Abstract
BACKGROUND: This study investigated the perceptions and experiences of Gauteng Department of Health (GDoH) senior managers about factors that contributed to the high incidence of coronavirus disease 2019 (COVID-19) in Gauteng, the hardest hit province in South Africa. METHODS: An exploratory qualitative study was conducted using online in-depth interviews with senior managers in Gauteng. Audio recordings were transcribed verbatim, coded and thematically analysed in NVivo 10. Data saturation was reached at 13 participants (n = 13). Findings were reported in line with the Consolidated Criteria for Reporting Qualitative Research (COREQ). RESULTS: Two main themes emerged from the analysis. Theme I: Perceptions of the burden of COVID-19 in Gauteng. Theme II: Key health and behavioural factors, including poor protocol adherence, exacerbated the spread of COVID-19. Economic challenges such as limited employment prospects and informal settlements, sociocultural enablers like vaccine hesitancy, social media misinformation, limited vaccine and treatment options, and environmental factors such as the OR Tambo International Airport contributed to high population density and heightened the infections and transmission of COVID-19. Governance issues, including corruption in personal protective equipment procurement and embezzlement of COVID-19 funds, undermined the GDoH response. CONCLUSION: Understanding perceptions of factors that influence disease transmission is crucial for effectively managing infectious diseases like COVID-19 and future outbreaks. Addressing infrastructure gaps in underserved communities and strengthening government regulations could help to reduce congestion in Gauteng, ultimately reducing the spread of contagious diseases.Contribution: The study presents a model for investigating and addressing the human factors that drive the transmission of infectious diseases.