FACT-FINDING
SITE-VISITS AT
SELECT PUBLIC
HEALTHCARE
HOSPITALS
BULLETIN
JULY 2020

STRENGTHEN WORKPLACE ORGANISATION, DEEPEN CLASS
CONSCIOUSNESS AND ADVANCE INTERNATIONALISM

 TABLE

OF

CONTENTS

EDITORIAL

INTRODUCTION
CONTEXT
KEY FINDINGS FROM THE LEADERSHIP TEAMS’ SITE
VISITS
OUR DEMANDS AND PROPOSALS FOR THE
PROTECTION OF THE PUBLIC HEALTHCARE
WORKERS
OUTCOMES OF THE JOINT MEETING WITH MINISTERS
OF HEALTH, EMPLOYMENT AND LABOUR AND TRADE
AND INDUSTRY

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EDITORIAL
COMMENT

GENERAL SECRETARY - CDE ZOLA SAPHETHA

WHO titled “Operational guidance for
maintaining essential health services during
an outbreak”, the Coronavirus pandemic is
anticipated to generate massive pressure
on the healthcare systems of countries and
some may well become overwhelmed as
the cases of the COVID-19 increase with the
exponential rise of the infections.
Whilst countries must continue to put in
place measures to flatten the curve of the
rate of infections, they must simultaneously
develop plans and find resources to
strengthen their healthcare systems ahead
of the national peak of the country’s
infections so as to meet the health needs of
the population.
Comrades
The National Office Bearers’ leadership
collective of the red, transformative and
militant national union of Bheki Mkhize
and Yure Mdyogolo brings revolutionary
greetings to members, one and all, under the
difficult conditions in the unfolding national
resistance against the novel Coronavirus.
In early March 2020, the World Health
Organisation (WHO) declared the novel
Coronavirus a global pandemic, having
noted the rapid spread of transmissions
across the world and called for countries to
put in place emergency health mechanisms
that would assist in the efforts against
the virus. According to a report by the

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Since March, we have witnessed the
devastating effects of the Coronavirus the
world over, in which hundred thousands of
lives have been lost, as millions contracted
the virus and this has produced a combined
crisis of collapsing economies and
healthcare systems across the world due
to the pandemic. Since the first reported
case on the 5th March 2020 in South
Africa, we have witnessed how inadequate
government’s response has been on the
healthcare front. This national epidemic
has engulfed the public healthcare system
that historically has been faced with
multitudes of challenges, ranging from
poor infrastructure, shortage of medical
personnel, crucial medical equipment

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and poor management. Under such a
state of affairs of the government’s poor
response and the already debilitated public
healthcare sector, it was inevitable that we
would bear witness to the devastation of
the COVID-19 on the frontline healthcare
workers such as doctors, nurses, community
healthcare workers, EMS workers, porters,
workers in forensic pathology and all those
that continue to provide essential services.
The number of frontline workers that have
contracted the virus continues to skyrocket
and so is the death-toll of those that are
perishing whilst valiantly holding the last
line of defence for the nation in the frontiers
of the war against COVID-19.
The national union has been in the forefront
in championing and fighting for better
working conditions faced by healthcare
workers. Amongst others, we have been
calling for adequate provision of Personal
Protective Equipment (PPEs) as per the
guidelines of the WHO to ensure that the
healthcare workers are not unduly placed in
harm’s way as they carry out their mission
of saving lives against this deadly virus.
However the struggle to acquire these PPEs
has been a difficult one, given the poor
response from government. Hence, too
many healthcare workers have contracted
the virus on duty and others have actually
been fatally claimed by COVID-19.

resources to contribute to the national stock
of PPEs, especially in the four provinces
of Gauteng, Western Cape, Eastern Cape
and KwaZulu-Natal that are the epicentres
of the pandemic. NEHAWU shall never be
deter in its mission of ensuring that frontline
workers are at all material times protected
and safe against the pandemic.
Comrades, the national union can now
confidently without any doubt proclaim
that the government has not adequately
responded as per the norms and
standards of the WHO in efforts against
the Coronavirus, we can report that based
on the programme embarked upon by the
NOBs, provincial and regional leadership,
in almost all the institutions that we have
visited, there’s a similar pattern of the lack
of adequate provision of PPEs, lack of
compliance with the Occupational Health
and Safety Act, shortage of staff, poor and
broken management system, dysfunctional
district health system and poor adherence
to the National Core Standards as well
as the issued COVID-19 guidelines by the
National Department of Health.

We have developed this bulletin to share
our experience based on the unfolding
concrete reality prevailing in our public
healthcare institutions. As NEHAWU we
shall in due course announce a detailed and
comprehensive programme of action to
It was against this background that the fight for workers, members and the broader
national union embarked on a programme society at large.
of site-visits in the health districts that
are the current epicentres of COVID-19, to Amandla!!!
concretely verify the information at our Matla!!!
disposal and to pledge our solidarity with All Power!!!
frontline workers. The union further mobilised Aluta!!!

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INTRODUCTION

South Africa is facing even dire prospects
in the fight against the COVID-19 epidemic
when the “last line of defence”, namely the
frontline healthcare workers are infected, put
out of commission and fatally claimed at the
current rate. According to the Health Care
Workers’ DATCOV Surveillance System of the
National Institute of Occupational Health
(NOIH), as of 12 July 2020, about 597 infected
health care workers were recorded in its
DATCOV database. Most of such COVID-19
admissions were reported in Gauteng, KZN,
and the Western Cape. If the Eastern Cape
health institutions were functioning relatively
better than at present and were cooperating
with the NOIH, the province would have
probably registered one of the highest rates
of infections and admissions amongst the
healthcare workers given the current trends.

