An Emergency Strategy for Intersectoral Local Government Responses to COVID-19 in Long-term Care Facilities in Western Cape Province, South Africa

Context: There are growing numbers of long-term care facilities (LTCFs) in low- and middle-income countries (LMICs). In 2020, a network of academics and stakeholders developed the CIAT (Coordinate, Identify, Assess and Targeted support) Framework, an emergency COVID-19 policy guidance that sought to address specific needs of LMIC government agencies responsible for LTCFs.

Objective: This paper reviews the South African COVID-19 response experience, with particular reference to Western Cape Province, and assesses the degree to which policy responses conformed with the CIAT Framework.

Methods: The paper draws on an opportunistic, improvised research design, based on the establishment of a pragmatic partnership between the authors and local government stakeholders. This entailed proactive engagement and informal discussions with policymakers as the pandemic unfolded, as well as privileged access to official documents.

Findings and implications: Responses to the pandemic, especially in the early months, did not follow the CIAT Framework. They were hindered by government departments’ poor coordination, weak information systems, and dysfunctional engagement with LTCFs. These problems dated back to before the pandemic and require structural reform to long-term care policy.

Limitations: The lack of data on LTCFs in South Africa (though itself an important finding) prevents analysis of policy effects at the level of individual facilities.