Primary healthcare workers at risk during COVID-19: An analysis of infections in HIV service providers in five districts of South Africa

K Rees, J L Dunlop, S Patel-Abrahams, H Struthers, J A McIntyre


Background. Protecting healthcare workers (HCWs) from COVID-19 is a global priority. Anova Health Institute (Anova) is the PEPFAR (US President’s Emergency Plan for AIDS Relief) District Support Partner for the Johannesburg, Cape Town, Sedibeng, Capricorn and Mopani districts in South Africa, operating in public sector primary healthcare facilities. At the time of the emergence of COVID-19, Anova employed close to 4 000 people: 41% community health workers (CHWs), 23% data staff, 20% nurses and doctors, 12% management/
support and 5% allied HCWs.
Objectives. To describe rates of COVID-19 diagnosis in Anova-employed HCWs in five districts.
Methods. Employees exposed to, tested for or diagnosed with COVID-19 were required to report the event. These reports were compiled into a database to monitor the impact of COVID-19 on the workforce. We kept a timeline of key events occurring at national and district level, including Anova’s policies and their implementation, that was used to describe organisational response. We described the number of confirmed cases, cumulative incidence rates and testing rates, broken down by district and job category. We estimated expected deaths and the effect on time off work.
Results. Of Anova employees, 14% (n=562) were diagnosed with COVID-19 by the end of September 2020. Cumulative incidence was highest in Sedibeng (29%) and lowest in Mopani (5%). All HCWs experienced high incidences: data staff 17%, allied HCWs 16%, CHWs 14%, nurses and doctors 13%, and management/support 11%. At the peak of the epidemic, for 5 weeks, >5% of employees were unable to work owing to exposure or infection, significantly disrupting service delivery. The additional administrative burden on managers was substantial.
Conclusions. It is critical that all cadres of HCWs are protected in the workplace, including in primary care settings, where better structures
are needed to perform risk assessments and conduct outbreak investigations. CHWs and data staff may be at higher risk owing to poor infrastructure, limited power to negotiate working conditions, and limited experience of infection prevention and control. Their working conditions must be improved to reduce their risk.

Authors' affiliations

K Rees, Anova Health Institute, South Africa; Department of Community Health, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

J L Dunlop, Anova Health Institute, South Africa; Division of Community Paediatrics, School of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

S Patel-Abrahams, Anova Health Institute, South Africa

H Struthers, Anova Health Institute, South Africa; Division of Infectious Diseases and HIV Medicine, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

J A McIntyre, Anova Health Institute, South Africa; School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

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SARS-CoV-2; Healthcare workers; COVID-19; Infection prevention and control; Community health workers

Cite this article

South African Medical Journal 2021;111(4):309-314. DOI:10.7196/SAMJ.2021.v111i4.15434

Article History

Date submitted: 2021-01-18
Date published: 2021-01-18

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