Strengthening System Resilience: Insights from the Western Cape Province Strategic Toolkit for Assessing Risks (STAR) Assessment, South Africa
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
Facilities Infrastructure Management, Environmental Health and Climate Change, Western Cape Government, Department of Health and Wellness, Cape Town, South Africa
4
Office of the Chief of Operations, Disaster Medicine, Western Cape Government, Department of Health and Wellness, Western Cape, Cape Town, South Africa
5
Jhpiego, Pretoria, South Africa
6
Epidemic Preparedness and Response, World Health Organization, Pretoria, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):A1780
ABSTRACT
INTRODUCTION:
The Western Cape Department of Health and Wellness operates in a complex risk environment shaped by recurring biological, environmental, and human‑induced hazards. Adverse events including the 2017–2018 drought, flooding, major fires, energy instability, and the COVID‑19 pandemic have repeatedly challenged continuity of care, underscoring the need for resilient health systems. To strengthen the province’s capacity to anticipate, absorb, adapt, and transform in the face of disruptions, the Department, in partnership with the World Health Organization (WHO), and Jhpiego, conducted a risk assessment using the Strategic Tool for Assessing Risk (STAR).
METHODS:
A participatory multi‑stakeholder STAR workshop was conducted from 8–12 September 2025 with provincial and district leaders, programme specialists, and technical partners to generate an evidence‑based assessment of public health hazards and support risk‑informed planning. Using the WHO STAR framework, participants engaged in structured dialogue and facilitated group assessments to identify hazards, prioritize risks, and guide contingency planning. Multi‑criteria scoring was applied to evaluate likelihood, impact, and system vulnerability, after which hazards were categorized along a five‑tier risk scale through consensus‑based analysis.
RESULTS:
A total of 33 hazards were identified and risk ranked, with 11 classified as very high risk, 12 high risk and 10 exhibiting seasonal patterns. Very high‑risk included water supply failure, power outages, violence, transportation accidents, selected communicable diseases (including measles and diphtheria) and antimicrobial resistance. High‑risk hazards included floods, wildfires, chemical exposures, structural collapse, pandemic‑potential pathogens, cyberattacks, and heatwaves. While strong governance structures and risk awareness were evident, gaps in surge capacity, intersectoral coordination, and routine practices supporting long‑term resilience were noted.
CONCLUSIONS:
The STAR process generated a comprehensive understanding of systemic vulnerabilities, priorities, bottlenecks, and cross‑cutting constraints. These insights will inform contingency planning, programme refinements, and the development of a provincial resilience roadmap to protect service delivery during future shocks.
The Western Cape Department of Health and Wellness operates in a complex risk environment shaped by recurring biological, environmental, and human‑induced hazards. Adverse events including the 2017–2018 drought, flooding, major fires, energy instability, and the COVID‑19 pandemic have repeatedly challenged continuity of care, underscoring the need for resilient health systems. To strengthen the province’s capacity to anticipate, absorb, adapt, and transform in the face of disruptions, the Department, in partnership with the World Health Organization (WHO), and Jhpiego, conducted a risk assessment using the Strategic Tool for Assessing Risk (STAR).
METHODS:
A participatory multi‑stakeholder STAR workshop was conducted from 8–12 September 2025 with provincial and district leaders, programme specialists, and technical partners to generate an evidence‑based assessment of public health hazards and support risk‑informed planning. Using the WHO STAR framework, participants engaged in structured dialogue and facilitated group assessments to identify hazards, prioritize risks, and guide contingency planning. Multi‑criteria scoring was applied to evaluate likelihood, impact, and system vulnerability, after which hazards were categorized along a five‑tier risk scale through consensus‑based analysis.
RESULTS:
A total of 33 hazards were identified and risk ranked, with 11 classified as very high risk, 12 high risk and 10 exhibiting seasonal patterns. Very high‑risk included water supply failure, power outages, violence, transportation accidents, selected communicable diseases (including measles and diphtheria) and antimicrobial resistance. High‑risk hazards included floods, wildfires, chemical exposures, structural collapse, pandemic‑potential pathogens, cyberattacks, and heatwaves. While strong governance structures and risk awareness were evident, gaps in surge capacity, intersectoral coordination, and routine practices supporting long‑term resilience were noted.
CONCLUSIONS:
The STAR process generated a comprehensive understanding of systemic vulnerabilities, priorities, bottlenecks, and cross‑cutting constraints. These insights will inform contingency planning, programme refinements, and the development of a provincial resilience roadmap to protect service delivery during future shocks.
| eISSN: | 2654-1459 |
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