Case Study on Gauteng City Region’s efforts to combat the impact of COVID-19 A Provincial Deep Dive Draft V0.2 20 January 2021 Compiled by: Dr. Bangani Ngeleza Government Technical Advisory Centre National Treasury Acknowledgments This work was made possible by the lead researchers and their teams who authored the chapters of this report. Dr. Rob Moore and Mr Graeme Gotz for the governance, leadership and decision making chapter, Prof. Laetitia Rispel for the health and health system response chapter, Dr. Lungiswa Nkonki for the resource allocation, prioritisation and the public health response chapter, Prof. Ivan Turok for the economic response chapter, Prof. Hettie Schonfeldt for the food security response chapter, Prof. Rajend Mesthrie and Prof. Leketi Makalela for the community mobilisation, communication and change management chapter and Prof. Salome Human-Vogel for working on the education response chapter. Each of them kindly and willingly offered their valuable time, effort and expertise in conducting the research and writing the insightful papers contained in this report. This work was also supported by a diverse team of officials and technical advisors drawn from different institutions, who collaborated to ensure the successful completion of this project. From the Gauteng Office of the Premier, Mr. Mdu Mbada and Mr. Rashid Seedat provided strategic guidance at key moments during this research process. Mr. Ismail Akhalwaya, Ms. Carmel Joseph and Ms. Khuthala Pangwa ensured that the project kept its momentum, and that any blockages that may have arisen were removed. Ms. Neo Thate and Ms. Kedifentse Merafe for their diligent and patient management of all required administrative processes including the scheduling of meetings and interviews. From the Gauteng City Region Observatory, Ms. Melinda Swift for her consistent support in findings practical and workable solutions to some of the data and information challenges that seemed intractable. From the National Research Foundation, Ms. Tshegofatso Makete worked tirelessly to ensure that all the identified thematic areas have a team of researchers allocated and recruited. Ms. Puleng Tshitlho who despite her primary focus on the national DPME process, never took her eye off the Gauteng study and supported all efforts at ensuring its success. From the Department of Planning, Monitoring and Evaluation, Dr. David Makhado was always available for Gauteng case study meetings. He provided invaluable guidance to ensure that this case study is aligned with and supports the national COVID-19 research process. He also led the process of obtaining ethical clearance. From the Government Technical Advisory Centre (GTAC), Ms. Subethri Naidoo for her foresight in identifying the need to support GPG with this initiative, offering GTAC support to the Gauteng Office of the Premier. Ms. Elaine Venter for her support with troubleshooting, consistently contributing to the search for creative solutions to some of the difficulties that confronted the process. Mr. Tsholofelo Thulare for his untiring and consistent support with coordinating meetings and help with resolving some of the data related issues. Ms. Simone Le Hane for supporting with joint leadership and coordinating of this effort from the GTAC, including chairing some of the Project Management Team and Researchers’ meetings whilst also supporting with some of the administrative tasks. This included the coordination of interview schedules and supporting the research communication, community mobilisation and compliance team of researchers with all their research needs. Ms. Sury Pillay, Mr. Sipho Dayel, Ms. Sanitha Naidoo and Mr. Vinodh Singh for responding to the call of duty once invited to do so to dedicate their valuable time and effort to supporting the different teams of researchers with coordination. TABLE OF CONTENTS LIST OF TABLES, FIGURES AND BOXES .................................................................................. I ACRONYMS AND ABBREVIATIONS........................................................................................... II GLOSSARY OF TERMS ............................................................................................................... VI CHAPTER 1 .................................................................................................................................... 1 BACKGROUND AND INTRODUCTION ....................................................................................... 1 CHAPTER 2 .................................................................................................................................... 5 GOVERNANCE, LEADERSHIP AND DECISION-MAKING ....................................................... 5 2.1 INTRODUCTION: OVERVIEW AND KEY QUESTIONS .......................................................................... 6 2.2 CONCEPTUAL FRAMING ..................................................................................................................... 7 2.3 KEY STRUCTURES AND SYSTEMS ESTABLISHED AT THE START OF THE RESPONSE ............... 10 2.3.1 Setting up Gauteng’s COVID-19 response structures: national directives meet the reality of pre-existing arrangements ............................................................................................. 13 2.3.2 An overview of the Gauteng arrangements ..................................................................... 16 2.3.3 The definition of the Programme Management Office and workstreams .................. 18 2.4 THE ROLE OF LEADERSHIP .............................................................................................................. 21 2.5 EXPERIENCE AT OPERATIONAL LEVELS......................................................................................... 24 2.6 THE ROLE OF DATA IN DECISION-MAKING AND GOVERNANCE .................................................... 26 2.7 REFLECTIONS ON ADAPTIVE CAPABILITIES ................................................................................... 28 2.8 CONCLUDING COMMENTS............................................................................................................... 31 CHAPTER 3 .................................................................................................................................. 34 THE HEALTH AND HEALTH SYSTEM RESPONSE TO COVID-19 IN THE GAUTENG CITY REGION: INNOVATIONS, CONTESTATIONS AND LESSONS FOR THE FUTURE ........... 34 3.1 INTRODUCTION ................................................................................................................................. 36 3.2 METHODOLOGICAL APPROACH ...................................................................................................... 37 3.2.1 Specific Objectives ................................................................................................................ 37 3.2.2 Study Setting ........................................................................................................................... 38 3.2.3 Study design ........................................................................................................................... 38 3.2.4 Conceptual framework .......................................................................................................... 38 3.2.5 Document review ................................................................................................................... 41 3.2.6 Key informant interviews ...................................................................................................... 41 3.3 COVID-19 IN THE GAUTENG CITY REGION ................................................................................... 44 3.3.1 Preparation and strategic response ................................................................................... 44 3.3.2 Overview of comprehensive health response ................................................................. 45 3.3.3 Bed needs for the COVID-19 peak in the GCR............................................................... 48 3.3.4 Ward-based Battle Plan ........................................................................................................ 49 3.3.5 Surveillance, containment and control .............................................................................. 50 3.4 KEY INFORMANTS’ PERSPECTIVES ON STRENGTHS, INNOVATIONS AND CONTESTATIONS .. 51 3.4.1 Characteristics of key informants ....................................................................................... 51 3.4.2 Leadership ............................................................................................................................... 53 3.4.3 Governance ............................................................................................................................. 55 3.4.4 Management of the COVID-19 response ......................................................................... 58 3.4.5 Coordination and collaboration ........................................................................................... 59 3.4.6 Communication and engagement ...................................................................................... 60 3.4.7 Surveillance, containment and control .............................................................................. 62 3.4.8 Saving lives ............................................................................................................................. 64 3.4.9 Community Resilience .........................................................................................................