Coronavirus (2019-nCoV) on the 5th March
2020 by the Minister of Health, Dr Zweli
Mkhize, as the National Education Health
and Allied Workers’ Union (NEHAWU) we
expressed strong concerns about the health
and safety of our members at the ports of
entry in the face of the immediate hazard
caused by international travel. At that stage,
workers who are posted at border controls,
such as the security and customs officials, as
well as those in port-health, were the most
exposed to this contagion as many travellers
were hurriedly returning home and foreign
visitors in South Africa were leaving. In fact,
the World Health Organisation (WHO) had
already declared the Coronavirus a public
health emergency of international concern,
as it was rapidly spreading across the world.

At the same time, at that stage NEHAWU
From the moment of the announcement of went to the PSCBC on the 15th March
the South African infections of the novel 2020 to place on the agenda a discussion

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on the employers’ state of readiness and
preparations for the frontline public services,
especially in public healthcare, given the
pressure that was already engulfing the
healthcare systems of countries such as
China and Italy. The DPSA completely failed
to provide a progress report in this regard,
other than merely presenting its guidelines
to the provinces.
Despite the declaration of the maximum
lockdown (i.e. alert level 5) by government
from the 26th March 2020 amidst the rise of
the domestic or community infections, the
frontline healthcare workers became the
most exposed as the cases of the COVID-19
patients began to rise, in both the public and
private healthcare sectors. In this regard,
all occupational categories of healthcare
workers, across the whole chain of the
healthcare service became endangered
- from the nurses, EMS workers, doctors,
Community Health Workers, cleaners, porters
to those working in the forensic pathological
services.
Thus, the rate of infections amongst the
healthcare workers’ started to rise very fast
and to surpass the overall national infection
rate, as indicated in the NIOH’s Health Care
Workers’ DATCOV Surveillance System. From
our own investigations, which have been
confirmed by the feedback that we have been
receiving from our members at institutional
level on a daily basis, there has been an
alarmingly persistent lack of provision of
the Personal Protective Equipment (PPEs)
to protect healthcare workers and other
frontline or essential workers. Where the
PPEs have been provided, no proper training
with regard to their donning and doffing were
undertaken in time. In fact, the directorate of
the National Department of Health (NDOH)
that is responsible for ensuring adherence
to regulations and guidelines on workplace
hygiene, health and safety in healthcare
institutions did not even have resources
to run education and training on the PPEs,
COVID-19 itself nor on the Occupation Health
and Safety Act (hereunder, the OHS Act).

April 2020, the National Office Bearers (NOBs)
of NEHAWU met with Minister of Health,
who was accompanied by the Minister of
Employment and Labour, Thulas Nxesi, the
Minister of Trade and Industry, Ebrahim
Patel and the Acting Director General of
the NDOH, Dr Anban Pillay. This meeting
took place in the midst of a legal dispute in
which NEHAWU sought relief from the court
that would compel the NDOH and provincial
departments to adhere to the prescripts
of the OHS Act, including the provisions
dealing with the PPEs, in order to protect the
frontline workers. To back up its dismissal of
our demand for the adequate provision of
Thus, against this background on the 8th PPEs and its claim that there was enough
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in stock, during this meeting government
presented provincial data-sets of PPEs
stocks. The outcomes of our joint meeting
with the Minister are attached at the end of
this document.

the fact that what was available in stock
was inadequate when measured against the
headcount numbers of different categories
of healthcare workers per institution and
provincially.

Subsequently, our analysis of these datasets in fact validated what we already knew
– that what was there in the national stock
was woefully inadequate. In the first instance,
PPEs were procured in a competitive
scramble amongst provinces in which
some provinces ended up monopolising
some items whilst totally lacking others.
So there was an obvious problem of the
maldistribution of the PPEs as a result of
the interprovincial scramble for supplies on
the first-come-first serve basis. Whereas,
we would have expected that instead there
would be a nationally coordinated response
in the wake of the declaration of the state
of national disaster, in which there would
be a centralised national pool of PPEs
stock that would be rationally distributed guided by the realities of the provincial and
district concentrations of the population,
socioeconomic demographics, the emerging
epicentres, etc. Our analysis further exposed

As part of the outcomes of this meeting of
the 8th April 2020 with the ministers, NEHAWU
participated in a national multi-stake-holder
forum on occupational health and safety,
which largely involved national departments
and provinces. From the reports of the
provincial officials of the government, it was
clear to us that actually the preparations
of the provinces were in fact worse than
we expected. In addition, it seemed as if
our contributions in these meetings were
not making any difference. We have tried to
bring the feedback that we were receiving
from our members on the situation in the
institutions to bear in these meetings to no
avail. What is more, considering the pace
and manner in which the provinces were
responding to the unfolding crisis in terms
of their weekly reports with regard to issues
such as the procurement and distribution
of the PPEs, signified to us that there
was an entrenched bureaucratic inertia,

