Organizational factors associated with health worker protection during the COVID-19 pandemic in four provinces of South Africa

Muzimkhulu Zungu,Nosimilo Mlangeni,Jonathan Ramodike,Saiendhra Vasudevan Moodley,Kuku Voyi,Molebogeng Malotle,Annalee Yassi,Elizabeth Wilcox,Jerry Spiegel,Nico Claassen,Nkululeko Thunzi

doi:10.1186/s12913-021-07077-w

Abstract

BackgroundHealth workers, in short supply in many low-and-middle-income countries, are at increased risk of SARS-CoV-2 infection. This study aimed to assess how South Africa, prepared to protect its health workers from SARS-CoV-2 infection.MethodsThis was a cross-sectional study design applying participatory action research in four provinces of South Africa. A semi-structured questionnaire and a qualitative observational HealthWISE walkthrough risk assessment was carried out to collect data on occupational safety and health (OSH) systems in 45 hospitals across four provinces to identify factors associated with health worker protection. Adapting the International Labour Organization (ILO) and World Health Organization (WHO) HealthWISE tool, we compiled compliance scores through walkthrough surveys. We used logistic regression to analyze the relationship between readiness indicators and the actual implementation of protective measures.ResultsWe found that health facilities in all four provinces had SARS-CoV-2 plans for the general population but no comprehensive OHS plan for health workers. Provincial Departments of Health (PDoH) varied in how they were organized to respond: Provinces A and D had an OSH SARS-CoV-2 provincial coordinating team and a dedicated budget for occupational health; Province A had an occupational health doctor and nurse; while Province B had an occupational health nurse; Province A and D PDoHs had functional OSH committees; and Province D had conducted some health risk assessments specific to SARS-CoV-2. However, none of the assessed health facilities had an acceptable HealthWISE compliance score (≥ 75%) due to poor ventilation and inadequate administrative control measures. While the supply of personal protective equipment was adequate, it was often not worn properly. Our study found that having an OSH SARS-CoV-2 policy was significantly associated with higher personal protective equipment and ventilation scores. In addition, our analysis showed that hospitals with higher compliancescores had significantly lower infection rates (IRR 0.98; 95% CI: 0.97, 0.98).ConclusionsDespite some initial preparedness, greater effort to protect health workers is still warranted. Low-and-middle-income countries may need to pay more attention to OSH systems and consider using tools, such as ILO/WHO HealthWISE tool, to protect health workers’ health.

Highlights

Health workers, in short supply in many low-and-middle-income countries, are at increased risk of severe acute respiratory syndrome (SARS)-CoV-2 infection
We aimed to explore the extent to which South Africa has been abiding by its legal and social responsibility to protect health workers, a potentially vulnerable workforce by 1) assessing the readiness of occupational safety and health (OSH) systems in place to protect health workers from SARS-CoV-2 in four Provincial Departments of Health (PDoH) using the World Health Organization (WHO)’s health system framework; 2) conducting a health facility assessment for the protection of health workers against SARS-CoV-2 infection based on principles of the HealthWISE tool; and 3) ascertaining the relationship between, on the one hand, the existence of policies and/or easy-to-use tools such as HealthWISE, and, on the other hand, the implementation of concrete OSH programmes and/or protective measures at the time (April – June) that WHO declared a global pandemic
Based on the observation of our research team using the HealthWISE tool, our research showed that in South Africa, OSH for health workers was occupational health nurse driven and with a large number of environmental health practitioners supporting at health facilities, with a significantly low number of occupational medical practitioners

Summary

Introduction

In short supply in many low-and-middle-income countries, are at increased risk of SARS-CoV-2 infection. Health workers were among the highest risk occupations for exposure to the previous severe acute respiratory syndrome (SARS) pandemic [7]. They were further identified as a high-risk occupational group in Asian countries during both the SARS and the Middle East respiratory syndrome (MERS) coronavirus outbreaks [8]. Clinicians and those performing aerosolgenerating procedures in particular account for a significant proportion of SARS-CoV-2 infection and may experience exceptionally high infection incidence following unprotected exposure [9]

Objectives

Methods

Results

Discussion

Conclusion