When Systems Strengthen from the Bottom Up: Lessons from Community-Led Resilience in Health Crises

By Mokgadi | Best Health Solutions

 The most recent facebook post by @Ntate Pinampi Maano , a comrade and passionate community developer, deeply moved me.

“Mme Mokgadi has always championed Community Systems Strengthening. I remember way back in 2016 when we first met her. She is always about Empowerment of Community Structures, with a special focus on Sustainability.”

That reflection didn’t just stir memory—it activated a call. Because we’ve been here before.

When COVID-19 Hit, Community Systems didn’t flinch

During the height of the COVID-19 crisis, while formal systems were overwhelmed, civil society sectors stepped up. They didn’t wait for new funding or revised guidelines—they acted swiftly. Information continued to circulate through WhatsApp groups, while the SANAC CSF Traditional Health Practitioners Sector played a critical role in disseminating messages around alternative medicine and community health practices.

Other SANAC CSF sectors led robust community sensitisation, screening, and linkage-to-care initiatives, reaching key and priority populations across even the most remote corners of our communities. They showed us something we too often overlook: When systems are built from the bottom up, they don’t collapse under pressure—they adapt.

 Now, another crisis is here: The Stop-Work Orders

Today, we’re once again facing a shock to the system. The stop-work orders—with their sweeping suspension of donor-funded activities—have created abrupt service gaps across provinces. This time, it’s not a virus shutting us down, but decisions from faraway desks. And once again, we are turning back to the same community systems that held us through COVID. Except now, those very systems are under-resourced, under-acknowledged, and overstretched.

 This moment is more than a funding disruption—it is a test of systems resilience.

 The only way through is together—From the Bottom Up

This is why we must act—urgently and deliberately—to reinforce what already exists:

• Map the network: Every ward and municipality holds potential—Civil Society Organisations, youth groups, faith-led movements, informal collectives. Registered or not, we need to see them. “Some are even about to be Deregistered from the Department of Social Development due to non-compliance”.
• Invest in layered capacity building: Meet organizations where they are. Don’t train for them—build with them.
• Reignite peer-led learning: Let the more experienced pull others forward. Horizontal learning is the glue of community resilience.
• Integrate communities into planning frameworks: They’re not optional stakeholders—they’re structural pillars. They need to actively led the development of the Multisector Local Implementation Plan (MLIP) development.

 What we’ve learned—and must not forget

• Community-led systems are not emergency backups—they are core infrastructure.
• Qualitative data is not anecdotal—it is strategic.
• Sustainability is not only about budgets—it’s about trust, proximity, and shared ownership.

When donors step back, when policy fails to keep pace, and when systems falter, it’s the community that stays standing.

 A Note to Pinampi Maano and the South African National Aids Council (SANAC) SANAC CSF Collective

To Pinampi, my colleagues across the SANAC CSF, and every community voice still showing up despite the uncertainty:

This is not the time to step back. It’s the time to step closer—to each other.

• Let’s document what we’ve built. Let’s identify every organization—1 day or 10 years old.
• Let’s strengthen the systems that have already proven they can hold.

Because if the last few years have taught us anything, it’s this: Real resilience is built from the ground up.

Let’s build what lasts—together.

— Mokgadi

Dr Thembisile Xulu (Dr T) Hon Mmapaseka Steve Letsike Mabalane Mfundisi Mulalo Murudi Nonhlanhla MC Mkhize Elphas Nkosi Ndumiso Tshuma PhD, MBA Tshepo M Ndhlovu Rentia Agenbag Gugu Shabangu Gonondo Sheila Mbele-Khama Treatment Action Campaign (TAC) René Liezel Sparks