Organizational factors associated with health worker protection during the COVID- 19 pandemic in four provinces of South Africa
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Date
Authors
Zungu, Muzimkhulu
Voyi, K.V.V. (Kuku)
Mlangeni, Nosimilo
Moodley, Saiendhra Vasudevan
Ramodike, Jonathan
Claassen, Nico
Wilcox, Elizabeth
Thunzi, Nkululeko
Yassi, Annalee
Spiegel, Jerry
Journal Title
Journal ISSN
Volume Title
Publisher
BioMed Central
Abstract
BACKGROUND : Health 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.
METHODS : This 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.
RESULTS : We 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 compliance
scores had significantly lower infection rates (IRR 0.98; 95% CI: 0.97, 0.98).
CONCLUSIONS : Despite some initial preparedness, greater effort to protect health workers is still warranted. Low-andmiddle-
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.
Description
Additional file 1: Appendix 1. How the semi-structured HealthWISE
walk-through risk assessment survey was conducted.
Keywords
HealthWISE, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), South Africa (SA), Healthcare workers (HCWs), Occupational safety and health (OSH)
Sustainable Development Goals
Citation
Zungu, M., Voyi, K., Mlangeni, N. et al. 2021, 'Organizational factors associated with
health worker protection during the COVID-
19 pandemic in four provinces of South
Africa', BMC Health Services Research, vol. 21, art. 1080, pp. 1-15.