Background Gauteng was one of the provinces in South Africa most hit by COVID-19. However, there has been no assessment of the pandemic’s impact on essential maternal, neonatal and child health (MNCH) services in Gauteng, for planning against future emergencies. This study sought to assess the impact of the COVID-19 pandemic on essential MNCH service utilisation, delivery and health outcomes in Gauteng province. Methods We employed a quasi-experimental interrupted time series (ITS) study design, using the District Health Information System (DHIS) data set to evaluate the impact of COVID-19 on eight key MNCH indicators between March 2019 to February 2021. Using Stata V.17.0 and 5% alpha, a segmented linear regression (ITS) model quantified the trends of the indicators before COVID-19 (March 2019 to February 2020) (β1), the immediate change in level due to the March 2020 lockdown (β2), the post-lockdown (March 2020 to February 2021) trend (β4) and the change in gradient from before to after the lockdown (β3). Results COVID-19 lockdown exerted a significant decline in primary healthcare headcount<5 years (n) (β2= −60 106.9 (95% CI, −116 710.4; −3503.3), p=0.039); and postnatal care visits within 6 days (rate) (β2=−8.2 (95% CI, −12.4; −4.1), p=0.001). Antenatal care first visits before 20 weeks (rate) declined during COVID-19 (β3=−0.4 (95% CI, −0.7; −0.1), p=0.013) compared with the pre-COVID-19 period. COVID-19 adverse effects on service delivery (measles second dose coverage and fully immunised<1 year) and health outcomes (facility deaths 0–6 days, maternal mortality ratio and pneumonia case fatality<1 year) were insignificant. While some indicators post-lockdown attempted to recover, others deteriorated. Conclusion In Gauteng province, the COVID-19 pandemic significantly disrupted essential MNCH service utilisation, particularly during the March 2020 lockdown. The mechanism of MNCH service disruption by COVID-19 was induced by both supply and demand services. It is imperative to strike a balance between maintaining routine healthcare services and managing an outbreak.

The COVID-19 pandemic has highlighted many barriers to healthcare including structural factors like poverty and governance, and intermediary factors such as service delivery, especially in low and middle-income countries where resources are limited. Social Determinants of Health like poverty, governance and access to basic services significantly affect the effectiveness of health interventions. This study aimed to explore healthcare managers’ experiences of delivering health interventions during the COVID-19 pandemic in Gauteng Province, South Africa, using the Social Determinant of Health lens. Exploratory qualitative study. Online in-depth interviews were conducted with senior healthcare managers at the Gauteng Department of Health, to explore their experiences during COVID-19, using open-ended questions. The data was saturated with 13 respondents and was analyzed thematically and inductively in NVivo 10. We identified four interrelated themes that adversely impacted health interventions from the manager's COVID-19 experiences: poor governance through non-service delivery, government distrust, poverty within communities and the influence of social media on societal values. The failure of the government to deliver community services leads to public distrust and in turn has a spill-over effect which constitutes a barrier to healthcare. COVID-19 has reaffirmed that poverty, poor governance and societal values (influenced by social media) are structural Social Determinants of Health that exacerbates the vulnerability of the poor during outbreaks. Poor governance and poverty limit behavioral options, trust and the effectiveness of health interventions. Social support is needed to assist the poor and vulnerable during outbreak. Finally, while social media messages negatively influenced health-seeking behaviors during COVID-19, they are also a potential tool to counter disease infodemics.

Female Condoms are 90–95% effective against HIV transmission when correctly and consistently used and are also cost-effective. In general, condoms prevent sexually transmitted infections (STIs) and unwanted pregnancies. Although the COVID-19 pandemic had the potential to undermine routine healthcare services delivery and utilisation, there is limited evidence about the pandemic’s effect on Female Condom uptake in Gauteng, one of the hardest-hit provinces in South Africa. This study aimed to compare female condom distribution in Gauteng Province, South Africa, before and during COVID-19, to inform decision-making for the attainment of universal access to sexual and reproductive health (SRH) by 2023 as per the sustainable development goal 3.7 and also, to empower women over their SRH during future pandemics. This secondary data anslysis examined the percentage change in routine female condom distribution in Gauteng province and its five districts as an indirect effect (lockdown) of the COVID-19 pandemic, by comparing the aggregated District Health Information System (DHIS) data collated from primary health care facilities within the ditrict, before COVID-19 (2018–2019) and during COVID-19 (2020). Analysis in MS Excel 2016 illustrates the changes in the patterns and the trend in female condom distribution over the study period. In 2020, during the COVID-19 pandemic, Gauteng province experienced a 43.7% increase in female condom distribution compared to the pre-COVID-19 period of 2019. The highest female condom distribution during the pandemic was observed in the Ekurhuleni Metropolitan (150.0%), followed by the Sedibeng (92.8%) and the Johannesburg Metropolitan (67.9%) districts respectively. However, the Tshwane Metropolitan (-8.5%) and the West Rand (-16.6%) districts experienced a decline in female condom distribution during COVID-19. Gauteng province witnessed a substantial surge in female condom distribution during COVID-19 in 2020, with a disproportionate district variation in demand. Female condom distribution is crucial, necessitating its enhancement and the continuum of distribution and stakeholders stockpiling at all times with particular attention to a potential increase in demand during outbreaks with lockdowns. Undisrupted access to female condoms will enable a consistent and correct use and empower women against HIV, STIs and unintended pregnancies, as a strive towards universal access to SRH.

