The SACCESS network for COVID-19 wastewater surveillance: a national collaboration for public health responsiveness

The global COVID-19 pandemic has highlighted the need for stronger health systems, and the potential role of networks in this strengthening. In the early phase of the pandemic, wastewater surveillance as a predictive and monitoring tool for COVID-19 was identified internationally. This realisation alerted researchers in South Africa, who through various pathways formed the South African Collaborative COVID-19 Environmental Surveillance System (SACCESS) network. Made up of a wide range of actors, SACCESS has progressed rapidly in a field with many unknowns. This qualitative case study aimed to explore the lessons that the SACCESS network provides in terms of network governance and bottom-up collaboration, and to apply this to health system strengthening. Key informant interviews (n=12) were conducted with purposively selected members of the SACCESS network. Data were analysed thematically. Four main themes emerged: the enabling factors of network formation in the time of COVID-19; the importance of relationships; strengths and challenges of an informal network; and lessons for building health systems. Several lessons emerged for health system strengthening in the time of COVID-19 and beyond: the importance of informal networks, and bottom-up collaboration; recognition that individuals, not institutions, are key in informal networks; and the time required for building trust. It is important for network governance to be flexible as it evolves, particularly in times of crisis. It may be difficult for an informal network to interact with more formal, bureaucratic structures. There is need to explore how to create a recognised role and space for informal networks, such as the SACCESS network, to move towards stronger health systems.