What can we learn about everyday health system resilience and pandemic response and preparedness from Kenyan and South African COVID-19 experiences?

In this chapter we apply the everyday health system resilience framework in examining COVID-19 responses over 2020-22 in Kenya (primarily considering national experience) and South Africa (primarily considering experience in the Western Cape province). Set against a background description of country contexts and pandemic governance structures and processes, the chapter analyses both the strategies implemented in response to COVID-19 (the ‘what’ of response, considering public health containment strategies and actions to strengthen health services) and the health system capacities that enabled or constrained these responses (the ‘how’ of response, considering cognitive, behavioural and contextual capacities). Perhaps the weakest area of the COVID-19 response across countries lay at the interface of community and public health and social care. Nonetheless, by 2022 positive system adjustments were noted in both countries that built on past experience and may have enhanced overall health system capability to respond to future challenges. These include a greatly strengthened surveillance capacity; novel leadership practices, including strengthened capacity to use evidence in decision-making; wider sets of learning processes; and a range of strengthened relationships, including inter-sectoral collaboration. Overall, these experiences suggest that pandemic preparedness must embrace efforts to strengthen primary care services and community-level networks, as well as deepen the everyday health system resilience capacities that sustain collective action in response to any challenge.