What Is COVID-19 Teaching Us About Community Health Systems? A Reflection From a Rapid Community-Led Mutual Aid Response in Cape Town, South Africa

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has exposed the wide gaps in South Africa’s formal social safety net, with the country’s high levels of inequality, unemployment and poor public infrastructure combining to produce devastating consequences for a vast majority in the country living through lockdown. In Cape Town, a movement of self-organising, neighbourhood-level community action networks (CANs) has contributed significantly to the community-based response to COVID-19 and the ensuing epidemiological and social challenges it has wrought. This article describes and explains the organising principles that inform this community response, with the view to reflect on the possibilities and limits of such movements as they interface with the state and its top-down ways of working, often producing contradictions and complexities. This presents an opportunity for recognising and understanding the power of informal networks and collective action in community health systems in times of unprecedented crisis, and brings into focus the importance of finding ways to engage with the state and its formal health system response that do not jeopardise this potential.

How kindness can be contagious in healthcare

“…Finally, pay-it-forward principles have been used to structure community-support activities focused on COVID-19. Many mutual-aid groups have used pay-it-forward programs to provide material support, advice and encouragement to other local people 3 . A related example is time banking, a mutual-support approach whereby people contribute volunteer service hours to help others in need within their local community and are then rewarded with time credits or currency that can be used for ordering volunteer services from subsequent volunteers 20 .…”

“…We define 'generosity' as the capacity to give more than is necessary or expected 2 . COVID-19related messages, fundraising projects and community-engagement activities have demonstrated substantial generosity in these uncertain times [3][4][5] . This generosity not only showcases the endurance of the human spirit but also may provide a way to help control infectious diseases.…”

Collective reflections on the first cycle of a collaborative learning platform to strengthen rural primary healthcare in Mpumalanga, South Africa

“…This evaluation reflects the collective views and inputs of researchers, health system stakeholders and community representatives, providing insights and learning from within the health and local community systems. The COVID-19 pandemic brought the importance of policy learning to the forefront, with inclusive and collaborative community responses demonstrated to be powerful in the context of crisis situations where responses through formal decision-making structures may be slow and limited [ 58 , 59 ].…”

Mutual aid organisations and their role in reducing food insecurity in Chicago’s urban communities during COVID-19

“…(11) They rely on the reciprocal exchange of services and resources for mutual benefit within local communities and have historically provided social support through informal networks with limited resources. (12) Mutual aid organizations use a strengths-based, holistic approach that emphasizes shared power distribution amongst participants. (13) Specifically, as it relates to improving food access and food security, mutual aid organizations support the local food system by building social, human, and financial capacities, which are foundational in the resilience of food systems.…”