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Pandemic lessons from community health systems

A nurse talks about her experience while her masked colleagues listen in the background

A professional nurse from the West Rand in Gauteng talks about the experience of being part of a Community Covid team.

Community health systems played a critical role in the response to the Covid-19 pandemic in South Africa. Civil society organisations were already strongly embedded in communities and enjoyed their trust at a time of uncertainty and confusion. The invaluable work done by community teams in screening, testing and vaccinating, as well as linking people to other needed services, has helped society to recognise the importance of community organisations and workers as part of the pandemic response.

With funding from the Global Fund, NACOSA deployed 43 Covid teams from community organisations including nurses, screeners, tracers, data capturers and drivers, to support government health services with education, screening, testing and tracing services. These organisations, as well as the organisations that are part of our community systems strengthening programme, shared crucial lessons on how community systems can help prepare for the next pandemic.


“There was a lot of confusion in the community, not too many people believed that COVID was real,” says Colin Van Wyk, the Director of Phambili, a community organisation that was part of NACOSA’s Covid-19 Community Response programme in the Western Cape.

“So we, being in the community – people trusted us when we said come for vaccinations. There was a trust element between civil society and the community.”

Community organisations successfully networking within communities was also mentioned in a focus group discussion NACOSA held with some of the Covid teams working in Gauteng. During the pandemic, organisations increased networking to share knowledge and skills through trainings that were conducted jointly. The field teams worked with many different structures – churches, political leaders, other organisations – which also helped to mobilise communities to test and get vaccinated. This network of community organisations proved strong. They supported each other and shared knowledge and resources openly. “We are coming from different organisations,” says Community Nurse Brenda Tsotetsi, from Sedibeng Sa Bophelo Community Project in Gauteng.

“They come with something that we don’t know about, and we know something, so when we are together, it helps us because we learn from each other.”

People on chronic medication, ARVs in particular, started to default during the various Covid surges as a result of less contact with health facilities. There was also a dip in HIV testing and TB screening because of the focus on Covid-19. However, those who were linked with of community Covid teams fared better.


“Just before the Covid pandemic, we were 35 networking organisations working together,” says Colin Van Wyk. “Twenty-nine of these organisations have actually closed down due to lack of funding. Especially through the pandemic, we needed each other.”

The Gauteng focus group participants also raised funding as a major challenge. Many organisations had to use funding for other activities to implement Covid-19 response activities, putting a strain on other performance indicators. Shortages of supplies and personal protective equipment (PPE) were also stressful for organisations, as well as a lack of clarity on the correct specifications for PPE. Some of these issues eased when Covid-19 funding was received from the Global Fund through NACOSA and provincial health departments.


The pandemic created other challenges for organisations. People were not eager to allow health workers to enter their homes because of fear of infection (health workers are associated with infection because they work with sick people), however community awareness activities addressed this challenge over time. Organisations lost many healthcare workers, nurses in particular, as they were employed by government and other organisations that pay better as a result of increased demand for healthcare professionals.

Many healthcare workers got sick and tragically, some even lost their lives during the pandemic. Workers were impacted financially because many did not enjoy paid sick leave. The funding from the Global Fund via NACOSA enabled organisations to keep up the community response and retain their community healthcare workers by paying staff when they fell ill.

Community workers also experienced considerable trauma and distress due to the stressful conditions of working through the pandemic as well as personal trauma. Some organisations reported that female healthcare workers experienced increased gender-based violence in homes, a phenomenon also borne out by national statistics on GBV during the pandemic. Over 80% of the Community Covid teams that NACOSA supported requested psycho-social support. The programme therefore made provision for one-on-one counselling with a psychologist, team debriefing sessions and staff team-building activities.

“They’ve seen people dying,” says Colin Van Wyk. “Some of them were the last person to see somebody dying.”

A table with information on masks and vaccinations with a group of people waiting for services in the background

Community members receive services and information at Phambili in the Western Cape


Organisations quickly learnt more about effective modalities of community engagement and service delivery, and it improved collaboration between civil society and government. Some district health departments did not have Covid-19 implementation plans in the beginning but plans were later put in place with collaboration and coordination with civil society partners, including community organisations.

Proper and effective messaging using relevant channels and promotional materials for different communities was also one of the important lessons. Focused, district-specific communications proved the most effective in driving behaviour change to prevent the spread of Covid-19 and mitigate the pandemic-linked challenges of GBV and declining testing and treatment for other diseases.

Focus group discussions and interviews with leaders of community organisations underlined the importance of sustained empowerment and capacity building with community partners to support community implementation and service delivery. Organisations expressed a need to create a data system similar to (the Department of Health’s data system) that can be used to track Covid-19 clients’ progress through the cascade of health and other services.

“When the pandemic came, we were given an opportunity to see how much we’ve learned, if we can implement a programme like that,” says Thabo Makheti, a project manager from Sedibeng Sa Bophelo Community Project. The one thing that could be improved, according to Thabo, is to plan together with government in advance “…so that we can also have some input, because I think there are areas where we know a little bit better than them, particularly in terms of a community outreach, as a community based organisation.”

Watch a video about Phambili’s work during and beyond the Covid-19 pandemic: