.
Already weeks behind, the team set up a two-phased approach: establish new relationships with Chinese manufacturers to speed up importation; and find innovative local businesses that could provide or adapt their existing and idle businesses to manufacture PPE on home soil.
All hands on deck
Reza Khader was working as a physiotherapist in a KwaZulu-Natal hospital when the pandemic hit, and he witnessed just how quickly PPE shortages came into effect. His family business, REDAK Investments, has been manufacturing medical supplies since 2016. The company immediately escalated production of PPE to meet demand, but were incredulous when their sales started dipping instead of increasing.
“Going by what we were seeing on the tender supply database, it was only a few who were benefiting from the funding allocated by government, despite the fact that we were manufacturing quality South African products at a fair market price,” said Khader’s brother and head of operations, Zaid Khader. “There are so many facets to a supply chain like this, all of which provide jobs for local people instead of just importing bad quality supplies through tenderpreneurs” he said.
When DGMT approached the Khaders for 50 000 face shields, they were able to provide them within a week, at a fraction of the cost.
“When we heard the shields were going to the Masked Heroes campaign, we dropped our invoice to the lowest cost price. We wanted to help the community and we figured it was better to see them being used where they were needed instead of just sitting in the warehouse,” Reza Khader said.
Next, the team found a business in the Western Cape called Stellenbosch Nanofiber Company (SNC), a scientific material innovator producing cutting-edge products for the global medical and cosmetic industry, using proprietary nanofiber technology.
“We’d deliberately never made nanofiber filters before, but sitting at home in the first week of lockdown we decided to see if we could contribute to combatting the surgical mask shortage,” said SNC CEO, Dr Eugene Smit. “By spinning nanofibers onto polyester fabric we found we could produce high quality, medical-grade reusable masks to counteract the single-use aspect of surgical masks, which creates waste management problems and can present health and environmental threats,” Smit said.
After verifying quality standards, DGMT put in an order for 1.5-million filters, an amount so significant it has taken the company more than five months to fulfil, despite using only local materials and hiring 70 new staff from the surrounding community. The mask filters can be sterilised with boiling water and reused up to nine times, meaning 13.5-million single-use masks can be kept out of landfill – and the daily cost of PPE provision greatly reduced.
“If we were not in this situation we would also have been sitting at home. Instead we have been able to focus on something constructive to do, knowing that it will make a difference and proving that not everything is doom and gloom,” said Smit.
For 53-year-old machinist Felicia Stringer, a school tuckshop manager laid off by the Covid-19 lockdown, the opportunity to do more than piecemeal work during lockdown, while contributing towards lowering PPE procurement rates, came as a relief to her and her family.
“I saw the advert for a factory machinist and jumped at the chance,” said Stringer. For me, every opportunity is one well-spent, and I’m very grateful for this one. It has been an exciting and interesting journey,” she said.
“Ek het die advertensie vir ‘n fabrieksmasjinis gesien en daarop gespring,” sê Stringer. “Vir my is elke geleentheid een wat goed bestee is, en ek is baie bly daarvoor. Dit is ‘n opwindende en interessante reis gewees,” sê sy.
Community care for community workers
With procurement underway, the Masked Heroes team began to focus its attention on arguably the more complex and time-consuming part of the process: Getting all these resources safely and transparently into the hands and homes of community care workers around the country.
Prominent South African activist and writer Elinor Sisulu is a former board member of the waste tyre management initiative, REDISA. The NGO had also seen the warning signs in January and realised that neither community care workers nor their vulnerable patients were likely to gain access to PPE via traditional procurement channels. Sisulu put REDISA, which has many years’ experience working with governments to implement circular economies and community logistics programmes, in touch with DGMT, and on March 24 plans for distribution rolled into action.
Working alongside Coca-Cola in utilising its unparalleled distribution networks across South Africa, REDISA customised their existing logistics system so that they could track the movement of PPE from warehouses to community care workers countrywide.
NGOs working with care workers were invited to apply to the Masked Heroes team, who vetted them and their capacity to receive and distribute PPE. After a rigorous process, 326 organisations were deemed eligible to take part.
“Rolling out PPE has to be driven by demand, so we had to work through DGMT’s existing networks to get reliable data and ensure the eligibility of NGOs” said REDISA director, Stacey Jansen. “Otherwise there’s risk involved when you don’t have supply linked to real demand, especially when it comes to something as precious as PPE,” she said. “PPE is the gold of this pandemic.”
With Coca-Cola storing the growing piles of PPE, the REDISA team handled the route planning for deliveries to community connectors, and implemented a mobile database and SMS PIN system linked to each community care worker’s phone.
Despite many challenges and delays, the first of four PPE distribution drives rolled out in late July, bringing a month’s supply of masks, gloves, sanitisers and face shields to tens of thousands of relieved care workers. And the next rounds will be simpler.
The last six months have proved to be a major learning curve for the NGO sector, said Harrison.
“Over the past decade, we NGOs have allowed ourselves to be pigeonholed into becoming service providers to government and not necessarily to citizens,” he said. “The response to the pandemic has exposed the need to band together as equal partners and be viewed as equal partners. We might not be able to do this work forever, but we feel we have shown what can be done in procurement and distribution going forward.”
Good thing, Harrison cautioned. “This won’t be the last time we’ll need it.” DM