Background: Voluntary medical male circumcision (VMMC) is a significant biomedical and cost-effective intervention in preventing human immunodeficiency virus (HIV) transmission. This study aimed to compare VMMC before and during coronavirus disease 2019 (COVID-19) in Gauteng, one of the most affected provinces in South Africa by HIV and/or acquired immunity deficiency syndrome (AIDS) and COVID-19, to inform VMMC delivery and uptake during future pandemics. Method: A comparative analysis. Routine VMMC data were obtained from all public and private hospitals in Gauteng province from the District Health Information System and medical schemes. The datasets were merged with the years 2019 and 2020 as before and during COVID-19 periods, respectively. Percentage change in VMMC was calculated to determine changes in VMMC before and during the COVID-19 pandemic. Results: Provincially, VMMC declined in 2020 by an overall 33.8% for ≥ 10 years, 32.4% for 10–14 years and 35.8% for ≥ 15 years. All five districts in Gauteng province were affected differently. Exceptionally, the Tshwane Metropolitan district recorded an increase of 21.8% in ≥ 10 years and 36.0% in 10–14 years, despite a decline of –18.2% in ≥ 15 years in VMMC. While the other four districts saw a significant percentage decline in the three age groups of VMMC, the highest disruption was experienced in the West Rand district, in all three age groups. Conclusion: In 2020 during the COVID-19 pandemic, VMMC substantially declined in Gauteng province. However, Tshwane, one of the five districts in Gauteng experienced an increase in VMMC, highlighting a health system resilient lesson to be learned. The fight against HIV is crucial and warrants the continuum of VMMC during future crises. Contribution: The evidence may inform policies on VMMC delivery post-COVID-19 and particularly during future outbreaks as a strive to curb HIV transmission in South Africa.

This study explores senior health managers' perspectives on COVID-19 response and challenges, lessons learned, and opportunities in Gauteng, one of the most affected provinces in South Africa, and further presents recommendations for health systems strengthening, preparedness, and effective response against future infectious outbreaks or pandemics. Using a qualitative exploratory study, online in-depth interviews were conducted with purposively selected senior managers from the Gauteng Department of Health (GDoH) who were at the forefront of managing the pandemic. Recordings were transcribed verbatim, and saturation was reached with thirteen interviewees (n = 13). Thematic and inductive analyses were performed in NVivo 10 and reported following the Consolidated Criteria for Reporting Qualitative Research (COREQ). The findings are presented in four main themes, namely: GDoH's response to the COVID-19 pandemic, COVID-19-related challenges, lessons learned and opportunities from COVID-19, and participants' recommendations on dealing with future pandemics. The managers' perspectives suggest that GDoH's response to COVID-19 was comprehensive, multi-sectoral, and effective through public awareness, the War Room/nerve Centre that managed the response, resources mobilization like the recruitment of additional nurses and doctors, and vaccination. The challenges included the adverse effects of "long-COVID" and mental health, demised health workers, corruption and embezzlement of COVID-19 funds, high cost of living, and gender-based violence associated with COVID-19. The lessons learned included the importance of technology, surveillance, and data analytics during crises, improved hygiene-like hand washing, to mitigate infection transmission, and the urgency to build resilient health systems. The pandemic also highlighted the need for inclusive and collaborative public-private partnerships in the National Health Insurance (NHI) implementation. Participants' recommendations for dealing with future outbreaks included improvements in ICT, the need for social media regulation, working remotely, pandemic incentives for health workers, improved and accountable leadership, addressing corruption and the need for further COVID-19 research. According to the health managers interviewed in this study, the GDoH response to COVID-19 appeared to be resilient, comprehensive, multi-sectoral and effective despite the challenges emanating from the pandemic. Although the pandemic harmed the health system, lessons were learned with opportunities for leveraging the impact of future outbreaks, particularly as South Africa is in the process of providing universal health coverage, pronounced through the NHI. Not applicable.

South African adolescent girls face a triple burden of malnutrition, undernutrition alongside overweight/obesity, and micronutrient deficiencies, heightene