Health systems’ resilience during the COVID-19 pandemic: A South African polio surveillance case study

BACKGROUND: More needs to be known on how the South African health system contained the coronavirus disease 2019 (COVID-19) pandemic and maintained the core business of health service delivery. We describe the practices that have shown to affect the health systems' resilience in ensuring maintenance of polio surveillance and immunization systems in South Africa (SA) during the COVID-19 pandemic. METHODOLOGY: This is a descriptive, reflective desk review study using the South African polio surveillance systems and immunization coverage as a case study. We applied a health systems' resilience framework to highlight how the South African health system contained the pandemic and maintained its core business. Routine immunization and polio surveillance data were obtained and analyzed. RESULTS: The effect of SA's immunization campaigns, which contributed positively to maintaining the polio immunization coverage during the COVID-19 pandemic, is highlighted, with varied performances among provinces. We established delayed integration of pandemic services and missing public health emergency response structures, which led to redeployment of service providers compromising on the health systems' core business. CONCLUSION: Immunization campaigns are key in maintaining coverage, with individualized approaches in supporting the provinces. The existing health systems' structures of countries are a critical determinant of response to pandemics regardless of the available resources. Therefore, to ensure that the health systems maintain a balance between containing pandemics like COVID-19 and maintaining its core business, we recommend the establishment of a public health structure from the national to the community level to respond to public health emergencies and the early integration of pandemic services into the day-to-day health systems' business.