A health systems intervention project to address the suboptimal disease surveillance and response capacities in the Western Cape
1
Emergency and Clinical Services Support, Service Priorities Coordination, Communicable Disease Control and Outbreak Response, Western Cape Government, Department of Health and Wellness, Cape Town, South Africa
2
Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa
3
People Development Centre, Western Cape Government, Department of Health and Wellness, Cape Town, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):A1102
ABSTRACT
INTRODUCTION:
Public health surveillance underpins timely outbreak detection and epidemic response. In the Western Cape, limited district and facility‑level capacity, fragmented surveillance systems, absence of a formally designated trained surveillance and outbreak response workforce, and data analysis skills, have contributed to delayed and suboptimal responses. This study aims to design, implement, and evaluate an intervention to strengthen disease surveillance and response capacities.
METHODS:
A critical descriptive analysis of a policy implementation challenge and evaluation of a health system intervention project was undertaken. Health systems frameworks guided the development of a “Rich Picture” to contextualize the problem. Analytical tools - including CATWOE (Customer, Actors, Transformation, Worldview, Owner, Environment), stakeholder mapping, the 5Cs (Create, Comprehend, Communicate, Collaborate, Confront) of people management, opportunity cost analysis, Brinkerhoff and Crosby’s strategy areas, and monitoring and evaluation methods were applied. These tools supported the identification and implementation of two “small- win” interventions.
RESULTS:
The Rich Picture revealed the broader system context and resource‑intensive processes shaping implementation. Root Cause Analysis identified 12 underlying factors: three key drivers, five linking factors, and four outcomes. Stakeholder analysis informed seven overarching actor‑management strategies. Availability of human resource capacity for disease surveillance and response emerged as a key driver and priority intervention area. Opportunity cost analysis informed the first small win through collaboration with a national training unit to upskill a group of provincial trainees. This enabled a second small win of engagements with a provincial training unit to develop online training modalities. Monitoring and evaluation indicated positive outcomes, including trained public health officials, publication of online courses, and interest in further curriculum development.
CONCLUSIONS:
The critical systems analysis informed stakeholder management and targeted interventions to strengthen human resource capacity for surveillance and response. These gains illustrate how effective planning, leadership, and people management can drive improvements in surveillance and response.
Public health surveillance underpins timely outbreak detection and epidemic response. In the Western Cape, limited district and facility‑level capacity, fragmented surveillance systems, absence of a formally designated trained surveillance and outbreak response workforce, and data analysis skills, have contributed to delayed and suboptimal responses. This study aims to design, implement, and evaluate an intervention to strengthen disease surveillance and response capacities.
METHODS:
A critical descriptive analysis of a policy implementation challenge and evaluation of a health system intervention project was undertaken. Health systems frameworks guided the development of a “Rich Picture” to contextualize the problem. Analytical tools - including CATWOE (Customer, Actors, Transformation, Worldview, Owner, Environment), stakeholder mapping, the 5Cs (Create, Comprehend, Communicate, Collaborate, Confront) of people management, opportunity cost analysis, Brinkerhoff and Crosby’s strategy areas, and monitoring and evaluation methods were applied. These tools supported the identification and implementation of two “small- win” interventions.
RESULTS:
The Rich Picture revealed the broader system context and resource‑intensive processes shaping implementation. Root Cause Analysis identified 12 underlying factors: three key drivers, five linking factors, and four outcomes. Stakeholder analysis informed seven overarching actor‑management strategies. Availability of human resource capacity for disease surveillance and response emerged as a key driver and priority intervention area. Opportunity cost analysis informed the first small win through collaboration with a national training unit to upskill a group of provincial trainees. This enabled a second small win of engagements with a provincial training unit to develop online training modalities. Monitoring and evaluation indicated positive outcomes, including trained public health officials, publication of online courses, and interest in further curriculum development.
CONCLUSIONS:
The critical systems analysis informed stakeholder management and targeted interventions to strengthen human resource capacity for surveillance and response. These gains illustrate how effective planning, leadership, and people management can drive improvements in surveillance and response.
| eISSN: | 2654-1459 |
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