Strengthening occupational health systems and services for health workers during the COVID-19 pandemic and beyond : the role of occupational health and safety information systems

Abstract

Introduction The World Health Organization’s (WHO) global plan of action on workers’ health urged member states to work towards full coverage of all workers with essential interventions and occupational health (OH) services to support primary prevention of occupational and work-related diseases and injuries. Globally, health workers (HWs) face a range of occupational hazards, especially in low- and middle-income countries (LMICs), and have limited access to OH services especially in LMICs. The calls by the WHO, International Labour Organization (ILO), International Commission on Occupational Health (ICOH) and other stakeholders, for OH systems to support needed OH services for HWs became more urgent when the COVID 19 pandemic struck. Some of the recommended OH interventions for HWs include the use of “HealthWISE”, a tool jointly developed by the WHO and ILO to support participatory action to improve workplace health, and occupational health and safety information systems, to help plan, guide and evaluate the various measures implemented. Both these interventions have been piloted and used to improve OH in South Africa. Strengthening OH systems is essential to the attainment of a healthy and safe workforce in the health sector, especially during the COVID-19 pandemic. This study aimed to assess the extent to which the introduction of HealthWISE tool along with a specific information system referred to as Occupational Health and Safety Information System (OHASIS), could strengthen OH systems in South African health settings during the COVID-19 pandemic and potentially beyond, through greater emphasis on how information was systematically collected and implemented in the workplace. Methods This was a quasi-experimental study utilising a mixed methodological approach, based on the principles of participatory action research to enable action and empower active participation in strengthening and evaluating OH. It assesses changes in OH systems (policy, leadership, and coordination; financing; human resources; infrastructure, technology and medicines; information management; and services) in health facilities, following the concurrent introduction of HealthWISE and OHASIS. Using Poisson regression models, it also assesses COVID-19 infection rates in relation to HealthWISE compliance scores in participating health facilities. Results Our baseline survey for HealthWISE, found that health facilities in all provinces had SARS-CoV-2 response routine and emergency plans for the general population but no comprehensive OH plan for HWs. Some provinces had an OH SARS-CoV-2 provincial coordinating team and a dedicated budget for OH, an occupational medical practitioner and an OH nurse, a functional health and safety committee, and 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. In addition, our analysis showed that hospitals with higher compliance scores had significantly lower infection rates (IRR 0.98; 95% CI: 0.97, 0.98). In facilities where HealthWISE had been implemented, we found that HWs adherence to administrative and personal protective equipment declined over time as the COVID-19 pandemic restrictions were relaxed, while the ventilation did not change, as it was poor from the baseline. Our Poisson regression model showed that higher HealthWISE administrative measures score in an area was associated with a reduction of the infection rate and higher HealthWISE ventilation measure score was also associated with a reduction of the infection rate.

For the baseline OHASIS study, there were 71 participants comprised of hospital managers, health and safety representatives, trade unions and OH and safety professionals. At least 42% reported poor accessibility and poor timelines of OH information systems for decision-making. Only 50% had access to computers and 27% reported poor computer skills. The existing OH information systems were poorly organized and needed upgrades, with 85% reporting the need for significant reforms. Only 45% reported use of OH information systems for decision-making in their OH and safety role. Following numerous attempts to implement OHASIS, we were unable to do so within the study period. The observed barriers for the establishment, provision, maintenance and sustaining OH and IPC, particularly our OHASIS intervention for HWs during the COVID-19 pandemic was a lack of leadership or stewardship in OH; lack of interest in the use of effective intelligence systems for decision making; ineffective health and safety committees; inactive trade unions; untrained and overworked OH professionals, among others. Conclusions Despite some initial preparedness, greater effort to protect HWs is still warranted. LMICs may need to pay more attention to occupational safety and health systems and consider using tools, such as HealthWISE to protect HWs’. HealthWISE, similar to other health strengthening measures, requires commitment and motivation of stakeholders, however if implemented, there are positive implications for OH. The significant association between infection rates and HealthWISE compliance scores is notable and merits further attention. Given the persistence gaps in access to and utilization of information needed to protect the rights of HWs to a safe workplace in South Africa and beyond, more attention is warranted to the systems that support data management and information implementation in this setting, including OH information system education and training.