Pivoting during a crisis: lessons for Emergency Medical Services (EMS)
and everyday health systems resilience from the Vaxi Taxi in South
Africa.
Abstract
Covid-19 demanded new ways of working. In this paper, we present
the experience of the Vaxi Taxi, a community-orientated model of care
developed when Emergency Medical Services (EMS) pivoted in response to
the Covid-19 pandemic, converting its ambulances into mobile vaccination
units in the Western Cape, South Africa. Using a five-year long embedded
research approach, we drew on traditions of organizational ethnography
and critical action research. Data collection included documenting
observations and reflections in a research diary during implementation.
In addition, in-depth interviews, focus group discussions and a series
of sensemaking discussions with academic research team members were
done. Our analysis draws on the Everyday Health Systems Resilience
framework (EHSR) which understands resilience as an emergent process
underpinned by system capacities (cognitive, behavioral and contextual)
that can be nurtured through response to stress and shock. Responses
take the form of absorptive, adaptive or transformative strategies. We
consider the Vaxi Taxi as adaptive resilience strategy that nurtured
system capacities which may have transformative potential in future. For
health practitioners, it highlights the value of creative
problem-solving to generate ‘slack in the system’ and creating ‘spaces
of unlearning’ in supporting adaptive strategies. However, the
experience also highlighted that the relational work to support
meaningful community relationships that enable trust take time. Routine
EMS operations don’t support this trust building, and this requires
alternative approaches. Finally, the paper represents a rare empirical
example of an adaptive response to crisis tracked over time, and thus
offers globally relevant lessons to the still-small EHSR literature.