Safety and Health at Work

Occupational Safety and Health Research Institute, Korea Occupational Safety and Health Agency (산업안전보건연구원)
권호 표지
DOI QR코드

DOI QR Code

Systematizing Information Use to Address Determinants of Health Worker Health in South Africa: A Cross-sectional Mixed Method Study

  • Muzimkhulu Zungu (National Institute for Occupational Health, A Division of the National Health Laboratory Service) ;
  • Annalee Yassi (School of Population and Public Health, University of British Columbia) ;
  • Jonathan Ramodike (National Institute for Occupational Health, A Division of the National Health Laboratory Service) ;
  • Kuku Voyi (School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria) ;
  • Karen Lockhart (School of Population and Public Health, University of British Columbia) ;
  • David Jones (National Institute for Occupational Health, A Division of the National Health Laboratory Service) ;
  • Spo Kgalamono (National Institute for Occupational Health, A Division of the National Health Laboratory Service) ;
  • Nkululeko Thunzi (National Institute for Occupational Health, A Division of the National Health Laboratory Service) ;
  • Jerry Spiegel (School of Population and Public Health, University of British Columbia)
  • Received : 2023.07.18
  • Accepted : 2023.10.24
  • Published : 2023.12.30
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Recognizing that access to safe and healthy working conditions is a human right, the World Health Organization (WHO) calls for specific occupational safety and health (OSH) programs for health workers (HWs). The WHO health systems' building blocks, and the International Labour Organization (ILO), highlight the importance of information as part of effective systems. This study examined how OSH stakeholders access, use, and value an occupational health information system (OHIS). Methods: A cross-sectional survey of OSH stakeholders was conducted as part of a larger quasi experimental study in four teaching hospitals. The study hospitals and participants were purposefully selected and data collected using a modified questionnaire with both closed and open-ended questions. Quantitative analysis was conducted and themes identified for qualitative analysis. Ethics approval was provided by the University of Pretoria and University of British Columbia. Results: There were 71 participants comprised of hospital managers, health and safety representatives, trade unions representatives and OSH professionals. At least 42% reported poor accessibility and poor timeliness of OHIS for decision-making. Only 50% had access to computers and 27% reported poor computer skills. When existing, OHIS was poorly organized and needed upgrades, with 85% reporting the need for significant reforms. Only 45% reported use of OHIS for decision-making in their OSH role. Conclusion: Given the gap in access and utilization of information needed to protect worker's rights to a safe and healthy workplace, more attention is warranted to OHIS development and use as well as education and training in South Africa and beyond.

Keywords

Acknowledgement

The authors are grateful to the management of GPDOH and MPDOH, the four study hospitals, the occupational health coordinators (Ms Patricia Moloi, Dr Sipho Senabe and Ms Refiloe Bodibe) and all the HWs who participated. We would like to acknowledge the University of Pretoria's School of Health Systems and Public Health, the National Health Laboratory Service and the National Institute for Occupational Health for their contributions in supporting the research. The funders, the International Development Research Centre was not involved in the research.

