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 Table of Contents  
REVIEW ARTICLE
Year : 2020  |  Volume : 4  |  Issue : 3  |  Page : 106-108

Work-related COVID-19 infection prevention among health-care workers in Sub-Saharan Africa: Challenges and prospects


1 Department of Community Medicine, University of Medical Sciences, Ondo City, Ondo State, Nigeria
2 Department of Community Medicine, University of Medical Sciences Teaching Hospital Complex, Ondo City, Ondo State, Nigeria

Date of Submission18-Jul-2020
Date of Acceptance27-Jul-2020
Date of Web Publication21-Sep-2020

Correspondence Address:
Dr. Olorunfemi Akinbode Ogundele
Department of Community Medicine, University of Medical Sciences, Ondo City, Ondo State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/LJMS.LJMS_62_20

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  Abstract 


At present, no African country is spared of COVID-19 infection, with existing weak health systems, significant limitations are unsurprisingly encountered in response capacity to the pandemic. Health systems are stretched, leaving health-care workforce vulnerable to infections, yet not protected and motivated, but left to pay the highest price for the decades of neglect of public and occupational health services in many African countries. Healthy frontline health-care workers are pivotal to the success and sustenance of the prevention and control of the COVID-19 pandemic, hence the need to urgently protect them. African governments need to take responsibility to prevent work-related COVID-19 infections among health-care workers. Beyond the current pandemic, African governments should elevate the right to health topmost in their policies and programs to improve people's lives, including health-care workforce.

Keywords: COVID-19, health-care workers, infections, occupational, pandemic, sub-Saharan Africa, work related


How to cite this article:
Ogundele OA, Omotoso AA. Work-related COVID-19 infection prevention among health-care workers in Sub-Saharan Africa: Challenges and prospects. Libyan J Med Sci 2020;4:106-8

How to cite this URL:
Ogundele OA, Omotoso AA. Work-related COVID-19 infection prevention among health-care workers in Sub-Saharan Africa: Challenges and prospects. Libyan J Med Sci [serial online] 2020 [cited 2020 Oct 22];4:106-8. Available from: https://www.ljmsonline.com/text.asp?2020/4/3/106/295618




  Introduction Top


Since the WHO declared COVID-19 which outbreak started in Wuhan, China, a public health emergency of international dimensions, serious concerns had been raised about the ability of countries with weak health systems to contain the spread of the virus. As of May 13, 2020, every African country had recorded an infection, the last being Lesotho.[1] By July 12, 2020, more than half a million confirmed cases of COVID-19 cases had been recorded with 284,972 recoveries and 12,989 deaths.[1] Regular tracking and reporting of total cases and deaths across the world is done daily at both global and country levels. However, what is less reported is the contribution to these figures by health-care workers and other high-risk groups through workplace exposure. Health-care workers are at the front line of risk of infection and death during this pandemic like in past epidemics such as Ebola in the African continent. Since the onset of the outbreak, health systems generally and frontline health-care workers specifically are stressed and overstretched considerably with influences ranging from difficult triage decisions, exhaustion, increased risk of being infected, separation from families, stigma, and the agony of losing clients and colleagues.[2] The scarcity of personal protective equipment globally has resulted in the less resourced African countries experiencing difficulty in securing new supplies with the resultant effect of inadequate supply for health-care workers due to depletion of personal protective equipment reserves and without international replacement support.[3]

During epidemics, hospitals become fertile ground for the spread of infections and also increase the risk of contracting such infections. The health systems get overwhelmed by the epidemics and also weaken the hospital's service delivery capacity.[4] The vulnerability of health-care workers at their workplace to SARS-CoV-2 infections is further worsened by the little or no resources available to trace and control the spread of the virus. Healthy frontline health-care workers are essential to the success and sustenance of the prevention and control of the COVID-19 pandemic; hence, the need to protect them carefully.

