A report by the Rural Health Advocacy Project (RHAP) has exposed the devastating aftermath for health systems countrywide of the COVID-19 pandemic, which disrupted routine services ranging from childhood immunisation to tuberculosis screening, the most affected being rural provinces that are now paying the price.
South Africa has seen several outbreaks of childhood diseases in some of these areas this year, including measles and whooping cough, which researchers have attributed to a fall in vaccination rates.
About a third of the country’s population inhabits the rural areas, and while, for example, childhood vaccination programmes declined in most provinces, the biggest knock in the number of fully jabbed children was recorded in the Northern and Eastern Cape, as well as Mpumalanga, said the report’s author Samantha Maughan.
The government’s lockdown restrictions, for a time, shut down all but essential health services. Simultaneously, many people delayed seeking care for non-emergency conditions, either because they were unable to travel or from fear that they might contract the virus in a health facility.
“The implications are enormous,” Maughan told Business Day. “There is a possibility of resurgence of diseases that could potentially pose a large burden on the health system in the future.” Childhood vaccination levels were suboptimal before the pandemic and were further damaged by the vaccine hesitancy during the national COVID-19 vaccination drive, she added.
Vaccine coverage for highly infectious childhood diseases needs to be extremely high to achieve herd immunity and prevent outbreaks, with measles, for example, requiring coverage of 95%.
The greater Sekhukhune area, which had a measles outbreak in October, saw immunisation coverage for the first dose fall from 87% to 64% between 2017 and 2022, and from 86% to 60% for the second dose over the same period, according to the National Institute for Communicable Diseases.
“The report demonstrates … the response to COVID, was inequitable and the burden of the pandemic was disproportionately borne by the poor,” said RHAP director Russell Rensburg.
“As we start rebuilding our health system, we have an opportunity to strengthen primary care with a particular focus on diagnostic availability, more proactive vaccine roll-outs, and improved governance that puts the community most affected at the centre of the response rather than as subjects of a response,” he said.
RHAP project co-ordinator Sihle Mahonga said SA’s TB programme was “still reeling” from the pandemic, due to a sharp drop in diagnostic testing and delays in getting laboratory results. “An estimated 304 000 people were infected, and 64 000 perished in 2021 alone,” she said. There were also declines in testing for HIV, and non-communicable conditions such as diabetes, high cholesterol, and thyroid disease, she said.
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