References

  1. Moore D, Gamage B, Bryce E, Copes R, Yassi A., other members of The British Columbia Interdisciplinary Respiratory Protection Study Group. Protecting health care workers from SARS and other respiratory pathogens: organizational and individual factors that affect adherence to infection control guidelines. American Journal of Infection Control 2005;33(2):88-96. https://doi.org/10.1016/j.ajic.2004.11.003
  2. Harrigan SP, Tsang VW, Yassi A, Zungu M, Spiegel JM. Impacts of economic inequality on healthcare worker safety at the onset of the COVID-19 pandemic: cross-sectional analysis of a global survey. BMJ Open 2022;12(10):e064804.
  3. Imran A. Why addressing digital inequality should be a priority. The Electronic Journal of Information Systems in Developing Countries 2022:e12255.
  4. Tshoose C. Placing the right to occupational health and safety within a human rights framework: trends and challenges for South Africa. Comparative and International Law Journal of Southern Africa 2014;47(2):276-96.
  5. Assembly UG. Universal declaration of human rights. UN General Assembly 1948;302(2):14-25.
  6. International Labour Organization ILO Constitution Geneva (Switzerland) ILO [updated October 8th, 2015; cited 2022 June 18]. Available from: https://www.ilo.org/dyn/normlex/en/f?p=1000:62:0 1919; 1919. NO:62:P62_LIST_ENTRIE_ID:2453907:NO.
  7. Milgate N, Innes E, O'Loughlin K. Examining the effectiveness of health and safety committees and representatives: a review. Work (Reading, Mass) 2002;19(3):281-90.
  8. International labour organization ILO statement to the third committee of the 68th general assembly: decent work is a human right Geneva (Switzerland). ILO. 2013 [cited 2023 January 7]. Available from: https://www.ilo.org/ newyork/speeches-and-statements/WCMS_229015/lang-en/index.htm.
  9. International Labour Organization. Occupational health services convention (No. 161). Geneva, Switzerland: International Labour Organization; 1985.
  10. Word Health Organization. World Health Assembly. Resolution 60.26. Global plan of action on workers' health 2008-2017. Geneva (Switzerland): WHO; 2007.
  11. Rantanen J, Lehtinen S, Iavicoli S. Occupational health services in selected International Commission on Occupational Health (ICOH) member countries. Scandinavian Journal of Work, Environment & Health 2013;(2):212-6.
  12. LaDou J. International occupational health. International Journal of Hygiene and Environmental Health 2003;206(4):303-13. https://doi.org/10.1078/1438-4639-00226
  13. Lucchini RG, London L. Global occupational health: current challenges and the need for urgent action. Annals of Global Health 2014;80(4):251-6. https://doi.org/10.1016/j.aogh.2014.09.006
  14. O'Hara L, Nophale L, Zungu M, Yassi A. Occupational health, infection control and TB control. GOHNET The Global Occupational Health Network; 2014.
  15. Moodley PP, Bachmann MO. Inequity in occupational health services for government hospital workers in South Africa. Occupational Medicine 2002;52(7):393-9. https://doi.org/10.1093/occmed/52.7.393
  16. Jeebhay M, Jacobs B. Occupational health services in South Africa. South African Health Review 1999;29(19):257-76.
  17. Baker PA. From apartheid to neoliberalism: health equity in post-apartheid South Africa. International Journal of Health Services 2010;40(1):79-95. https://doi.org/10.2190/HS.40.1.e
  18. World Health Organization. Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies. World Health Organization; 2010.
  19. Lynch JJ. Components of occupational health information systems. Journal (American Medical Record Association) 1986 Jan 1;57(1):19-22.
  20. Wyatt JC, Sullivan F. What is health information? BMJ (Clinical Research Ed) 2005;331(7516):566.
  21. World Health Organization. Health information systems: toolkit on monitoring health systems strengthening. Geneva: WHO; 2008.
  22. Benach J, Muntaner C, Benavides FG, Amable M, Jodar P. A new occupational health agenda for a new work environment. Scandinavian Journal of Work, Environment & Health 2002:191-6.
  23. Mumcu G, Koksal L, Sisman N, Catar RO. The effectiveness and outcomes of computerized provider order entry in emergency care department of private hospitals. Clinical and Experimental Health Sciences 2013;3(2):83.
