Health workers speak from the Covid-19 frontline

According to Health Minister Dr Zweli Mkhize, about 24,000 South African healthcare workers were diagnosed with Covid-19 as at 2 August, with 181 recorded deaths.

On Thursday 6 August, the Human Sciences Research Council (HSRC), in partnership with the University of KwaZulu-Natal, released the results of a survey that looked at the impact of Covid-19 on healthcare workers.

The survey, which was conducted from 11 April to 7 May, reached 7,607 healthcare workers and aimed to ascertain how the virus is affecting South African health professionals – both physically and emotionally.

Nearly 50% of participants worked in the public health sector and 32% worked in the private sector.

Healthcare workers were invited to participate in the online survey on the biNU data free platform which comprised 45 close-ended questions pertaining to the following issues:

1. Training received to respond to Covid-19;


2. Levels of knowledge, awareness, and attitudes to Covid-19;


3. The use of and access to personal protective equipment (PPE) in the workplace;


4. Perceptions of risk in the workplace;


5. Concerns in relation to Covid-19; and


6. Health and psychosocial wellbeing of the respondent.

The webinar was facilitated by Professor Khangelani Zuma, with an introduction to the study given by Professor Priscilla Reddy and the results delivered by Professor Mosa Moshabela. National Department of Health representative Simon Hlungwani also attended.

Primary findings

1. Knowledge of main symptoms 

“Knowledge is important in terms of the way that it determines behaviour and practice,” says Moshabela.

When asked what the main symptoms of the pandemic were, over 85% of the respondents correctly identified a cough, sore throat and fever.

However, significantly fewer nurses correctly identified a cough and fever as a main symptom compared to medical practitioners and other healthcare workers.

2. Confidence in overall knowledge about Covid-19

Nearly 55% of medical professionals demonstrated confidence in their knowledge of Covid-19. However, nurses had the lowest percentage of those who lacked confidence in their knowledge.

3. Information sources used for Covid-19

Moshabela notes that significantly more healthcare practitioners working in urban formal areas received their information from the national Department of Health, as well as official organisation websites such as the World Health Organisation and the Centre for Disease Control, with over 60% of respondents using these sources.

4. Formal training for Covid-19 management

Formal training included training in infection control, screening, isolation referrals, case definition, treatment guidelines and declaring patients. The majority indicated that they were trained or instructed in screening and workplace infection control.

Only a quarter reported that they had received training in declaring patients as recovered. There were significant differences among professional categories for each training area.

More medical practitioners reported receiving training in every training area, compared to nurses and other healthcare professionals.

Among nurses, less than half reported being trained in treatment guidelines and declaring patients as recovered.

“We want to make an argument that all healthcare professionals would need to receive training in these different areas, but training appropriate to the professional,” says Moshabela.

5. Self-perceived risk of contracting Covid-19

Participants had a significantly high self-perceived risk of contracting Covid-19. This was the same across all provinces. High risk perception was highest in North West and Free State and lowest in Western Cape and Gauteng. Nurses had the highest self-perceived risk among all professional categories.

There was a direct correlation between those who are confident in their knowledge and those who have a lower perceived risk of infection.

6. Infection prevention, control measures, and PPE

Overall, more than two-thirds of participants expressed the need for all forms of PPE (apart from rubber boots).

The majority expressed the need for environmental controls, eye shields, goggles, gloves and N95 masks.

Forty-five percent of all healthcare professionals were confident in the donning, doffing, and correct use of PPE.

However, professionals expressed low confidence in the availability and accessibility of PPE.

7. Psychological distress

Overall, about 20% of participants were severely distressed and just over half the sample had low distress.

Psychological distress was significantly higher among nurses then medical practitioners and other healthcare professionals and among public sector employees than those in private or other sectors.

Among nurses, general health and well-being were the lowest as compared to medical practitioners. There was a significant difference in the general health and well-being among the professional categories.

Moshabela explains that the number of healthcare workers experiencing severe distress should be zero. Unfortunately, these findings suggest that around one in four healthcare workers are experiencing severe distress.

Recommendations and responses 

Based on their findings, the HSRC and the UKZN made several recommendations pertaining to health and well-being, surveillance, community support, communication strategy, in-service training and continuing medical education, workplace support, and infection control and PPE.

Moshabela says one thing is explicitly clear: there is a great need for an up-to-date central database of all healthcare professionals and their demographics in South Africa. Such a database would be of great advantage for future research and planning.

He also emphasised that South Africa is in dire need of improved communication strategies with clear implementable plans in case of public health emergencies.

Moshabela says that there needs to be a strong emphasis and improvement in training.

“Training should be timely, equitable, impactful, and comprehensive.”

It is recommended that training should combine on-the-job sessions rehearsals with periodic assessments.

“In terms of when people have information and they’ve been trained, this contributes to their confidence in terms of knowledge.”

Proactive health and well-being programmes should be developed and implemented to support health professionals.

These findings and recommendations are welcomed by the National Department of Health, says department representative Simon Hlungwani:

“We appreciate this. The research is highly informative. It confirms what we wanted, and we welcome it.

“This study is highlighting extremely fundamental issues; with shortcomings on our side.

“The reason why we were so exposed is that we were not even ready in terms of the availability of human resources; and currently we don’t have a system that provides support to people who are working in the health sector.”

Hlungwani says that the big question now is whether we are prepared for another pandemic once the storm of Covid-19 passes.

“Are we ready for another? We need to prepare as a country. We need to prepare as health professionals and for health professionals. The question will come to see if our curriculum is ready for any health disaster.” DM/MC