EHS-COVID (55) Q1 How has COVID-19 affected the delivery of essential health services in your health facility or country? (4) Child health in South Africa

16 November, 2020

The message below is forwarded from our sister forum CHIFA (child health and rights). Child health services in this South African hospital have been severely disrupted although there have been positive aspects: "The pandemic enhanced the spirit of working together".


The pandemic has really impacted the child health service delivery where I'm working. The debate is whether positive or negative.

Our hospital is a quartenary children hospital which works with referrals only. During the early period of the pandemic, we had to focus only on the emergency surgeries. At the beginning of January we had paeds surgery lists for Cardiothoracic surgery, ENT surgery, Cardiac Cath labs and general surgery. All these were put on hold until july when we had established the flow processes of how the patients will flow from admission to theatre. The only functional wing was the dialysis services which couldn't be stopped.

The pandemic enhanced the spirit of working together in the hospital in my view. Even referring hospitals in and around Johannesburg knew that they had to do COVID-19 swabs before sending the patients for surgery to make the journey easier for the child and family. This strategy reduced hospitalization and helped to speed up the surgical work up process. We had to establish flow processes for NICU, PICU, theatre and general wards.

Once we had established the processes, we commenced slowly with elective cases. There was however an added layer of doing the COVID-19 swab before any surgical intervention could be done. In emergency cases, those were allowed to be done under stricter COVID-19 hospital policy.

The only sad thing was that children who tested positive for COVID-19 and were due to have surgery, were send back to their referring hospital. These are children coming as far as Eastern Cape province, North West province and Swaziland. They had travelled all this way to have their surgery done and they had to go back without the surgery.

The other impact was that our waiting list for 2020 was impacted on. Cardiothoracic was having about 96 kids on their waiting list for surgery who needed to be presented at multidisciplinary teams and that couldn't happen because of the pandemic. Missed immunization has been reported and observed on a number of the admissions we have had in the hospital. Upon enquiring, the reasons were either the clinic was closed because someone at the clinic tested positive for COVID-19 or a limited number of people allowed in the clinics barred them from enering the premises.

I have seen the children defaulting on their ARTs. On the other site we were able to get the hospital ready to function amid the COVID-19 pandemic and i think that process has had positive effect on the hospital and staff.

Kind regards

Mmusetsi Mokwatsi

Advanced Nurse Practitioner: Child

CHIFA Profile: Mmusetsi Mokwatsi is a Child Nurse Specialist at the Kimberley Hospital Complex in South Africa. Professional interests: Health policy development, Clinical Leadership, Clinical Research, Child advocacy, Child Nurse development, community involvement in child health, Clinical governance. Email: ratolaonemok AT

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Best wishes, Neil

Coordinator, WHO-HIFA Collaboration: HIFA project on Essential Health Services and COVID-19

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