  24. Yassi A, Grant JM, Lockhart K, Barker S, Sprague S, Okpani AI, Wong T, Daly P, Henderson W, Lubin S, Kim Sing C. Infection control, occupational and public health measures including mRNA-based vaccination against SARS-CoV-2 infections to protect healthcare workers from variants of concern: a 14-month observational study using surveillance data. PloS One 2021;16(7):e0254920.
  25. Wilson KS, Ntlebi V, Made F, Sanabria N, Vetten M, Joseph J, Chin G, Jones D, Tlotleng N. COVID-19 cases among medical laboratory services staff in South Africa, 2020-2021: a cohort study. PloS One 2022 Jun 17;17(6):e0268998.
  26. Che Huei L, Ya-Wen L, Chiu Ming Y, Li Chen H, Jong Yi W, Ming Hung L. Occupational health and safety hazards faced by healthcare professionals in Taiwan: a systematic review of risk factors and control strategies. SAGE Open Medicine 2020;8:2050312120918999.
  27. International labour organization international labour standards on occupational safety and health; 2019.
  28. Nathavitharana RR, Bond P, Dramowski A, Kotze K, Lederer P, Oxley I, Peters JA, Rossouw C, van der Westhuizen HM, Willems B, Ting TX. Agents of change: the role of healthcare workers in the prevention of nosocomial and occupational tuberculosis. La Presse Medicale 2017 Mar 1;46(2):e53-62. https://doi.org/10.1016/j.lpm.2017.01.014
  29. Routine health information systems: the glue of a unified health system. In: Lippeveld T, editor. Keynote address at the workshop on issues and innovation in routine health information in developing countries. Potomac; 2001. March.
  30. Vitacca M, Vitacca M. Proposal of a multidimensional strategic-management dashboard for use in a rehabilitation respiratory unit. Medicine (Baltimore) 2019;98(20):e15728-e.
  31. Gaiotto EMG, Godoy Vieira A, Soares CB. Workers' occupational health surveillance systems in low- and middle-income countries: a scoping review protocol. JBI Evidence Synthesis 2020;18(9):2098-103. https://doi.org/10.11124/JBISRIR-D-19-00242
  32. International Labour Organization. Technical and ethical guidelines for workers' health surveillance (OSH No. 72). Geneva: International Labour Office: International Labour Office; 1998 October. 11 p.
  33. Chen M, Tan X, Padman R. Social determinants of health in electronic health records and their impact on analysis and risk prediction: a systematic review. Journal of the American Medical Informatics Association 2020;27(11):1764-73. https://doi.org/10.1093/jamia/ocaa143
  34. Rohde JE, Shaw V, Hedberg C, Stoops N, Venter S, Venter K, Matshisi L. Information for primary health care: primary health care: systems support. South African Health Review 2008 Jan 1;2008(1):195-209.
  35. English R, Masilela T, Barron P, Schonfeldt A. Health information systems in South Africa. South African Health Review 2011;2011(1):81-9.
  36. LaDou J, London L, Watterson A. Occupational health: a world of false promises. Environmental Health 2018;17(1):81.
  37. Garnett J, Jones D, Chin G, Spiegel JM, Yassi A, Naicker N. Occupational tuberculosis among laboratory workers in South Africa: applying a surveillance system to strengthen prevention and control. International Journal of Environmental Research and Public Health 2020;17(5):1462.
  38. Spiegel JM, Lockhart K, Dyck C, Wilson A, O'Hara L, Yassi A. Tool, weapon, or white elephant? A realist analysis of the five phases of a twenty-year programme of occupational health information system implementation in the health sector. BMC Medical Informatics and Decision Making 2012;12(1):84.
  39. Pillay YG, Bond P. Health and social policies in the new South Africa. International Journal of Health Services 1995;25(4):727-39. https://doi.org/10.2190/YJU7-0HDM-7TYW-XLMF
  40. Zungu M, editor. Rodney ehrlich PhD protocol review. Cape Town: University of Pretoria; 2020.
  41. Kiberu VM, Matovu JKB, Makumbi F, Kyozira C, Mukooyo E, Wanyenze RK. Strengthening district-based health reporting through the district health management information software system: the Ugandan experience. BMC Medical Informatics and Decision Making 2014;14(1):40.
  42. Spiegel JM, Zungu M, Yassi A, Lockhart K, Wilson KS, Okpani AI, Jones D, Sanabria N. Protecting healthcare workers during a pandemic: what can a WHO collaborating centre research partnership contribute? Revista Panamericana de Salud Publica 2023 Mar 17;47:e33.
