Stories from the field: Special series on the COVID-19 response – South Africa

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7 August 2020

South Africa steps up hygiene in health facilities to protect against COVID-19

South Africa approved a national strategy to better protect patients and health workers from avoidable infections in health facilities. The strategy, which includes strengthening practical measures such as proper hand hygiene, use of personal protective equipment and cleaning and disinfection of the environment and medical equipment, is one of the crucial aspects of its COVID-19 response. Learn how South Africa is building its infection prevention and control capacity to address the spread of COVID-19.
This is a developing story that is updated as information from the field becomes available. Please check back regularly for updates.



The Government of South Africa urgently approved and is now implementing its ‘National Infection Prevention and Control Strategic Framework’, a critical strategy underpinning responses to epidemics and pandemics.


Effective infection prevention and control protects both patients and health workers, which is especially important when COVID-19 is spreading rapidly.


Strong infection prevention and control measures will help save lives among the 58 million people living in South Africa, especially in vulnerable populations. It has a direct impact on healthcare associated infections and the spread of COVID-19.


WHO supported the development of the South African National Infection Prevention and Control Strategic Framework and its roll-out to provinces.


COVID-19 is a highly transmissible virus, and countries around the world are fighting to prevent and control its spread. One of South Africa’s top priorities when the pandemic struck was to scale up infection  prevention and control. This fundamental work has been supported by WHO and the UHC Partnership.


When the first case of COVID-19 was confirmed in South Africa on 5 March 2020, it prompted national concern. South African President Cyril Ramaphosa declared a state of National Disaster on 15 March and later initiated a four-week national lockdown, which was further extended. This is now being relaxed gradually in order to allow economic activity to begin to resume.


From the outset, the Government prioritized scaling up of Infection Prevention and Control (IPC). IPC is a vital component  of quality care, itself a key element in achieving universal health coverage (UHC). The National Department of Health – among other measures – urgently approved the ‘National IPC Strategic Framework’ and ‘Practical Manual for Implementation of National IPC Strategic Framework’. The timing was crucial in order to support the national control and response to COVID-19.


The effective implementation of the framework will have a direct impact on delivering health services that are designed and managed to minimize the risks of avoidable infections for both patients and health workers. This is crucial at this moment in time in South Africa when COVID-19 cases are escalating.

Promoting infection prevention and control


Good hygiene practices like hand hygiene, use of personal protective equipment and cleaning and disinfection of medical equipment and environment – just some of the elements of IPC – are at the forefront of COVID-19 responses worldwide. They protect both patients and health workers from infection.

However, these IPC practices, along with many others, are needed in hospitals and health centres at any given moment.

Without good IPC, many medical practices can lead to healthcare-associated infections and can cause harm to patients and health care workers. In low- and middle-income countries, healthcare-associated infections are double those in high-income countries. Current threats posed by epidemics such as Ebola and cholera, pandemics like influenza and COVID-19, and antimicrobial resistance (AMR) are increasingly major challenges to public health. Strong IPC measures play a key role in combatting them all.

“I believe and trust that this strategic framework for IPC and the practical manual for its implementation will strengthen evidence-based practices at national, provincial, district and health facility levels towards combating threats posed by epidemics, pandemics and antimicrobial resistance,” said Dr Anban Pillay, Acting Director General, National Department of Health, South Africa.

Dr Owen Kaluwa, WHO Representative, is briefed on COVID-19 supplies in one of the WHO-supported provinces

© WHO South Africa


© WHO / Elena Longarini

Developing guidance for infection prevention and control


Initiated in 2007, South Africa’s first National IPC Policy and Strategy pre-dated the key elements of the WHO guidelines on core components of IPC programmes which were issued in 2016. The Government therefore needed to make revisions to align their policy with current WHO guidance.


WHO worked with the National Department of Health and the IPC technical working group to develop the National Infection Prevention and Control Strategic Framework. The draft document was presented to several national committees and at a national consultative workshop with a range of representatives from the public and private health sector.

This support was provided through the UHC Partnership as part of WHO’s overall COVID-19 response. The Partnership is funded by the European Union (EU), the Grand Duchy of Luxembourg, Irish Aid, the Government of Japan, the French Ministry for Europe and Foreign Affairs, the UK Department for International Development and Belgium.


“I believe and trust that this strategic framework for IPC and the practical manual for its implementation will strengthen evidence-based practices at national, provincial, district and health facility levels towards combating threats posed by epidemics, pandemics and antimicrobial resistance.”

Dr Anban Pillay, Acting Director General, National Department of Health, South Africa

The strategic framework gives guidance to public and private health facilities and health workers on compliance with standards relating to IPC practices. A practical implementation manual to accompany the framework was developed in parallel, to further assist health facilities.

© WHO / Blink Media – Gilliane Soupe

“Thank you to WHO for the support provided throughout the development of the documents,” said Ronel Steinhobel, National Department of Health, Directorate Quality Assurance.


“Since 2010, and in line with the EU’s human rights approach to health, the Union has supported the Government’s efforts regarding Universal Health Coverage. In addition, since 2016, the EU has financed WHO to provide technical assistance on this important work-in-progress. This year the EU significantly increased its global support to WHO to tackle the global coronavirus pandemic. We support WHO’s swiftly re-oriented efforts to stand by South Africa at this time of crisis by deploying doctors and much needed expertise to the most affected provinces of the country. As South Africa’s number one transformation partner we remain committed, in this period of global pandemic, to South Africa’s efforts to roll out a universal National Health Insurance scheme,” said Dr Riina Kionka, European Union Ambassador to South Africa, and speaking on behalf of #TeamEurope.

Dr Zweli Lawrence Mkhize, South Africa’s Minister of Health, in discussion with the KwaZulu Natal provincial team and WHO staff

©  WHO South Africa

“The COVID-19 response requires scaling up urgent multisectoral actions, at the centre of which should be robust containment measures while preparing for surge capacity. It is critical to ramp up testing, treat and isolate those who are infected while quickly tracing the contacts for appropriate measures,” explained Dr Owen Kaluwa, WHO Representative to South Africa, as he addressed the South African public on national TV.


South Africa demonstrated its commitment to pandemic preparedness by volunteering in 2018 for a Joint External Evaluation of its capacities to prevent, detect and respond to health emergencies. The country used the results to develop a National Action Plan for Health Security the following year, which included a focus on antimicrobial resistance.


WHO is also currently working with the Incident Management Team (IMT) on the National Plan for COVID-19 Health Response looking at various ways in which the Government’s response could be scaled up. The country health response outlines key containment and mitigation measures including roles of key players at different levels of the health system.

Alexandra township, Johannesburg 

Photo courtesy of Brand South Africa

Dr Rajesh Narwal, WHO Health Systems Advisor said, “This strategy derives from the WHO framework on Country Operational Preparedness and Response Guidance but has been contextualized to South African scenario and needs. It aims to support the Government in slowing the spread COVID-19 in South Africa and minimize potential negative impact on the health and wellbeing of South African society and economy.”


WHO has sent teams to five highest risk provinces where they are working hand-in-hand with provincial departments of health in joint operation centres. These teams continue to provide technical advice and support to provincial health departments on a day-to-day basis, which is critical for the response on the ground.


Given the number of rising cases of COVID-19 in South Africa, the Government’s strategic direction and actions together with the support it receives from all partners, including WHO and the EU, are crucial. Infection prevention and control will play a key part in protecting health workers and patients both during and after this crisis.