Following reports of healthcare workers who have been bitten, punched, hit in the face, robbed, assaulted or even killed in healthcare facilities in Gauteng, the province’s health department announced that healthcare workers will now be trained in handling patients who become violent.

The initiative was recently announced by Motalatale Modiba, spokesperson for the Gauteng Department of Health, on social media.

A lack of security at public healthcare facilities is not a new problem. A previous series of Spotlight articles highlighted security challenges in public health facilities in several provinces – including Gauteng – and reports of robberies and assaults at some facilities. Last year, a fatal shooting of a nurse at Tembisa Hospital sparked an outcry among health worker unions over the safety of their members.

The study found that female healthcare workers were disproportionately affected compared to their male counterparts, and most of the incidents were reported in Gauteng.

The department’s announcement prompted questions by organised labour and an opposition politician about whether the authorities have lost trust in the multi-million rand security measures already in place in health facilities to protect both workers and patients, with some arguing that security guards, rather than healthcare workers, should be responsible for safety.

However, according to Modiba, the training of staff has nothing to do with the security contracts of security companies. 

“Security personnel are non-medical personnel, therefore, their presence in facilities does not substitute the need to ensure that our staff is empowered with techniques to know how to handle difficult patients,” he told Spotlight.

Nurses’ union Denosa says the training of healthcare workers does not address safety concerns in public health facilities. (Photo: Flickr / Krysten Newby)

‘Just a tick-box exercise’

The training plans, however, have inspired little confidence among healthcare workers.

According to the nurses’ union Denosa Gauteng Provincial Secretary Bongani Mazibuko, the training does not address the safety concerns that exist in the facilities. “It’s just a tick-box exercise to say the employer is trying to do something. The root cause of these attacks is the influx of mental health patients and the mixing of mental health patients with medical patients,” he told Spotlight.

The department, in an April statement, said many of the incidents were reported at Weskoppies Psychiatric Hospital, with 21 cases since January last year. At Carletonville District Hospital there were nine safety incidents, nine incidents at Far East Rand Hospital, seven at Chris Hani Baragwanath Academic Hospital, four at Thelle Mogoerane Hospital, and three at Kopanong Hospital. There were also reports of some isolated incidents at other facilities. 

Read more in Daily Maverick: Violence and hospital disruptions persist despite provincial health departments securing interdicts against strikers

Mazibuko said that from the reports they received from their members working in Gauteng public health facilities, the training has also not yet taken place. “We would like the department to tell us which institutions they have provided the training to so that we can confirm with our members if they received the training or not.”

Training, what training?

Modiba did not respond to Spotlight’s questions about where training had taken place so far, how many healthcare workers have been trained, or the impact it is having.

Explaining aspects of the plan, however, Modiba said that the department training staff to know how to protect themselves is a practical step that shows that they are conscious of the environment they operate in. According to him, training on how to manage a violent mental healthcare user is generic to the training of doctors and psychiatric nurses, as regulated by the Health Professions Council of South Africa, which is a statutory body established in terms of the Health Professions Act.

“A special course on management of violent mental healthcare users is planned to be rolled out from the second quarter of the 2023-2024 financial year. It is based on a similar course attended by one of the healthcare workers in the UK. He will be working in one of our specialist psychiatric hospitals, Sterkfontein Hospital. He will be the main facilitator, and will be working with other employees from the regional training centres, OHS and wellness practitioners,” said Modiba. He said the department is also working with the police.

But Mazibuko said Denosa has had many talks with the department about healthcare workers’ safety concerns and the need to create a safe working environment. “This was part of our demands when we marched last year. Even on International Nurses Day, we were vocal about our concerns about the safety of our members at the workplace.”

He said the union had previously presented its safety campaign to the department.