  43. Zungu M, Voyi K, Mlangeni N, Moodley SV, Ramodike J, Claassen N, Wilcox E, Thunzi N, Yassi A, Spiegel J, Malotle M. Organizational factors associated with health worker protection during the COVID-19 pandemic in four provinces of South Africa. BMC Health Services Research 2021 Dec;21:1-5. https://doi.org/10.1186/s12913-020-05996-8
  44. Zungu M, Yassi A, Voyi K, Ramodike J, Kgalamono S, Senabe S, Jones D, Naicker N, Thunzi N, Okpani A, Grant J. Occupational health information systems for health workers during the COVID-19 pandemic in South Africa. Safety and Health at Work 2022 Jan;13:S211.
  45. Kaduruwane IR. An empirical investigation of health information system failure in regional Sri Lanka. Queensland University of Technology; 2012.
  46. Ranasinghe KI, Chan T, Yaralagadda P. Information support for health management in regional Sri Lanka: health managers' perspectives. Health Information Management Journal 2012;41(3):20-6. https://doi.org/10.1177/183335831204100303
  47. Box D, Pottas D. Improving information security behaviour in the healthcare context. Procedia Technology 2013;9:1093-103. https://doi.org/10.1016/j.protcy.2013.12.122
  48. Kleinpeter E. Four ethical issues of "e-health". IRBM 2017;38(5):245-9. https://doi.org/10.1016/j.irbm.2017.07.006
  49. Sevimli E, Altingoz EN, Kitapci NS, , Kitapci OC, Koksal L, Yay M, Aksu PK, Mumcu G. An assessment of health information systems through the perspective of computer engineering students and medical students. Acta Informatica Medica 2019 Dec;27(5):300.
  50. Mphatswe W, Mate KS, Bennett B, Ngidi H, Reddy J, Barker PM, Rollins N. Improving public health information: a data quality intervention in KwaZuluNatal, South Africa. Bulletin of the World Health Organization 2012;90:176-82. https://doi.org/10.2471/BLT.11.092759
  51. Heeks R. Health information systems: failure, success and improvisation. International Journal of Medical Informatics 2006;75(2):125-37. https://doi.org/10.1016/j.ijmedinf.2005.07.024
  52. Avgerou C. Information systems in developing countries: a critical research review. Journal of Information Technology 2008;23(3):133-46. https://doi.org/10.1057/palgrave.jit.2000136
  53. Garrib A, Stoops N, McKenzie A, Dlamini L, Govender T, Rohde D, Herbst K. An evaluation of the district health information system in rural South Africa. South African Medical Journal 2008 Jul 18;98(7):549-52.
  54. AbouZahr C, Boerma T. Health information systems: the foundations of public health. Bulletin of the World Health Organization 2005;83:578-83.
  55. Canela-Soler J, Elvira-Martinez D, Labordena-Barcelo MJ, Loyola-Elizondo E. [Information systems in health and health indicators: an integrating perspective]. Med Clin (Barc). 2010;134(Suppl. 1):3-9. https://doi.org/10.1016/S0025-7753(10)70002-6
  56. Rantanen J, Lehtinen S, Valenti A, Iavicoli S. A global survey on occupational health services in selected international commission on occupational health (ICOH) member countries. BMC Public Health 2017;17(1):787.
  57. Moyo D, Zungu M, Kgalamono S, Mwila CD. Review of occupational health and safety organization in expanding economies: the case of Southern Africa. Annals of Global Health 2015;81(4):495-502. https://doi.org/10.1016/j.aogh.2015.07.002
  58. Moyo D. An overview of occupational medicine and health services and associated challenges in southern Africa. Occupational Health Southern Africa 2021;27(2):51-4.
  59. Malotle MM, Spiegel JM, Yassi A, Ngubeni D, O'Hara LM, Adu PA, Bryce EA, Mlangeni N, Gemell GS, Zungu M. Occupational tuberculosis in South Africa: are health care workers adequately protected? Public Health Action 2017 Dec 21;7(4):258-67. https://doi.org/10.5588/pha.17.0070
  60. Theo L, Rainer S. A framework for designing Health Information Systems;2000.
  61. Beck EJ, Gill W, De Lay PR. Protecting the confidentiality and security of personal health information in low- and middle-income countries in the era of Sustainable Development Goals and Big Data. Global Health Action 2016;9(1):32089.
  62. Ali S, Zada I, Mehmood Z, Ullah A, Ali H, Ullah M. Publishing and interlinking COVID-19 data using linked open data principles: toward effective healthcare planning and decision-making. Mathematical Problems in Engineering 2022;2022:4792909.
  63. Tilahun B, Kauppinen T, Kessler C, Fritz F. Design and development of a linked open data-based health information representation and visualization system: potentials and preliminary evaluation. JMIR Medical Informatics 2014;2(2):e3531.
