The stealth, speed and scale of SARS-CoV-2 contagion and mutation has demanded the management of isolation versus exposure, while enforcing involuntary introversion when connection is most needed. 

A multitude of old and new challenges, risks and contradictions for health care in South Africa have been stripped bare, many compounding the underlying and pre-existing resource and system constraints, deficiencies and inertia analysed in previous editions of Health Systems Trust’s annual South African Health Review (SAHR). 

The content of the 2021 edition of the SAHR − released on 22 April 2022 in partnership with the University of KwaZulu-Natal’s Health Economics and AIDS Research Division − addresses the question “Covid-19: what have we learnt?”

Approaches and interventions for policy reform and crisis management in this context have to deal with not only health outcomes following infection with the Coronavirus as a biological entity, but – in tandem – to project, assess and model for primary and secondary health and economic risk scenarios, while ensuring preparedness for the unquantifiable intensity of infection surges and virus variants, among other future shocks to national systems.

The destabilisation wrought by the epidemic and measures for its containment in South Africa have exposed society to all of the hardship and unmet needs affecting the majority of our population: unemployment, poverty, food insecurity and hunger, crowded homes and public transport, and limited or no access to basic services; the distinctive vulnerabilities of homeless, migrant and undocumented persons, rural communities, the elderly, health workers, women, people with disabilities and those with mental health conditions, tuberculosis, HIV, substance addiction and non-communicable diseases; and a fiscally constrained environment assailed by budget crucibles − all of which subdue the quality of care.

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Through considered analyses within their specialities, the authors of chapters in the SAHR 2021 have illustrated how health system actors have accepted this uncertainty as normative, and focused on what can be controlled and created – working pragmatically to shape and establish buffers across a range of focus areas that mitigate structural weaknesses, and to coalesce valid information that accelerates important decision making amid a vortex of evolving health system dynamics and parallel pressures.

The need for strong, equitable and people-centred health systems grounded on universal health coverage has never been more urgent, as Covid-19 has catalysed serial days of reckoning in terms of who is left behind. As envisioned by Health Systems Global in its October 2021 outline of HSR2022 − the 7th Global Symposium on Health Systems Research – “the challenge ahead goes beyond the key function of service provision, and should focus on the role of values such as trust, solidarity, equity, and social justice”.

Several of this year’s SAHR chapters describe how service policies, protocols and practices are indifferent to vulnerable populations or are not adequately designed to achieve equal access to health care. Covid-19 is spurring change towards instilling our health systems with more inclusive and responsive content.

In his article entitled ‘We see you: In honour of the unrecognised and out-of-sight people of the year’, Mark Heywood points out that in measuring the impact of the pandemic, communities and non-governmental organisations have much to teach us about new ways of sharing and using information towards action. Civil society should not be bypassed in this process. 

We see you: In honour of the unrecognised and out-of-sight people of the year

Nor can these efforts be piecemeal. Nimako and Kruk, in a Viewpoint piece published in The Lancet, urge for a holistic approach: “Governments and entrepreneurial leaders, supported by citizens, health professionals, and global development partners, have an opportunity to channel the attendant energy, attention, and funding into a meaningful shift towards high-quality health systems.”

By synthesising evidence to meet knowledge needs, the SAHR serves as a publication hub for institutionalised learning on implementation science. The contributing authors are subject specialists working in the formal public health sector, parastatal organisations, scientific councils, non-governmental organisations, academia, and bilateral and multilateral support agencies, assisted wherever feasible by less-experienced researchers as a means of capacity development.

Throughout this edition runs a rich seam of argument for intersectoral and interdisciplinary collaboration, and integrative governance for coordinated responses to systemic risk, with a focus on the salient values of community and agency – a whole-of-society response in which we learn and work together. 

The challenge of this pandemic is not merely the human body’s inability to ward off and heal from Covid-19 infection – in a collective sense, it is the body of humanity’s failure to ensure optimal and equitable wellbeing in society. We are the virus, and its outbreak is instructive of the idea that our social, economic, political, environmental and moral immunity has long been compromised. 

It is through synchronised endeavours on a vast scale, in which every convergent component is reliably effective, that a global foe can be defeated. While it is tempting to analogise the pandemic with a war effort, we should be wary of such metaphors. 

In choosing the universal regeneration of human health in a forward trajectory against all pandemic risk, we should instead use the language and stance of enquiry and enlightenment through transparent engagement and inclusion. DM/MC

To read the full publication, click here and for Chapters-at-a glance, click here.

Judith King is the Copy and Content Editor: SA SURE.