The Ocean View Community Care Centre (CCC): Lessons for everyday health systems resilience from a community-led response to the Covid-19 pandemic in South Africa

Abstract

Community engagement is widely acknowledged as critical to Everyday Health Systems Resilience (EHSR), but there are few empirical case studies that examine ‘how’ and ‘why’ initiatives at the community-health system interface unfold over time. In this paper, we present the experience of the Ocean View Community Care Centre (CCC), a community-led response to the Covid-19 pandemic in the Western Cape, South Africa. Using a five-year long embedded research approach, we drew on traditions of participatory action research and organisational ethnography. Data collection included documenting observations and reflections in a research diary during implementation, in-depth interviews, focus group discussions (using photo-elucidation methods) and a WhatsApp archive. In addition, a series of sensemaking discussions with academic research team members were done. Our analysis draws on and extends the EHSR framework which characterises resilience as an emergent phenomena of health systems. We consider the CCC as a potentially transformative resilience strategy as it nurtured system capacities (networks and relationships) that could support future responses to shocks. Our findings demonstrate how relationships and networks can generate resources (hardware and software) and nurture system capacities for EHSR, but also highlights that relationships and networks on their own are not enough. The CCC experience offers the notion of boundary spanning (not yet explored in the EHSR literature) to shed light on how the energy of these networks needs to be harnessed by individuals who have a ‘passport of legitimacy’ to work across networks, suggesting that boundary spanners are themselves important in nurturing system capacities for resilience.