  64. Adu PA, Yassi A, Ehrlich R, Spiegel JM. Perceived health system barriers to tuberculosis control among health workers in South Africa. Ann Glob Health 2020;86(1):15.
  65. Garcia R, Spiegel JM, Yassi A, Ehrlich R, Romao P, Nunes EA, Zungu M, Mabhele S. Preventing occupational tuberculosis in health workers: an analysis of state responsibilities and worker rights in mozambique. International Journal of Environmental Research and Public Health 2020 Oct;17(20):7546.
  66. Liautaud A, Adu PA, Yassi A, Zungu M, Spiegel JM, Rawat A, Bryce EA, Engelbrecht MC. Strengthening human immunodeficiency virus and tuberculosis prevention capacity among South African healthcare workers: a mixed methods study of a collaborative occupational health program. Safety and Health at Work 2018 Jun 1;9(2):172-9. https://doi.org/10.1016/j.shaw.2017.08.004
  67. O'Brien DG, Yasnoff WA. Privacy, confidentiality, and security in information systems of state health agencies. American Journal of Preventive Medicine 1999;16(4):351-8.
  68. Republic of South Africa occupational health and safety act 85 of 1993. In: Department of employment and labour editor. Pretoria (South Africa): Government Gazette; 1993.
  69. Abdelrahim RA, Otitolaiye VO, Omer F, Abdelbasit Z. A scoping Review of the occupational health and safety governance in Sudan: the story so far. Safety and health at work; 2023.
  70. Marmot M, Friel S, Bell R, Houweling TA, Taylor S, Health CoSDo. Closing the gap in a generation: health equity through action on the social determinants of health. The Lancet 2008;372(9650):1661-9. https://doi.org/10.1016/S0140-6736(08)61690-6
  71. Muntaner C, Chung H, Solar O, Santana V, Castedo A, Benach J. EMCONET Network. A macro-level model of employment relations and health inequalities. International Journal of Health Services 2010 Apr;40(2):215-21. https://doi.org/10.2190/HS.40.2.c
  72. Word Health Organization Home/Health topics/Social determinants of health Geneva (Switzerland) WHO publishers [cited 2022 2022]. Available from: https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1 2022; 2022.
  73. Almost JM, VanDenKerkhof EG, Strahlendorf P, Caicco Tett L, Noonan J, Hayes T, Van Hulle H, Adam R, Holden J, Kent-Hillis T, McDonald M. A study of leading indicators for occupational health and safety management systems in healthcare. BMC Health Services Research 2018 Dec;18:1-7.
  74. Bottani E, Monica L, Vignali G. Safety management systems: performance differences between adopters and non-adopters. Safety Science 2009;47(2):155-62. https://doi.org/10.1016/j.ssci.2008.05.001
  75. Habeck RV, Hunt HA, VanTol B. Workplace factors associated with preventing and managing work disability. Rehabilitation Counseling Bulletin 1998;42(2):98-143.
  76. Mearns K, Whitaker SM, Flin R. Safety climate, safety management practice and safety performance in offshore environments. Safety Science 2003;41(8):641-80. https://doi.org/10.1016/S0925-7535(02)00011-5
  77. Reilly B, Paci P, Holl P. Unions, safety committees and workplace injuries. British Journal of Industrial Relations 1995;33(2):275-88. https://doi.org/10.1111/j.1467-8543.1995.tb00435.x
  78. Shannon HS, Walters V, Lewchuk W, Richardson J, Moran LA, Haines T, Verma D. Workplace organizational correlates of lost-time accident rates in manufacturing. American Journal of Industrial Medicine 1996 Mar;29(3):258-68. https://doi.org/10.1002/(SICI)1097-0274(199603)29:3<258::AID-AJIM5>3.0.CO;2-M
  79. Sarbaz M, Kimiafar K, Taherzadeh Z, Naderi H, Eslami S. Effect of modifying the information and training structure on the occupational safety of health care workers in exposure to blood and body fluids: a quasi-experimental study. American Journal of Infection Control 2017;45(1):80-2. https://doi.org/10.1016/j.ajic.2016.05.023
  80. Nutley T. Improving data use in decision making: an intervention to strengthen health systemsdMEASURE evaluation. Publication; 2012.
  81. Foreit K, Moreland S, LaFond A. Data demand and information use in the health sector: conceptual framework. Chapel Hill, NC: MEASURE Evaluation, Carolina Population Center; 2006. p. 1-17.
  82. Swart L-A, Taliep N, Ismail G, Van Niekerk A. The converging influence of social, economic and psychological factors on public responsiveness to the COVID-19 pandemic in South Africa. BMC Public Health 2022;22(1):1-11. https://doi.org/10.1186/s12889-021-12274-7