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incompetence and general neglect within
government. Nonetheless, as NEHAWU we
took the initiative of engaging the Minister of
Higher Education, Science and Technology,
Blade Nzimande, to facilitate the release
of resources through the HWSETA and
ETDPSETA for the training of the healthcare
workers and shopstewards at institutional
level on the Coronavirus, COVID-19 and the
donning and doffing of the PPEs.
As a country, since the 1st June 2020 we
have been under the alert level 3 in line
with the government’s Risk Adjustment
Strategy. Alongside the increasing daily
screening and tests that are taking place

involving increasing numbers of Community
Health Workers, the proportion of the active
COVID-19 cases and deaths have also
drastically increased under the alert level 3.
Similarly, the rate of infections and deaths
amongst the healthcare workers have
escalated to alarming proportions.
Given this life-threatening and grim reality
that is faced by the frontline healthcare
workers on a daily basis, for its part NEHAWU
mobilise resources at its disposable to
make a contribution to the national stock

of PPEs, especially in the four provinces of
Gauteng, Western Cape, Eastern Cape and
KwaZulu-Natal that had become epicentres
of the COVID-19 epidemic. These PPEs were
delivered by the NEHAWU NOBs, together
with the provincial and regional leadership
collectives, as part of our programme
of site-visits in public healthcare. This
programme helped us to empirically verify
the information and complaints that we
were already receiving from our members,
branches and regional structures. It provided
an opportunity for the union’s leadership
to probe for more information and answers
from the responsible officials in the visited
institutions, as well as to express the union’s

solidarity and support for the frontline
healthcare workers.
Thus, this report is a chronicle or a factual
account of our experiences in select public
health institutions that were visited in the
context of this programme, in which we
also assessed the conditions under which
healthcare workers were working, including
in terms of the availability PPEs, compliance
with the OHS Act and the state of the
institutions in terms of government’s criteria
of the National Core Standards (NCS).

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CONTEXT
Given our practical experience as a epidemic, there were:
transformatory union in dealing with
the NDOH and provincial departments, • 
Medico-legal claims that have been
unfortunately it is hardly surprising for us
growing very fast i.e. by 14% per year
that we are witnessing such a high and
from 2009 to 2015 and thus diverting
escalating rate of Coronavirus infections
the critical resources that should
amongst the public healthcare workers in
have been used to prevent such legal
South Africa, tragic as it is. The fact of the
matters in the first place. Conditions in
matter is that even before the outbreak of
the public healthcare institutions were
the Coronavirus epidemic, the South African
progressively deteriorating such that
public health system was known for pervasive
by the end of March 2019 government
non-compliance with the relevant health
was faced with contingent liabilities
and safety regulations and clinical protocols,
of about R104.5 billion arising from
which are key in the protection of healthcare
medico-legal claims. Such claims
workers. By extension, this managerial
include a significant proportion
incompetence, complacency and sheer
of nosocomial cases (i.e. diseases
neglect in adhering to the health and safety
contracted or generated in the hospital
requirements in institutions logically means
conditions).
that even the clinical protocols pertaining

to the care of the out and in-patients in the • 
institutions would also be ignored. Thus, the
COVID-19 epidemic engulfed the country at
the time when there was an entrenched and
pervasive culture of non-compliance with the
NCS and OHS Act in the public healthcare
sector in particular. Hence, leading to this

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The fact that the last report of the
Office of Health Standards Compliance
(OHSC), i.e. the Annual Inspection
Report for 2016/17 found that of the
696 facilities that were inspected,
only five were fully compliant with
NCS. This inspection report assesses

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all the seven domains of the core
standards, which are - Patient Rights;
Patient Safety; Clinical Governance
and Care; Public Health; Leadership
and
Corporate
Governance;
Operational Management; Facilities
and Infrastructure. In fact, about 412

facilities were simply non-compliant
with the core standards at all.
As NEHAWU we believe that the public
healthcare system did not recover from
the loss of the critical clinical expertise
that it experienced during the first term
of the democratic dispensation due to
the misguided and ill-informed Neoliberal
austerity measures. The public service and
the department of health in particular lost
highly experienced doctors, nurses and
allied medical professionals. At the same
time, the population has been growing, as
has its health needs against the background
of a huge and expanding quadruple burden
of disease. Now, since the fifth democratic
dispensation that began in 2015 and to date,
the Treasury has been imposing austerity
measures, especially with regard to the public
service vacancies. Thus, these austerity
measures began after their announcement
in the 2015 Budget Speech, in which the
Treasury set out how it was going to slash
the rate of growth in government spending,
which amongst others was to be achieved
by the freezing of the vacant posts in public

healthcare and other departments. Even
though in 2019 there was an attempt by
government to recruit doctors and nurses,
this was a case of too little and too late. The
public healthcare sector has already incurred
far-reaching and damaging corrosion of its
human and material capacities, thanks to
the rolling cuts administered by the
Treasury.
Hence, in the face of this catastrophic
epidemic, the frontline healthcare
workers find themselves in a service
that has pervasive shortages of
critical specialists, doctors, nurses
and other allied clinical occupations.
These shortages even extend to
cleaners, potters, security, and other
general workers. According to the
South African Health System Trust
(2018/19 District Health Barometer),
in the period leading to the outbreak
of the COVID-19 epidemic, there were
only 32 doctors per 100 000 people
and a mere 144 professional nurses
per 100 000 people. In fact, within
public healthcare the shortage of clinical
expertise of even worse. According to the
Econex study for the Hospital Association
of South Africa, it was found that there are
25 doctors per 100 000 people in the public
sector and 92 doctors per 100 000 in the
private sector, which translates to 16% and
60% of the world average ratio (152 doctors
per 100 000 population). Even in India (70),
Brazil (189) and China (194) there are more
doctors per 100 000 people.
Given the prevalent neglect and disregard
of the health and safety concerns of the
healthcare workers as underscored by the
present inadequate provision of PPEs and
failure to adhere to the occupational health
and safety legislation and regulations on the
part of the NDOH, provincial departments and
institutional managers, the fight against the
COVID-19 epidemic is already compromised
by the persistent culture of mismanagement
in public healthcare. And this is reflected in
the results of the surveys and studies on the
quality of care and management in these
institutions that were conducted before the
outbreak of the COVID-19 epidemic.

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KEY FINDINGS FROM
THE LEADERSHIP
TEAMS’ SITE-VISITS
Hereunder, we are now reporting on our own of the COVID-19 such as the Eastern Cape,
concrete experiences as captured in the Gauteng, Western Cape and KwaZulu-Natal.
findings of our site-visits in select health Thus, the following are the key findings:
districts and institutions, especially those
that are worst afflicted by the COVID-19 The lack of adequate provision
epidemic. These site-visits took place under
alert level 3, a period at the beginning of PPEs

of which it was a common refrain from
government ministers and spokespersons to
claim that the intensive sacrifices endured
by the nation during the alert level 5 and 4
have enabled government to buy enough
time to prepare healthcare institutions,
ahead of the curve of the COVID-19’s peak.
Our leadership teams set out in these sitevisits carrying at hand copies of the OHS
Act, Consolidated Direction for Health and
Safety in the Workplace issued by the DEL
on 4 June 2020, COVID-19 Disease: Infection
Prevention and Control Guidelines issued by
NDOH on 21 May 2020 and the WHO’s Rational
Use of Personal Protective equipment (PPE)
for Coronavirus Disease (COVID-19), issued
on 19 March 2020. These leadership teams
visited a select number of public healthcare
institutions in provinces and health districts
that are currently regarded as epicentres

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In almost all healthcare institutions that were
visited, our teams found that:
• 

There were generalised shortages of
the PPEs – this is after four months
since the union was told by government
that it had enough PPEs in stock and
that it was undertaking additional
procurement to replenish what was in
its inventories or warehouses.

• 

More disturbing, is that even with the
available stock in various institutions,
the responsible authorities without
exception could not indicate as to how
long they expected their PPEs to last. In
other words, no institution produced a
plan indicating how and when the PPEs
were to be replenished to meet the full
complement of the staff according to
the designated requirements of use

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• 

per occupational category, to ensure
there were no future incidents of stock
depletions.

unprotected due to the prevailing
misconception that the PPEs were
exclusively meant for the clinical staff.

Where the authorities claimed that • 
they had enough PPEs in stock such
as at the Chris Hani Baragwanath
Academic Hospital, our team found
that there were concerning challenges
pertaining to their distribution to the
staff. In other words, the department’s
guidelines were not followed such
that other occupational categories,
i.e. the cleaners and porters, were left • 

In fact, in an institution like the Charlotte
Maxeke
Johannesburg
Academic
Hospital, our team found that workers
had to resort to using plastics to protect
themselves. This was hardly a surprise
as we have heard such reports and
complaints from our different branches
across the country.
The bottom-line with regard to the

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PPEs that is not based on calculated
requirements according to different
categories of healthcare workers is
bound to lead to stock run-outs.

Lack of compliance with the
Occupational Health and Safety
Act
•   In all healthcare institutions that
were visited, there was pervasive noncompliance with the OHS Act. This is
despite the fact that at the national
and provincial departmental levels,
as well as at institutional level, there
are officials that have been appointed
specifically to deal with the health and
safety imperatives. In fact, some of our
teams have found that the authorities
at
institutional
level
shockingly
demonstrated complete ignorance of this
legislation as well as the departmental
guidelines that have been issued since
the outbreak of the COVID-19 epidemic.
Thus, from the inquiries of our teams in
their engagement with the responsible
authorities, none of the institutions were
able to show or present to our teams, as
to:
a.  When and how they have embarked
on Risk Assessments.
b  How the Infection Prevention and
Control measures that have been
implemented are informed and
linked to the Risk Assessments that
were undertaken, and whether there
is a process of active monitoring and
review to improve.
c.  That the Occupational Health
and Safety Committees have
been established according to the
legislation and are accordingly
operational. In fact, to underscore
the pervasive disregard of the law
and its regulatory requirements, in
all institutions there are no regular
briefings to the labour representatives
on the infections, cases of selfisolation, recovery and fatalities.

PPEs for us as NEHAWU is that the total
stock of PPEs was never adequate in
the first place, hence we have found
shortages across the board. We have
argued that the stocking up of the PPEs
must be matched with the headcount
numbers of the full-complement of the
healthcare workers and according to
the different occupational categories
and their designated use of PPEs,
which has never been the case. As the
rate of infections rise to the peak and
the number of COVID-19 cases swell
in the hospitals, the procurement of • 

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At best, we have found that a number

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• 

of institutions have established ad
hoc structures, that are often called
the Coronavirus Committees or Task
Teams. In themselves, these structures
underscore the fact that all along the
OHS Committees never existed nor have
been functional in public healthcare –
which means that the department has
not been complying with government’s
law, despite the existence of a

visited by our teams, the shortage of
staff was one of the primary factors that
were raised, amongst the challenges
facing the institutions, not only by
workers but also by some managers as
well. This is a chronic problem across
the public service since the austerity
measures that were implemented in the
1990s. In the foregoing where we outlined
the context, this issue has already been

dedicated division at the NDOH. In many
instances, such ad hoc structures are
largely constituted or dominated by the
institutions’ officials and managers that
are not even working at the coalface of
contact with the public patients within
institutions, in the wards, triages or • 
ICUs.

raised as part of the challenges that
were afflicting the public healthcare to
this day. We are still awaiting the Human
Resource Strategy for Health that has
been promised by the NDOH since 2017.

In fact, across the board we have
found no branch of the union that
expressed
satisfaction
with
the
managers’ consultation process, where
it is practiced. Actually, at the Tygerberg
Hospital labour was not even allowed to
participate in the established ad hoc
COVID-19 structure, despite the fact
that it is the healthcare workers that are
more practically informed about what is
happening and that are most exposed
to the contagion.

Shortage of staff
• 

In all healthcare institutions that were

• 

Our own experiences, which were
confirmed by these site-visits, is that
these shortages do not just involve the
categories such as specialists, doctors,
allied professionals and nurses, but
all the different non-clinical staff as
well. This generates an unbearable
environment and experience for
patients and visitors, not to mention the
extreme work overload that it imposes
upon the current workforce in the face
of the COVID-19 epidemic. Resultantly,
public health institutions are chronically
suffering from unsanitary conditions,
long queues, exhausted and irritable
workforce, etc.
An institution such as Livingstone
Hospital at the Nelson Mandela Bay

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highlights the extent of the neglect on
the part of the government. In this regard,
the responsibility cannot exclusively be
placed at the door of the management
of this hospital, incompetent as it is.
In fact, we believe the district and
provincial authorities still retain decisive
powers in the context of the current top- • 
down configuration of the operational
and management model that is used
in public healthcare and must be held
to account. In that institution, our

placed on one year contracts. The CEO
has since tendered his resignation and
now this institution has been an object
of national disgrace as its acute and
multiple crises have been broadcasted
internationally.
In fact, the question of the shortage
of staff is so pervasive across public
healthcare that in a number of
institutions that were visited, our teams
found that nurses are being forced to

visiting team found that about seven
do the work of cleaners and potters,
managers including the Chief Executive
without the necessary designated
Officer have been on protracted
PPEs.
suspensions which has left a huge void
in the leadership of the hospital. It is Authoritarian and broken
an outrage that we have even found a
worker that actually did additional work management system
that was previously done by two other
people, while being remunerated only One of the defining features of the
for work in one position. Other health- mismanaged hospitals, and typically those
workers are virtually casualised, being that tend to be filthy and unhygienic is

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that they are often led by very hostile and
authoritarian management – in dealing with
their staff. Rather than forging a collective
team-work approach based on the
understanding that the hospital operates like
an ecology in which the overall performance
of the institution is dependent on the proper • 
functioning of its component parts and
sections as well as the workforce as a whole,
such managers tend to resort to crude
and repressive methods. Across different
provinces, the preferred approach of such
managers is the marginalisation of the trade
unions and the victimisation of individuals
and shopstewards that stand up against • 
their mismanagement and incompetence.
In almost all the visited institutions, we have
found workers seething with anger, enraged
by the behaviours of the institutions’
management. Thus, in our engagement with
our branch structures workers voiced their
grievances, which amongst others include
the following:
• 

• 

That when a staff member has tested
COVID-19 positive, some managers
would refuse to carry out fumigation • 
(microbial fogging) to disinfect the
affected institution or section thereof.
Such behaviour endangers the rest
of the workforce as well as the other
patients.
We have a number of our members,
especially shopstewards, that have
been victimised in one form or another • 
just because they have raised questions
about the lack of PPEs, the absence of

daily screening of healthcare workers,
and the refusal by managers to allow
workers to go on self-isolation if they
reasonably suspected that they have
been exposed.
In some instances, our shopstewards
have been forced to sign confidentiality
forms, which means that they are not
supposed to report or raise concerns
about how the institution is managing
the COVID-19 issues, otherwise action
would be taken against them.
Generally, such managers regularly
issue written warnings to workers who
refuse to work under the conditions that
they deem unsafe (because of the lack
of PPEs), despite the provision of the
OHS Act which protects workers under
such circumstances. For instance, two
members of NEHAWU were given final
written warnings by management for
refusing to perform the duties without
PPEs at the Tygerberg Hospital.
In a province such as the Western Cape,
managers have rejected reports of
infection in the workplace from workers
and they would even go as far as to
compel such workers, who may have
already been diagnosed COVID-19
positive, to work as long as they did not
have or present symptoms.
At the General Justice Gizenga Mpanza
Hospital – our team found that about
two workers have been suspended after

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the management refused to provide a
report to them on the rising infections
within the facility.
• 

Lastly, we have to say that it is
hardly surprising that under such
circumstances as depicted above,
that in the course of the site-visits our
leadership found themselves having to
deal with erupting protest actions. In
fact, there have even been some strikes
in institutions such as iNkosi Albert
Luthuli Hospital, Kopanong Hospital
and others – and these have largely
been precipitated by the managers.

Dysfunctional district health
system
• 

Whilst the syndrome of the prevailing
dysfunctionality in the public healthcare
sector manifest at the coalface of service • 
delivery at the institutional level and at
the expense of the healthcare workers,
as well as the poor who overwhelmingly
depend on public healthcare sector, it

17

is also true that the district healthcare
authorities
that
are
overseeing
these institutions are themselves
dysfunctional. This compounds the
crises at institutional level. Across all
health districts nationally, there are
well-known problems of coordination,
complementarity and a broken referral
system. For instance, as part of the
site-visit in the Eastern Cape, our team
found an unfolding disaster at the
centre of which was the maternity ward
at Dora Nginza Hospital. The hospital is
supposed to work with about 7 feeder
clinics, three of which were closed. This
resulted in overcrowding at the hospital,
which exposed the already ailing
people to the danger of the COVID-19.
Numerous of such similar incidents have
been experienced by our members and
reported in the media previously.
Whilst government seems to be able
to gather statistics about the rate
of infections and deaths per health
districts, our members in the institutions

