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Health Systems Trust Launches 2021 SAHR

In responding to COVID-19, what have we learnt? 
Health Systems Trust launches the 2021 South African Review which focuses on COVID-19

The Health Systems Trust, in collaboration with the University of KwaZulu-Natal’s Health Economics and HIV and AIDS Research Division (HEARD), are proud to share some of the key findings of the 2021 special edition of the South African Health Review entitled Health sector responses to COVID-19, what have we learnt?

With over 50 contributors, most of whom are established experts in the health sector, the Review captures both the impact of COVID-19 and our response, and provides recommendations for building a stronger and more resilient health system.

Some of the key findings of the Review are as follows:
  • The Review notes that whilst Government’s response focused on containment and mitigation measures to flatten the peak of COVID‑19, with the aim of saving lives and reducing the strain on healthcare systems, prolonged lockdowns have had negative social and economic effects which have disproportionately affected the poor and other vulnerable populations.
  • The pandemic has resulted in devastating socio-economic costs; an estimated 2.8 million South Africans having lost their jobs. South Africa’s budgetary and Public Finance Management systems channelled the allocation of more than R20 billion to the health sector COVID-19 response and an additional R100 billion has been spent on income support through new social grants and TERS benefits.
  • COVID-19 has placed an even greater strain on South Africa’s overburdened and under-resourced health system and has stymied the progress the country has made in strengthening health systems towards achieving universal health coverage.
  • COVID-19 has taken a severe toll on healthcare workers, particularly those that work in resource-constrained settings, with healthcare workers enduring shortages of basic resources, rapid depletion and delayed restocking of COVID-19-related equipment, all of which have had a negative impact on their mental health.
  • The importance of taking a community-based approach to finding more sustainable and cost-effective methods of delivering services at the primary care and community levels has been consistently emphasised in chapters. The role of community health workers has expanded to include support for COVID-19-based community testing and screening highlighting their critical role in responding to this pandemic.
  • There has been an overall increase in maternal deaths, stillbirths and perinatal mortality.  Rural provinces experienced increased pressure on their services due to pregnant women migrating from metropolitan areas back to their homes; with metropolitan areas inundated with severe COVID-19-specific cases, leading to an increased burden in these areas and an inability to manage routine emergencies.
  • Government has not been disability-inclusive in its management of the pandemic and the vaccination programme has deepened the multiple layers of vulnerability and challenges for persons with disabilities who are at heightened risk of contracting the virus, not only because of underlying health conditions, but also due to contextual barriers in accessing health care.
  • The response to the COVID-19 pandemic has also accelerated action in a number of previously difficult areas. There has been progress in developing reporting systems that combine data from both the public and private sectors; there are promising examples of intersectoral collaboration, public-private partnerships, innovative joint ventures and examples of providing rehabilitation services under strict lockdown conditions.

In: Govender K, George G, Padarath A, Moeti T, editors. South African Health Review 2021. Durban: 
Health Systems Trust; 2021. URL:

Commenting on the findings of the Review, CEO of the Health Systems Trust, Dr Themba Moeti said: “COVID-19 has disrupted access to health care for chronic conditions, including testing, treatment initiation, and continuity of care for HIV and TB, as well as for sexual and reproductive health services, due to both travel restrictions and the re-orientation of healthcare services to respond to the pandemic. Overall, the publication is a repository of valuable information, providing insights and lessons for developing more resilient health systems that are capable of responding to future public health emergencies.”

The Health Systems Trust wishes to acknowledge the Johnson & Johnson Foundation for the grant funding that made the 2021 edition of the South African Health Review possible. For more on the Johnson & Johnson Foundation please go to:

About the South African Health Review

The South African Health Review (SAHR) is an accredited peer-reviewed publication. Now in its 24th edition, the aims of the Review are to advance the sharing of knowledge, to feature critical commentary on policy implementation, and to offer an empirical understanding towards improving South Africa’s health system. The Review is recognised as one of the most authoritative sources of commentary on the South African health system.

About the Health Systems Trust

The Health Systems Trust (HST) is a leading role-player in the South African public health arena, focusing on health systems strengthening, research, and strategic support in the implementation of priority health programmes. Established in April 1992, on the brink of democracy in South Africa, HST has played a significant role in the evolution of the national health system.

About HEARD at the University of KwaZulu-Natal

HEARD is an applied health research and training centre at the University of KwaZulu-Natal. Since its establishment in 1998, HEARD has conducted research on the socio-economic aspects of public health on issues of HIV and AIDS and sexual and reproductive health. The Centre has a long history of working in South Africa and the Southern and East African region.

Please direct all queries related to the SAHR 2021 to: