Organizational Factors Associated with Health Worker Protection: A Participatory Mixed-Method Cross-Sectional Analysis in Four Provinces of South Africa

Abstract

\n Background: Health workers, in short supply in many low-and-middle-income countries (LMICs), are at increased risk of SARS-CoV-2 infection during their employment. This study aimed to assess how South Africa, an LMIC, prepared to protect its health workers from SARS-CoV-2. Methods: This was a participatory mixed method study conducted in four provinces of South Africa. We used a semi-structured questionnaire and a walkthrough survey 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. For the questionnaire, the participants were provincial OSH managers. For the walkthrough survey, they were frontline health workers, facility managers, and OSH and Infection Prevention and Control (IPC) professionals. We used logistic regression to analyze the relationship between readiness indicators and the actual implementation of protective measures. We also evaluated the association between OSH compliance and hospital infection rates.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. Province A and D Provincial Department of Health (PDoH) had an OSH SARS-CoV-2 provincial coordinating team and a dedicated budget for occupational health. Province A had an occupational health doctor and an occupational health 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 (PPE) was adequate, PPE was often not worn properly. Our study found that having an OSH SARS-CoV-2 policy was significantly associated with higher PPE 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. LMICs may need to pay more attention to OSH systems and consider using tools, such as ILO/WHO HealthWISE tool, to protect health workers health.