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are questioning the authenticity or The decentralised response to
accuracy of this information. Almost in
the epidemic
all institutions, it was commonly held by
the frontline healthcare workers that
• 
Linked to the fragile district health
there was deliberate under-counting,
system, is the fact that over the past
especially with regard to the recorded
quarter of the century since the advent
and reported incidents and causes of
of democracy and freedom, government
deaths. In fact, the challenges faced by
has failed to develop a systemically
the NOIH’s Health Care Workers’ DATCOV
coherent and coordinated cooperative
Surveillance System in gathering data
governance and management of the
validates this view in that there seems
public healthcare sector. So far, the
to be no uniform or standardised
response to the outbreak of the COVID-19
method of data collection across the
epidemic underscores this. Instead of
institutions. For example, only 27%
centrally coordinating the procurement
(a total of 164 out of 597 cases of the
of PPEs and the deployment of human
healthcare workers) of the submitted
and material resources to ensure that
cases had information on the type of
intensive and high care requirements
work that the affected health workers
and facilities are available where they
do. The recent report of the Medical
are most needed, these planning and
Research Council of South Africa also
resources imperatives were largely left
gives credence to this problem of
to the discretion of the provinces. Hence,
undercounting of the COVID-19 deaths.
there was a shambolic and competitive
In itself this underscores the absence of
scramble amongst provinces for PPEs
proper oversight by the health districts
and other essential requirements as the managers of the institutions
which led to the maldistribution of these
seem to be able to influence the records
already inadequate resources.
of the COVID-19 death toll in such a
way that it may be distorting the actual
• 
Even when mobilising the resources
extent and scale that the country faces
of the private health industry, each
of this epidemic. In fact, only 18 public
province is allowed to engage and draw
healthcare institutions are cooperating
Service Level Agreements separately
with the NOIH in submitting their data
with the hospital groups, despite the
on weekly basis, whereas the private
fact that these three monopolies.
healthcare institutions are generally
i.e. NETCARE, Life Healthcare and
corporative.
Mediclinic are national companies that

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coordinating measures of
the mitigation, prevention,
recovery and rehabilitation
from disaster. Thus, this
provision
provides
for
the centralisation of the
response and thus it
circumvents the current
fragmentation arising from
the decentralised form of
response. The fact that in
our sites-visits, which were
conducted
under
alert
level 3 (more than 12 weeks
since the outbreak of the
epidemic), we have found
such vast deficiencies and
even
scandalous
levels
of ill-preparedness is a
serious indictment on public
healthcare
management.
It also underscores the
prevalence of managerial
incompetence
and
complacency
across
all levels of the public
healthcare sector.

are vertically integrated. This weakens
the government capacity to maximise
its buying power and the provincially
individualised approach weakens their
bargaining power.
• 

In our view, this fragmented and
decentralised approach in responding
to a national epidemic, significantly
contributed to poor preparations even
when government has claimed that
the maximum lockdown (alert level 5)
provided a window of opportunity to
prepare better. This is despite the fact
that Section 26 of the National Disaster
Management Act makes the national
executive “primarily responsible” for the

19

• Our findings at the Sebokeng
Hospital and Kopanong
Hospital
is
but
one
illustrative example of the
extent of disorganisation
in
public
healthcare
management in terms of
planning at the district level.
The Sebokeng Hospital is
the bigger institution of the two but
one that is under-resourced compared
to the Kopanong Hospital. In fact, an
illustration of this irrational distribution
of resources was in the fact that we
found that the Kopanong Hospital had
screening tents whilst the Sebokeng
Hospital did not have. Yet, at the same
time we found that the latter had a
huge caseload of COVID-19 patients
when only the Kopanong Hospital
was designated to provide care for
COVID-19 patients. At the same time,
the Sebokeng Hospital has ICU units
whilst the Kopanong Hospital has none.

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Lack of the implementation of
the OHS Act also means poor
adherence to the National Core
Standards as well as the issued
guidelines by the NDOH
• 

• 

In the foregoing, we have already alluded
to the recorded poor performance of
• 
the public healthcare institutions in
the annual surveys conducted by the
OHSC. Hence, as late as the alert level 3,
we could still find in institutions such as
the Uitenhage Provincial Hospital, Steve
Biko Academic Hospital, Sebokeng
Hospital and Empilweni TB Hospital
(and others that were not part of the
site-visits programme) that there were
no screening of the public or patients
• 
arriving at these institutions that were
taking place. Typically, we have also
found that such institutions were in very
bad conditions, i.e. they had unhygienic
wards, filthy corridors and toilets, etc.

Just to mention but a few of the
domains of the NCS, for example on
leadership, we have found that the
poor management of the Empilweni
TB Hospital was significantly caused
by the fact that the CEO had to run

the whole institution alone, because
there were many managerial vacancies.
Also mentioned in the foregoing is the
unfolding tragedy at the Livingston
Hospital, an institution whose terrible
state is compounded by the existence
of managerial vacancies, amongst
other categories.
In some hospitals, this managerial
dysfunctionality arises because of the
outsourcing of key services. This means
that the institution operates on the basis
of an inherently fragmented workforce
with different management structures
– which has a bearing on the provision
of the overall strategic leadership and
cohesion of the institution.
Lastly, our site-visits also exposed
the fact that there was a serious
failure on the part of the responsible
national departments and agencies
to enforcements the legislation,

regulations
and
guidelines
that
they issue, in this regard we cite the
directorates that are responsible for
health and safety at the NDOH and
DEL, respectively.

