Social Determinants of Health: Healthcare managers' COVID-19 experiences of poor governance, poverty and social media on health interventions

Objectives: 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. Study design: Exploratory qualitative study. Methods: 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. Results: 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. Conclusion: 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.