Worldwide, it has been shown that healthcare-user fees dramatically reduce demand for health services ― especially preventive services, because people may not perceive that they need interventions. (Delwyn Verasamy/M&G)
Staff held at gunpoint, kidnapped newborns and assaults — more than 30 hospitals across the country have reported serious security incidents in just the last five months, says the South African Medical Association (Sama). But government’s piecemeal approach may be leaving healthcare workers in the firing line.
It’s a chilly Friday afternoon and Tshiamo Legoabe is due for her regular birth control shot at the local clinic in Rosebank. Operating out of the same building as the local public library, the satellite clinic is only open one day a week, when nurses arrive from larger facilities in western Johannesburg that cater to more people. Legoabe goes up the steps to go inside, while groups of men loiter outside and in the adjacent park.
When she gets to the clinic door, nurses tell her there’ll be no services today. Speaking later, she remembers the reason: “One of the nurses’ cars was broken into so they closed the clinic for the public.”
The Gauteng health department admits that the clinic, in the shadow of pricey burgeoning high rises, is not safe for health workers.
“The clinic is not safe, especially for the staff members. There are people who are selling dagga in the neighbourhood. Staff members are consistently receiving intimidations from these people,” says Johannesburg district health services communication’s manager Sandile Gwayi.
“Two weeks ago staff members were physically harassed by these people,’’ he explains. “Police were called and one man was arrested for physical harassment”.
He admits: “It’s not only clinic staff who feel at risk.”
Legoabe says she does not feel safe coming to get her birth control shot.
In June, thugs burst into Witbank Hospital in Mpumalanga, demanding that healthcare workers withhold care from an injured man they’d fought in a nearby tavern. Ultimately, staff at three provincial hospitals embarked on a strike in protest of dangerous working conditions.
Days later, a shootout at a Mpumalanga clinic made headlines, TimesLive reported. The facility’s single armed guard had taken cover during the shooting.
Sama has received reports of similar incidents from more than 30 hospitals across Gauteng, Eastern Cape, North West, KwaZulu-Natal and the Free State, says Rhulani Edward Ngwenya. Ngwenya is the chairperson of Sama’s labour task team.
The facilities affected include high-profile hospitals such as Gauteng’s Chris Hani Baragwanath in Soweto, the Eastern Cape’s Mthatha General and Addington Hospital in Durban.
But exactly how to make our hospitals and clinics safer is largely up to facilities. No national guidelines exist as to how health facilities should be protecting workers, patients or property.
But the national health department and the South African Police Service are finalising a healthcare facility safety assessment as part of the government’s plans to improve security, says the department’s spokesperson Popo Maja.
The draft report will be presented to the health department’s director-general and the national police commissioner before being released.
The Office of Health Standards Compliance (OHSC), an independent body that ensures that both private and public facilities meet national health standards, doesn’t look at how physically safe the hospitals and clinics it inspects are, admits deputy director of communications Medupe Simasiku.
The OHSC will, however, have developed basic minimum security standards by the end of the year that will be used to measure facilities against in the future.
Meanwhile, when Bhekisisa canvassed provincial health departments to see whether they had regulations of their own, only the Free State provided a 51-page document that outlined its procedures. The Gauteng health department declined to comment, saying the information was classified.
The Free State has created a position of security manager within its provincial health department. This person is tasked with not only inspecting and assessing facilities but also keeping a record of all incidents. The manager is also responsible for developing policies for facilities, including how to vet security providers, keeping track of firearms and ensuring that all hospitals are equipped with metal detectors.
All health facilities must have emergency plans that would be triggered by events such as an active shooter or armed robbers.
Private security company Servest Security is contracted by both private and public health facilities. Better security comes down to three basic tenets, says Servest Security’s national operations director Rudi Esterhuizen.
Deter a threat, detect it and — if all else fails — delay it until help can arrive.
At Servest, security starts with assessing a facility’s risks and developing strategies and ways to address them. These methods are tested and re-tested periodically to ensure they’re still working.
But, he says, there are some good universal starting points for hospitals and clinics looking to increase security.
Start by having a good fence or wall that’s well monitored, he advises. Closed-circuit television surveillance systems and cameras — with a well-trained operator — are also good deterrents, especially if the community is likely to know culprits.
But good security solutions rest on more than just technology, Esterhuizen warns.
“In our experience, the challenge does not necessarily lie in the implementation of the latest surveillance, access control, intruder detection or fire detection systems,” he says. “Rather, it’s sourcing and retaining individuals with the necessary skills to utilise these technologies to full capacity.”
In the wake of attacks, trade union Democratic Nursing Organisation of South Africa (Denosa) says its members continue to go to work in fear. It is demanding that every hospital ward should have panic buttons, according to spokesperson Sibongiseni Delihlazo.
Security guards stationed at entrances should have metal detectors, the union says, cameras should be placed at various sections of facilities and security should be insourced.
In the United States, about half of all hospital security guards were armed with at least one of the following weapons: batons, pepper spray, handguns or Tasers, a 2016 survey of 340 hospitals found. Almost all carried handcuffs.
The research, published in the journal Workplace Health & Safety, found that half of the facilities had at least one security policy for specific departments such as casualty, maternity wards or psychiatry.
Most also had codes in place to alert staff to incidents like child abductions, aggressive patients or active shooters. Only a third had metal detectors and police were present in almost one out of four facilities surveyed.
When asked what more hospitals could be doing to make workplaces safer, almost two-thirds of people surveyed said that all staff should receive security training.
As more incidences of violence and crime continue to be reported in more facilities across the country, Denosa hopes that government intervenes quickly.
“Health workers themselves are in the first line of attack”, says Delihlazo. “Our greatest fear is that one night or day management would arrive at a hospital and find that all nurses have been hacked to death with no clue of what had happened.”
This story was produced by the Bhekisisa
Centre for Health Journalism, bhekisisa.org. Sign up to the newsletter http://bit.ly/BhekisisaSubscribe