South Africa: Health and safety of municipal workers neglected

Pambazuka News
The culture of neglect of workplace health and safety impacts not only on the healthcare workers, but also contributes to a declining quality of health care that they are able to provide to the communities they serve. The findings of this collaborative participatory research project were published in: Who Cares For Health Care Workers?: The State of Occupational Health and Safety in Municipal Health Clinics in South Africa, Municipal Services Project, Occasional Papers No. 8, January 2005.

The research, carried out by a collective of SAMWU members and conducted at 38 municipal clinics over an 18-month period, reveal a culture of reactivity and minimal legal compliance. OH&S is all too often reduced to the processing of compensation claims. No proactive or preventive procedures are in place for identifying hazards, evaluating risks, preventing workplace injury and illness, and maintaining a safe workplace. An inadequate supply and use of personal protective equipment, negligent waste disposal methods, overcrowding, bad ventilation, staff shortages and high patient loads, inadequate health and safety awareness amongst clinic staff, an absence of effective protocols and a culture of stigma around HIV/AIDS all increase the health and safety risks facing healthcare workers. Many clinics did not even have such basic supplies as soap.

Because their work involves coming into contact with people carrying infectious diseases, health workers are routinely exposed to dangerous pathogens, such as viruses, bacteria and parasites. Working with sharp instruments, such as needles, presents and an additional hazard to health workers. Furthermore, the critical shortage of staff, coupled with ever-growing queues of patients - especially those affected by the HIV epidemic is taking its toll on the health and safety of healthcare workers. While nurses consider a nurse/patient ratio of 1:35 to be the norm, clinics had ratios ranging from 1:40 to 1:90. Overworked staff face the trauma and stress of increasing numbers of HIV/AIDS patients a challenge which puts the resources of the clinics and the clinic staff under added strain. Stress and burnout also make healthcare workers more prone to infection and accidental injuries, such as preventable needle stick injuries resulting from fatigue or the rush to see patients. The pressure to provide care to all patients regardless of the circumstances creates a high workload for health workers and can result in mistakes being made with regard to patient care.

Staff shortages also often force clinic workers to work outside their job descriptions often without appropriate training or remuneration. The research found cases of nurses working as pharmacists, nurses working as senior sisters without being paid an extra allowance, nurses expected to counsel patients who come for HIV tests without receiving any counseling training, and even a clinic administrative clerk having to transport medical waste and suffering a needle stick injury in the process. Probably the most tragic story of staff shortage came from the Freedom Square clinic near Bloemfontein, where patients are required to clean the clinic before they are attended to because there is no cleaning staff at the facility. While 83% of the clinics surveyed said that they have a protocol in place in the event of a health worker being exposed to HIV in the workplace, the efforts of the employer with regard to preventive HIV measures are haphazard and inconsistent. Some OH&S initiatives have been taken but many remain on paper. HIV/AIDS workplace policies are often centralized in municipalities, very general and not directed at the specific conditions and needs of different departments or clinics. Staff are also often not familiar with the contents of these policies.

The SAMWU/IHRG/MSP research project emphasized that any challenge to the negligent and reactive culture of OH&S in the municipal health clinics (and in the public health sector more generally) must come from the organized activity of health workers. While employers have obligations towards their employees, and while workers OH&S rights are written in law, these will only be enforced and effective if workers and their trade unions build a proactive and preventive culture of health and safety in the workplace.
With regard to HIV the research findings indicate that only once healthcare workers develop the confidence to establish and enforce adequate protection against occupational exposure to HIV, can they overcome the fear and stigma associated with the disease and provide leadership to their patients in building a culture of prevention. Public health sector trade unions have a vital role to play in developing this leadership.

(Source: Pambazuka News, April 12, 2005)