The promotion and maintenance of the highest degree of physical, mental, and social well-being of workers are central in occupational health services.[5] This is crucial because it takes a physically, mentally, and socially healthy workforce to confront a pandemic. To achieve a healthy workforce requires preventing ill-health, controlling risks, protecting the workforce, and adapting work to the people and people to work, especially in the phase of the ongoing work challenges created by the pandemic. However, in the African region, work-related threats to human health and life are becoming increasingly rather evident.[5] The history of work-related health services, particularly in the region, has been a constant struggle between workers fighting for protective and preventive measures and employers seeking to deny or reduce their liability for work-related diseases and injuries.[5] Classic examples of such struggle during this ongoing pandemic are the recent strike actions by doctors in Sierra Leone and Nigeria government hospitals that could leave patients stranded. The contentions were lack of protection, non-payment of hazard allowance, and compensation for health-care workers; similar complaints caused the struggles in both the countries. Health-care systems in Africa have over the years suffered from man-made issues which cut across institutional, human resources, financial, technical, and political developments. These problems include inadequate human resource for health, insufficient budgetary allocations to health care, poor leadership and maintenance in health care. Health-care systems as a result of these challenges may not be able to respond to public health emergencies such as disease outbreak leading to increases in morbidity and mortality in these countries.[6] Health-care provision depends very much on the people who provide the services to the clients. However, over the years, attention and support for health-care workforce have not received the priority it deserves.[7]


  Covid-19 Pandemic and Health-Care Workers in Sub-Saharan Africa Top


The COVID-19 pandemic, unfortunately, has exposed gaps not just in the provision of health services but also in the state of occupational health services in many sub-Saharan African countries informing the need to attend to the situation now and postpandemic. Inadequate resources due to insufficient government investment in health-care infrastructure and equipment have no doubt affected the health system. These, in turn, have made retaining skilled health-care workers difficult and also affected the ability of health-care workers to perform their duties. Unsurprisingly, the United Nations Economic Commission for Africa reported in April that health-care systems across the continent are under-resourced, with lower proportions of available hospital beds, intensive care units, and health professionals than other regions of the world. All these realities, along with lack of consistent planning for health-care infrastructure and inadequate funds allocation, budgetary cuts have rendered the health-care systems ill-prepared to deal with the pandemic in Africa.[8] Aside from this problem and that of the risk of direct infection arising from close contact with patients and potentially infectious colleagues during the COVID-19 pandemic, health-care workers are also under increasing physical and mental stress due to the pandemic.[9] With inadequate provision and training on the proper use of personal protective equipments (PPEs) to mitigate the risk of infection, many health-care workers get exposed in the face of the increasing number of infected patients. Exposed health-care workers self-isolate either as a result of infection with COVID-19 or having contact with a case, thus increasing the workload for other nonexposed health-care workers. The risk of infection, therefore, rises among the remaining nonexposed health-care workforce due to work stress and anxiety, resulting in more mental health risks. The stress of work, anxiety, and or apprehension for fear of contracting the infection form a cascade that impacts the drive of the health workforce in combating the pandemic. The effect is the further weakening of an already weak health system, with a reduction in the number of available health-care workers and a drop in the health services provided. COVID-19 unrelated cases may likely suffer most at this time of the pandemic due to the shortages in the skilled health-care workers that should normally have attended to them who have either be affected directly or indirectly by the pandemic. In all, the physical and mental health state of health-care workers from the continent may deteriorate due to the many challenges confronting them during the pandemic. Some of the challenges were prepandemic and have only been worsened by the pandemic. Health-care workers in African countries have been on the receiving end of these ills, especially in facing the public health emergencies in the continent. They are overstretched yet not adequately protected, as there is an unforgivable lack of adequate protective equipment for health-care workforce which endangers their lives. While the countries in the continent make an effort to provide crucial protective equipments, there is an essential need for measures to maintain the mental health of health-care workers in the continent in such stressful situations like the ongoing pandemic.[9]

Despite these deadly sacrifices, health-care workers in many African countries are not well rewarded as wages are reduced, owed, irregularly paid, with meager hazard allowances, and no life insurance package and yet have to purchase their PPE. They are left with little or no morale, unmotivated, and frustrated working within this condition. This untold hardship usually culminates in industrial disharmony and strike actions by health-care workers as they abandon their duty post and often faced with threats of sack from the government. Health-care workers risk their health each time they attend to COVID-19 patients, and this is made worse by the shortage of PPE. Health-care workers are scared of their co-workers, their families, and friends contracting this disease. Despite this fear, they continue to fight on the frontlines to execute their job while in a persistent state of survival mode to protect everyone around them.[10]