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OUR DEMANDS AND PROPOSALS
FOR THE PROTECTION OF THE
PUBLIC HEALTHCARE WORKERS
Too many healthcare workers have lost
their lives due to the COVID-19 epidemic. In
our view, many of these workers, including
those that have thankfully recovered, have
been needlessly placed in harm’s way by
sheer neglect and incompetence on the
part of government – not only the NDOH,
but also national agencies such as the
DEL’s Chief Directorate on Occupational
Health and Safety, provincial departments
and institutional managers. Therefore, as
NEHAWU place the following on the table to
be address:

employer’s responsibility to ensure safety
for third parties using the workplace, e.g.
patients in a hospital. Thus, Section 9 of
the OHSA states that as far as reasonably
practicable the employer must ensure that
such persons are not exposed to hazards.
In addition, this legislation in Section 19
requires the employer to create a Health
and Safety Committee in the workplace that
are required to hold meetings at least once
every three months. Lastly, the employer has
a ‘duty of care’, amongst others, to eliminate
or mitigate all hazards and to provide the
Personal Protective Equipment (PPE) to
The OHS Act, in Section 8 places employees; to provide information, training
responsibility of workplace health and safety and supervision; to provide the means
to apply safety measures; not to permit
employees to work unsafely and to enforce
health and safety measures in the workplace.
Recently, on 4 June 2020, acting under the
state of national disaster, government has
reinforced this legislation through section
Regulation 4(10) of the R480 issued on the
28 April 2020 by the Minister of Cooperative
Governance and Traditional Affairs, by
issuing regulations in terms of section 27 (2)
of the National Disaster Management Act,
that require in consultation with registered
representative trade unions:
• 
The carrying out of Risk Assessments,
and
• 
The development of Infection Control
and Prevention measures

primarily upon the employer, requiring every
employer, in relation to its own employees, to
provide and maintain, as far as reasonably
practicable, a working environment that is
safe and without risk to the health of the
employees. The OHS Act also extends the

21

Thus, NEHAWU calls on the NDOH to
immediately issue a circular to all provincial
departments, district health authorities and
hospital managers to implement all these
and other relevant provisions of the OHS Act
and the issued regulations and directions. In
this regard, we expect that the NDOH shall
enable its own Directorate on occupational
health and safety to actively support the

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institutions in complying with this legislation, We call on the NDOH, to mandate the daily
related regulations and COVID-19 guidelines. screening of healthcare workers and that it
must roll-out a national testing programme
That since the provinces and hospitals of None-Communicable Diseases, as many
actually fall under the NDOH’s policy and of the frontline healthcare workers actually
legislative mandate and custodianship, live with such underlying diseases without
it must ensure that they follow its own being aware, which causes complications
guidelines. One of these relates to healthcare and deaths when such NCDs are only
workers returning to work after they have discovered at the late stage. According
been diagnosed with COVID-19 and isolated to the NIOH survey, some of the admitted
for 10 days. Thus, accordingly workers may healthcare workers had multi-morbidities/
only return to work on the following conditions: comorbidities, including diseases such as
a.  They have completed the mandatory 10 Hypertension, Diabetes, Chronic Cardiac
days of self-isolation;
disease, Chronic Renal disease, Malignancy,
b.  They have undergone a medical HIV and Tuberculosis, which have a decisive
evaluation confirming fitness to work influence in the outcome of their care in
if they have had moderate or severe hospitals. Thus, we propose that the results
illness;
of such tests must guide every district health
c.  They strictly adhere to personal hygiene, authorities, working with the institutions
wearing of masks, social distancing, under its jurisdiction, in determining the
and cough etiquette.
deployment of the frontline healthcare
d.  Managers at the institutional level must workers to ensure that the more vulnerable
closely monitor for symptoms on such cohort of the healthcare workers does not
workers returning to work.
directly deal with the COVID-19 patients.
Similarly, workers who are above 60 years
Furthermore, we therefore call on the NDOH must not be deployed in such COVID-19
to issue a circular, explicitly prohibiting coalface areas. In this regard, we demand
managers from preventing workers to go active consultation and involvement of
on quarantine if they believe that they have NEHAWU and other trade unions.
been exposed, whether at home or at the
workplace. The circular must explicitly prohibit Our fact-finding site-visits confirm what
managers from issuing or communicating has already been highlighted in numerous
any kind of threats or intimidating notices studies on the performance of public
or letters to workers in such a way that they healthcare sector, including the reports of
would be forced to work even when they are the OHSC. Leadership is an essential pillar for
diagnosed COVID-19 positive but without the optimum performance of an institution.
symptoms or when they have been in contact Our findings reflects the prevalence of
with individuals that have been diagnosed vacancies and acting personnel at this
COVID-19 positive.
management level. There are also question
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marks around the competencies or the
qualifications and experiences of some
of the current managerial personnel. We
have also found that there appears to be
no active and proper oversight exercised
upon the institutional managers on the
part of the district health and provincial
authorities, instead the involvement of the
latter in the operational activities of the
former tends to aggravate instability and
mismanagement. It is unclear as to whether
within a province any form of performance
management system is administered,
if at all. Indeed, it does not appear as if
managers of institutions are subjected to a
systematic practice of regular performances
assessments based on their contractual Key
Performance Indicators. Thus, we proposed
that the NDOH must immediately establish
a regularised, standardised and coherent
system of performance management
pertaining to the institutional managers. All
the managers of the public health institutions
must be subjected to performance based
assessments, taking into account the reports
of the OHSC. These assessments must take
place urgently rather than at the end of
their contracts and must be extended to the
district level.
We believe that there are a number of
recently qualified doctors and nurses that
are unemployed, as regularly reported in
the media. We are aware that there have
been recent recruitment drives announced
by government. However, in addition we call
on the NDOH to engage with the HPCSA
to expedite the applications and to review
the postponed arrangements for the board
exams for the foreign-trained doctors and
other healthcare workers, whether South
African or not. Similarly, we call on the SANC
to review its decision on the registration of
the foreign-trained nurse.
We call on government that it must
abandon the current decentralised and
fragmented approach in the procurement
of PPEs, as determined by the Guidelines
on the Management of the Coronavirus
(COVID-19) in the Public Service issued
by the Department of Public Service and

