What Is COVID-19 Teaching Us About Community Health Systems? A Reflection From a Rapid Community-Led Mutual Aid Response in Cape Town, South Africa

Document Type : Perspective

Authors

1 School of Public Health, University of the Western Cape, Cape Town, South Africa

2 Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has exposed the wide gaps in South Africa’s formal social safety net, with the country’s high levels of inequality, unemployment and poor public infrastructure combining to produce devastating consequences for a vast majority in the country living through lockdown. In Cape Town, a movement of self-organising, neighbourhood-level community action networks (CANs) has contributed significantly to the community-based response to COVID-19 and the ensuing epidemiological and social challenges it has wrought. This article describes and explains the organising principles that inform this community response, with the view to reflect on the possibilities and limits of such movements as they interface with the state and its top-down ways of working, often producing contradictions and complexities. This presents an opportunity for recognising and understanding the power of informal networks and collective action in community health systems in times of unprecedented crisis, and brings into focus the importance of finding ways to engage with the state and its formal health system response that do not jeopardise this potential.

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Main Subjects


  1. Sacks E, Morrow M, Story WT, et al. Beyond the building blocks: integrating community roles into health systems frameworks to achieve health for all. BMJ Glob Health. 2018;3(Suppl 3):e001384. doi:10.1136/bmjgh-2018-001384
  2. Collective C, Schneider H. Lenses, Metaphors and Research Priorities on Community Health Systems. Report of Workshop, Chaminuka Lodge, Lusaka, Zambia, June 10-14, 2019.Published2020.
  3. City of Cape Town. 2020. https://wazimap.co.za/profiles/municipality-CPT-city-of-cape-town/.
  4. Rajan D, Koch K, Rohrer K, et al. Governance of the COVID-19  response: a call for more inclusive and transparent decision-making. BMJ Global Health. 2020;5(5):e002655. doi:10.1136/bmjgh-2020-002655
  5. Whyle E, Ryneveld MV, Brady L, Radebe K. Sparks, flames and blazes: Epidemiological and social firefighting for COVID-19 . Daily Maverick. April 24, 2020. https://www.dailymaverick.co.za/article/2020-04-24-sparks-flames-and-blazes-epidemiological-and-social-firefighting-for-covid-19/.
  6. Sheikh K, Schneider H, Agyepong IA, Lehmann U, Gilson L. Boundary-spanning: reflections on the practices and principles of Global Health. BMJ Glob Health. 2016;1(1):e000058. doi:10.1136/bmjgh-2016-000058
  7. Leach D, K. The Iron Law of What Again? Conceptualizing Oligarchy across Organizational Forms. Sociological Theory. 2005;23(3):312-337.
  8. Cornish F, Campbell C, Montenegro C. Activism in changing times: reinvigorating community psychology – introduction to the special thematic section. Journal of Social and Political Psychology. 2018;6:526-542. doi:10.5964/jspp.v6i2.1111
  9. Gaventa J. Finding the Spaces for Change: A Power Analysis. IDS Bulletin. 2006;37(6):23-33. doi:10.1111/j.1759-5436.2006.tb00320.x
  10. Miraftab F. Insurgent Planning: Situating Radical Planning in the Global South. Planning Theory. 2009;8(1):32-50. doi:10.1177/1473095208099297

Articles in Press, Corrected Proof
Available Online from 01 September 2020
  • Receive Date: 06 July 2020
  • Revise Date: 13 August 2020
  • Accept Date: 22 August 2020