From the foregoing, the governments in the sub-Saharan African region and the employers of labor in different health systems have several obligations to the health-care workforce. The governments need to strengthen public health systems to respond appropriately to public health emergencies now and in future outbreaks. It is time to develop and implement a comprehensive social/life insurance scheme for health-care workers in the region where there are none and also to strengthen existing ones where such are obtainable. These will boost the confidence and commitment of health-care workers, especially in critical times, such as in this pandemic. The need for policy formulation for response in disease outbreak is essential and should be a priority. It should start with lessons learned from ongoing pandemic with a focus on the health-care workforce. Provision of personal protective equipment should be a top priority of the health systems, including other equipments. It must be incorporated into the health systems' essential needs beyond the pandemic because of unforeseen public health emergencies of future.[11] The pandemic presents opportunities for change of work-related culture in the various countries in the region amid the gloominess. The measures that are being implemented to protect health-care workforce in response to the pandemic might as well stay within the health systems beyond the pandemic. These measures such as personal and work environment hygiene, routine use of protective gears, workplace policies, prompt identification, and separation of exposed or infected staffs should be maintained. Other measures like health-care workers' social and vaccination policies and appropriate remuneration are interventions that are indispensable and must be sustained beyond the pandemic.

Health-care workers come in contact with infected persons and the public and are at higher risk of COVID-19 infection; hence, they require heightened protection. The COVID-19 pandemic, as earlier presented, has undoubtedly revealed the decades of neglects of work-related health services across the African continent. Regrettably, this is coming at a great price for both the employers of labor and employees, with health-care workers paying the highest price in this pandemic.[11] The right to life is a fundamental human right under international human right law and also a critical component of the sustainable development goals (SDGs). The health sector in the continent is in a poor state and will not change overnight, but continuous investment will breathe progress and eventual realization of the right to health. Beyond the current pandemic, African governments should elevate the right to health topmost in their policies and programs to improve people's lives, including health-care workforce. Africa is a continent that fails to learn from past crisis; hence, a new paradigm to create an enabling environment to build health system capacity and allocation of more funds to health care is a must.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Rahman A, Shaban A. Africa COVID-19 Stats. Africa News. July 12, 2020. Available from: http://www.africanews.com/2020/07/12. [Last accessed on 2020 Jul 12].  Back to cited text no. 1
    
2.
Chersich MF, Gray G, Fairlie L, Eichbaum Q, Mayhew S, Allwood B, et al. COVID-19 in Africa: care and protection for frontline healthcare workers. Global Health 2020;16:46. https://doi.org/10.1186/s12992-020-00574-3 [ Last accessed on 2020 Jul 14].  Back to cited text no. 2
    
3.
Hopman J, Allegranzi B, Mehtar S. Managing COVID-19 in low and middle income countries. JAMA 2020;323:1549-50.  Back to cited text no. 3
    
4.
World Health Organization. Hospital Preparedness for Epidemics. Geneva: World Health Organization; 2014. Available from: https://www.who.int/publications. [Last accessed on 2020 Jul 15].  Back to cited text no. 4
    
5.
Regional Committee for Africa. Occupational Health and Safety in the African Region: Situation Analysis and Perspective Report of the Regional Director. WHO. Regional Office for Africa; 2004. Available from: https://apps.who.int/iris/handle/10665/93116. [Last accessed on 2020 Jul 14].  Back to cited text no. 5
    
6.
Oleribe OO, Momoh J, Uzochukwu BS, Mbofana F, Adebiyi A, Barbera T,et al. Identifying key challenges facing healthcare systems in Africa and potential solutions. Int J Gen Med 2019;12:395-403.  Back to cited text no. 6
    
7.
Omaswa F. Solutions for Africa's health workforce crisis through country based research. Hum Resour Health 2014;12:1-2.  Back to cited text no. 7
    
8.
Human Rights Watch. Covid-19 Exposes Healthcare Shortfalls: Prioritize Investment to Improve Access to Care for All; June 8, 2020. Available from: http://www.hrw.org/news/2020/6/8. [Last accessed on 2020 Jul 17].  Back to cited text no. 8
    
9.
Sim MR. The COVID-19 pandemic: Major risks to healthcare and other workers on the front line. Occup Environ Med 2020;77:281-2.  Back to cited text no. 9
    
10.
Ehrlich H, McKenney M, Elkbuli A. Protecting our healthcare workers during the COVID-19 pandemic. April 8, 2020. Available from: https://doi.org/10.1016/j.ajem.2020.04.023. [Last accessed on 2020 Jul 17].  Back to cited text no. 10
    
11.
Fellows of the Collegium Ramazzini. 24th Collegium Ramazzini Statement: Prevention of Work-Related Infection in the COVID-19 Pandemic. Ann Glob Health 2020;86:79.  Back to cited text no. 11
    




 

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