OPINION | Covid-19: We need long-term solutions and a more resilient healthcare system

Disease-specific programmes can only be effective with the support of a health system that allows provision for basic, day-to-day health requirements, writes Zamanzima Mazibuko.

South Africa’s context, together with the dire socio-economic factors that many South Africans live under, should be at the forefront as we navigate our way through the coronavirus (Covid-19) pandemic that has spread globally and that has been growing by day in our country.

Not only does our country have to contend with the quadruple burden of an HIV/AIDS epidemic, a high burden of TB; high maternal and child mortality rates; high levels of violence and injuries; and an increasing burden of non-communicable diseases, South Africa also has a weakened healthcare system that struggles to provide day-to-day health services.

This context matters and is crucial when considering and planning for any eventualities. 

The government has put in place guidelines for how the country should manage the spread of Covid-19 and as decisive as it may be, it does say enough on how the poor will be protected.

Our reality is that an estimated 49.2% of the adult population (30.4 million) lives below the upper-bound poverty line and only about 44.4% of South Africans have access to water inside their dwelling.

About 30% of households have taps within their stand and the remaining make use of communal taps and natural water sources such as rivers and dams.

Poverty and inequality have been linked to vulnerability to infection. 

In addition, there are approximately 7.7 million people living with HIV in South Africa. People who are immuno-compromised do not fare well with Covid-19.

It is thus important that when government drafts a strategy for containing the spread of COVID-19 it has a broad and inclusive approach to how these communities will be guarded.  

The need for a syndemics approach for the management of disease and outbreaks is quite apparent.

A syndemics approach is one that recognises that political dynamics, socioeconomic issues as well as environmental factors contribute to the outbreak and management of disease.

Additionally, the quality of nutrition and not just food security plays a big role in disease management.

Focusing only on the biomedical aspect of containing a pandemic, albeit extremely important, means those other factors fall through the cracks.

Researchers in the Mapungubwe Institute for Strategic Reflection’s (MISTRA’s) book, Epidemics and the Health of African Nations, found that a more effective strategy would be to integrate the biomedical approach with an understanding of, and actions aimed at, structural factors closely associated with susceptibility to disease.  

For instance, one of the major guidelines for managing Covid-19 is the frequent washing of hands.

In a country with the above-mentioned statistics for availability of clean and reliable water this will prove difficult.

We know that a strong immune system helps fight Covid-19 but with such a large proportion of people living below the poverty line, how will we ensure they are provided with good quality nutrition and medication for other underlying conditions?  

It is important to highlight that diseases do not occur, spread or endure in isolation.

Diseases like HIV, TB and others interact with one another.

With the burden of epidemics being worsened by a significant increase in non-communicable diseases such as heart disease, stroke, cancer, and diabetes it's even more important to consider the increased risk of the relationship between these diseases and Covid-19.

The interaction of diseases can worsen the adverse effects of each of the diseases.

The impact of this interaction can be further aggravated by the social, economic, environmental, and political conditions within a population.  

Furthermore, it is important to ensure that with the introduction of systems and programmes to combat Covid-19 the routines of care for chronic patients continue being given due consideration.

Treatment of, and vaccinations against, other infectious diseases needs to remain a priority to prevent additional outbreaks.

Disease-specific programmes can only be effective with the support of a health system that allows provision for basic, day-to-day health requirements. 

The health system should manage both chronic conditions and the Covid-19 outbreak. 

All these actions require swift and decisive leadership and governance to play a massive role in managing the outcomes of Covid-19, even within a weakened and under-resourced health system.

Leadership should come not only from the national Department of Health, but also other government departments implicated in the provision of essential services, as well as the private sector and civil society.

The objective should be to find not only long-term solutions for the control and elimination of Covid-19 in South Africa, but also to build a resilient health system that can manage any future outbreaks as well as routine healthcare, without always scrambling for resources. 

- Zamanzima Mazibuko is a Senior Researcher in the Knowledge Economy and Scientific Advancement faculty at the Mapungubwe Institute for Strategic Reflection (MISTRA)