A recent in-depth review of the Coordinated Donor Support to the South African Covid-19 vaccination programme offers lessons for how South Africa might overcome its numerous challenges if all sectors of society can harness the power of working together.

As South Africans rolled up their sleeves to receive their Covid-19 vaccination shots in 2021, few would have realised just how much work went into rolling out South Africa’s first adult vaccination campaign.

Fewer still would know that the vaccination programme was only possible because of a major multi-sectoral collaboration between the National Department of Health (NDoH), provincial Departments of Health, funders, NGOs, organised labour, civil society and the private sector.

Indeed, the collaborative model that was created to reach a targeted 70% of the population with the vaccine offers many lessons and great hope that through working together, South Africa can overcome its greatest challenges.

It is easy to take the Covid-19 vaccination programme for granted now that the pandemic is largely just an unpleasant memory. But it took a gargantuan effort for a straining health system to administer 37 million vaccines between May 2021 and June 2022.

Zak Power 13, receives a first dose of the Pfizer Covid-19 vaccine at the Vaccination Centre of Hope at the Cape Town International Convention Centre in Cape Town, South Africa, on Wednesday 20 October, 2021. (Photo: Supplied)

Shot in the arm for SA

Seventy per cent of the most vulnerable 60+ age group received at least one dose of the vaccine, and although South Africa did not reach its initial target, the programme was a major contributor to the achievement of herd immunity and the full reopening of the economy and social services such as schools and early childhood development services.

This success was not at all guaranteed when in late 2020 the South African government was attempting to put its Covid-19 vaccination strategy in place. A group of donors approached the Department of Health in early 2021 to offer a coordinated support effort centred on providing both strategic support and technical skills at all levels.

This group raised R69-million between them and agreed that the DG Murray Trust would lead a combined effort to support the vaccination programme. The DG Murray Trust is a South African philanthropic foundation which over the past decade has also developed the capacity to manage pooled donor funding and incubate joint initiatives until they are ready to operate independently.

The Solidarity Fund also entered the arrangement, matching the money put forward by the donor group.

These funds were used mainly to hire over 200 highly skilled individuals to be placed within every level of government to ensure that the vaccine rollout was successful. An experienced core team worked closely with top NDoH officials in the drafting of the National Strategic Plan and an area-based guide and toolkit for local vaccination teams on the ground.

Communications were another critical area that the team supported, working closely with the NDoH communications department and other partners to run a sophisticated communications campaign, and the NDoH’s widely used SAcoronavirus website.

Power in collaboration

Working with the business sector, the partnership also established a National Contact Centre in record time, which fielded more than 3.5 million calls within its first year of operation.

The partners also established the multi-sectoral Demand Acceleration Task Team, which ran highly successful campaigns which vaccinated thousands more people. Outreach was also extended in innovative ways to the elderly, through Sassa pension paypoints, and to the youth through youth-led communications programmes and mobile services.

The successes of these endeavours are due in large part to multisectoral collaboration. Sectors of society normally at loggerheads — such as business and organised labour — came together to drive demand generation among their constituencies.

The arrangement allowed technical skills and resources to be quickly mobilised and provided to the health sector without going through the notoriously slow government procurement and hiring regulations. They were employed by the DG Murray Trust but crucially they were placed within government units, working under Department of Health line managers.

This ensured that rather than creating a parallel system, the initiative truly supported the state’s vaccine rollout.

Read more in Daily Maverick: Covid-19: Nicholas Crisp on the challenges with South Africa’s vaccine roll-out

At a national level, the core team supported clarity of strategy and leadership for NDoH officials whose capacity was under severe strain. The coordinated effort also ensured that the government did not have to handle the competing demands of numerous individual donors during a crisis.

Not all strategic goals were agreed upon, however. Repeated requests for full access to the government’s Electronic Vaccination Data System (EVDS) were denied, limiting the extent to which vaccination sites could be enabled to tailor their responses quickly and smartly, based on real-time data.

The newly amended Protection of Personal Information Act (Popia) was cited as the reason the NDoH declined to make EVDS data available, but a more pragmatic approach could have been found to ensure that the response was much more data-driven. Political barriers also meant that the National Strategic Plan was never officially signed off.

A Soweto resident walks in front of informative graffiti artwork educating local Soweto residents about the dangers of the coronavirus, Johannesburg, South Africa, on 30 November 2021. (Photo: EPA-EFE/Kim Ludbrook)

Model for betterment

Overall, however, this model has great potential, especially for building resilience in the face of both emergency and longer-term challenges faced by South Africa. It is a useful mechanism for pooling funds and expertise, and partnering with government on key strategies to address challenges without either overwhelming them or creating a parallel structure.

Particularly where funds, human resources and products have to be mobilised quickly, without the delays typical of government, the platform is highly valuable and is currently being harnessed in response to the electricity crisis.

The multi-sectoral partnership between government, business and civil society appears to have been solidified in the Covid response, with the embeddedness of the approach being of particular value in fostering good working relationships and trust between them.

Not only does the business sector enjoy a closer relationship with government than before, but it built a blueprint for how civil society can work with government.

We can hope that the lessons learned, relationships built and approaches put in place for South Africa’s Covid vaccination response can be repurposed to address many more of our most pressing challenges.

We really are stronger together. DM

Dr Andrew Hartnack is a social anthropologist with a PhD from the University of Cape Town. He works as an independent researcher and evaluator in southern Africa, focussing on a range of public health, education, youth development, livelihood and environmental issues. His 2016 book ‘Ordered Estates’ explores the history and dynamics of farm welfare initiatives in Zimbabwe. andrewhartnack@gmail.com website: https://andrewhartnack.wixsite.com/high-skies