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Table 3 Impact of the partnership on policies and practices in Free State

From: Protecting health workers from infectious disease transmission: an exploration of a Canadian-South African partnership of partnerships

Before the partnership Since the partnership became actively involved in the Free State Province
1. Management involvement was limited, and not in compliance with legislationa • CEOs of hospitals recognized their legal obligation and new policies were approved by the Free State Head of Department and Member of the Executive Council for Health in 2013, starting with the establishment of health & safety representatives and committees
2. Policies were not based on evidence. • New policy on management of TB at the workplace developed
• New policy on workplace assessment developed
3. Inadequate staff resources were allocated to this area • Four new Occupational Health Nurse Practitioners (OHNPs) were appointed to provide improved health services for the workforces.
4. Programme coordination was a gap, with limited working together of different professionals • The Partnership established programme coordination and working together of different professionals (Infection Control [IC] practitioners, TB Coordinators and OHNPs),
• There are regular meetings at Provincial level of these different professional groups who are now working together
5. TB and HIV management at OHC was not well utilised by healthcare workers; OH nurses were not trained or authorized to prescribe TB and HIV treatment nor other PHC treatment • All OHNPs are now authorised to prescribe TB and HIV treatment as well as other Primary Health Care (PHC) treatment and medication issues by hospital Pharmacy
• Improved healthcare workers usage of TB and HIV management at OH clinics (OHCs) - now free treatment available
• Health workers can get medication at own GP if preferred, come for follow-up and get service free at OHCs.
• Perception among OH staff that there has been decreased disability leave and staff leaving due to disability, and fewer employees suffering work related diseases and injuries (although this is in the process of being ascertained more rigorously)
6. No reliable electronic database for capturing information; no standardised medical surveillance tool; and no standardized approach to identifying and recording workplace hazards • OHASIS brought easy-to-use system, which specified data to be collected to inform Management of need for future policy reviews and/or implementation measures to better protect health workers.
• Training on OHASIS for OH/IC professionals as well as health and safety representatives, using a structured approach to code risks/hazards, made it easy to understand types of hazards
7. Very limited research capacity for occupational health and infection control intervention studies. • Research capability improved through 1-year Certificate course for OH and IC personnel
• Research output of short course gave evidence base of workplace conditions at different facilities
• Workplace conditions were perceived to have been improved through specific targeted efforts and reports to Managers and CEOs resulting in approvals for further research.
  1. aThe Occupational Health and Safety Act, 1993, states that occupational health and safety is the legislated responsibility of every employer including the public hospitals and clinics (OH&S Act, 1993). A National Health Plan for South Africa was prepared by the African National Congress (ANC) with the technical support of World Health Organization and (United Nations Children’s Fund) in May 1994. The ANC initiated a process of developing an overall National Health Plan based on the Primary Health Care Approach; occupational health and safety (OHS) was included in the Plan. Specifically, Chapter 14 of the White Paper for the Transformation Of The Health System In South Africa (1997) was entirely devoted to Occupational Health; this document later became the National Health Act no. 61 of 2003, with Chapter 4 section 25 (2)(r) stipulating that the Head of Health in the province must provide occupational health. The key strategy for delivering OHS services for the Department of Health is through Occupational Health Units attached to health facilities. It was also indicated that Provincial OHUs should be established as part of provincial health services to coordinate and monitor OHS, and to oversee training, information, surveillance, assessment of compensation for occupational disease and injury, advice on workers’ rights to compensation, research, and specialised medical services