23

Administration. Thus, government must use
part of the additional R21 billion set-aside for
health in the adjustment budget to procure
the PPEs (and other vital requirements in
the fight against COVID-19) according the
current and projected geographic spread
of the epidemic and taking into account
the population, epidemiological and class
dynamics. The procurement of the PPEs
must meet the requirements of the fullcomplement of the healthcare workforce
according to the department’s guidelines
designating the use of PPEs according to
different occupational categories.
We propose that the NDOH must review the
process of the reporting of COVID-19 fatalities
in all institutions, to ensure adherence with
uniform standards as recommended by
the WHO. In this regard, we also call on the
NDOH to compel all institutional managers
to regularly update NEHAWU and other trade
unions on all the Coronavirus and COVID-19
data, especially pertaining to the healthcare
workers in the institutions.
Government must use the experience
arising from the COVID-19 epidemic to take
seriously the imperative of rebuilding and
strengthening the public healthcare system
towards the realisation of the National Health
Insurance (NHI). In this regard, we reject the
Treasury’s austerity measures in terms of the
freezing of the posts as one of the ways it
is trying to retreat from the implementation
of the NHI. The current Medium Term
Expenditure Framework presented by the
Treasury, which outlines austerity measures,
seeks to repeat the same mistakes that
have weakened the healthcare system in the
past. We believe that the Human Resource
Strategy for Health has been withheld by
government as it would run counter to the
austerity measures of the Treasury. We call
on the department to release this document
immediately so as to begin the process of
a strategically planned way of the filling of
the vacancies according to the country’s
health needs and the implementation of
the outcomes of the 2018 National Health
Summit.

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OUTCOMES OF THE JOINT MEETING
WITH MINISTERS OF HEALTH,
EMPLOYMENT AND LABOUR AND
TRADE AND INDUSTRY
After all the efforts of the national to meet
the Minister of Health since the 5th March
2020 up to court battle for the meeting
between NEHAWU and the Minister of • 
Health, finally took place on the 8th April
2020. NEHAWU was represented by all its
National Office Bearers (all six NOBs) and
government was represented by Minister
of Health, who was accompanied by the
Minister of Employment and Labour, Mr. • 
Thulas Nxesi, the Minister of Trade and
Industry, Mr. Ebrahim Patel and the Acting
Director General of the NDOH, Dr Anban
Pillay.
After robust discussions, the meeting
came to the following conclusions and
way forward as part of addressing matters
raised by NEHAWU arising from PPEs for • 
frontline workers and compliance by all
healthcare facilities as part of preparing
for a real war against this deadly global
virus.
• 

• 

The available stock of the Personal
Protective Equipment (PPEs) must
be matched with the headcount
of the different categories of the
frontline workforce and their specific
designations in terms of the different
types of the protective gears to
determine shortage and additional • 
pipeline procurement going-forward.
The department undertook to send
out guidelines to provinces to ensure
uniform application of the same
norms in relation to the types of PPEs
per categories of the frontline of
workers as well as ensure that there
are proportional redistribution or
reconciliation of the different items • 

the PPEs across provinces and health
districts.
It was agreed that no worker shall be
forced or intimidated to work without
proper and sufficient provision of
occupational protection by any
employer.
The department undertook to ensure
that management at the institutional
level reviews all suspensions of workers
and that there is no harassment
related to shortages of the PPEs
at workplaces. Instead, there must
be collaborative effort in the fight
against the virus and disease.
It was agreed that the national
Health
and
Safety
Committee
shall be strengthen with additional
participation by NEHAWU and other
trade unions. The committee shall also
focus on the wellbeing of the frontline
workers, including counselling as and
when needed by workers under the
current stressful conditions. Moreover,
the work of the committee must cover
both public and private healthcare
workers equally.
The department also committed
itself to expedite the process of
the establishment of Health and
Safety Committees in the frontline
workplaces, in which risk assessments
would be undertaken to ensure proper
measures effecting infection control
and occupational hygiene are put in
place.
The

Department

of

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and Labour shall ensure that
inspectors would be available to
ensure compliance and enforce the
Occupational Health and Safety Act.

Co-ordinating Bargaining Council
[PSCBC] because of the 21 days
nation-wide lockdown.
• 

• 

It was agreed that there shall be
proper education on the PPEs
and the guidelines issued by the
department and NICD on workplace
disinfection measures, the handling
and movement of deceased bodies,
etc. Through the workplace Health
and Safety Committees the national
union shall insure that the members’
concerns are addressed in this regard.

• 

The Minister will establish a project
team in his office to strengthen • 
coordination with the OHS committee
and elevate issues speedily in terms
of safety, supply of PPE’s and training
of workers.

• 

The department agreed that the
issue of catering is a very important
matter as workers are expected to
work long hours without any food or
something to drink. In this regard, the
issue of the catering for workers and
the operations of the canteens shall
be referred to provinces to address as
a matter of urgency.

• 

NEHAWU raised sharply the issue of
lack of transport for workers especially
the inconsistency of public transport
during the lockdown. Workers are
usually stranded with no transport
to go to work or to return back home
after their shifts. The department
therefore agreed to look into staff
transport for healthcare workers and
will also engage the Department of
Transport to intervene on the issue of
public transport.

• 

The matter of the danger allowance
shall be considered in the appropriate
forum,
including
the
NEDLAC
rapid response team, taking into
consideration the suspension of
the activities of the Public Service

25

The Department of Trade and Industry
shall deal with the issues of donations
and assistance from big business
in terms of the Solidarity Fund. The
NEHAWU Investment Holdings, shall
accordingly make a contribution
on behalf of the members to help
secure the PPE’s and other related
necessaries. In this regard, the
Department of Health will assist
in procuring the correct PPE’s and
quality assurance thereof.
Parties agreed to communicate more
with workers and the public during
these tough times. Thus, messages
that encourages workers and appeal
to the public to observe the rules of
the lockdown will be developed and
disseminated widely as possible.

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