The Gauteng health department announced that healthcare workers will be trained to handle violent patients. (Photo: Rian Horn / Ritshidze)

Sama ‘deeply concerned’

Meanwhile, following a scoping review study, the South African Medical Association (Sama) recently published a report outlining the nature and extent of violence against healthcare workers between 2012 and 2022. The study found an increase in violent acts targeting healthcare workers, with the most affected being doctors, nurses and paramedics. The study found that female healthcare workers were disproportionately affected compared to their male counterparts, and most of the incidents were reported in Gauteng. 

In an interview with Spotlight, Sama chairperson Dr Mvuyisi Mzukwa said they are “deeply concerned” about the safety of healthcare professionals. He said they appreciate efforts that can realistically improve the safety of healthcare workers in the workplace. 

“Sama has shared an interim report [based on the study findings] on violence targeting healthcare workers with Denosa and the media. This report was designed to sensitise all stakeholders about crime targeting healthcare workers and to prime the stakeholders, including the National Department of Health, to initiate intersectoral solutions to limit and prevent safety threats in the workplace against all healthcare workers in the country,” Mzukwa said.

Sama’s report found eight murders of healthcare workers reported in the media “with six of the deaths (or 75%) occurring among doctors”. One nurse and one paramedic were also murdered in the set period, the report found. “Of all the 45 media reports examined, only 17 arrests (38%) were reported, with only two resulting in successful prosecution.”

According to Mzukwa, Sama had recommended that a multi-sectorial strategy for the security of healthcare workers, to protect them from targeted crime, be developed and implemented.

“Without this intervention, healthcare in itself continues being further jeopardised and more doctors will feel threatened and seek safer refuge in foreign countries, taking with them critical skills and expertise that is in dire need locally. Law enforcement agencies should also act swiftly in dealing with crime, and to ensure the safety of both patients and healthcare providers,” Mzukwa said.

Nomantu Nkomo-Ralehoko, MEC for Health in Gauteng. (Photo: GP Health and Wellness / Twitter)

Sixty-one incidents

Speaking in the Gauteng Legislature in April, MEC for Health and Wellness Nomantu Nkomo-Ralehoko said there were 61 incidents reported in health facilities between January 2022 and April 2023. She said that most of these incidents were attributed to mental healthcare users, while others relate to patients’ anger towards staff for various reasons, such as refusal to buy them items or patients trying to escape, as well as angry relatives and patients linked to criminal activities.

Nkomo-Ralehoko said that staff training in responding to aggression and violence in the affected institutions is one element of their intervention. She said the department will be installing CCTV cameras at strategic locations for monitoring purposes.

“Our goal is to minimise – if not eradicate – such incidents in our facilities. We have to work with healthcare workers and other stakeholders such as hospital boards, clinic committees and the patients themselves to curb incidents of attacks inside our facilities,” she said.

But security concerns in Gauteng’s public health facilities are also fuelled by systemic and contract management issues – something the MEC vowed to address. In March, responding to concerns over these multi-million rand security contracts that are rolled over year on year without a proper tender, Nkomo-Ralehoko acknowledged that the situation is unacceptable. 

In Gauteng’s public health facilities healthcare workers have been bitten, punched, hit in the face, robbed, assaulted, or even killed. (Photo: Flickr / J Ott)

R59m in monthly security contracts

The department is spending more than R59-million on month-to-month security contracts at its facilities.

“The security contracts are rolled over irregularly as there is currently no contract in place; only service level agreements are used to manage the contracts,” she said.

Responding to a question from Spotlight about the progress of the new security tender, Modiba said that the tender was advertised and has since closed. “The evaluation committee has been appointed and will now go through the evaluation process to assess the various bids that have been received. We are still on course to complete the process within this financial year,” Modiba said.

But according to Denosa’s Mazibuko, insourcing security services, separating mental health patients from other patients, and ensuring that mental health patients are only admitted to where the institutions can commit them, will help the department, and healthcare workers to work in a safe space.

He said the fact that there have been years of year-on-year security contracts, shows that the department is not in touch with the challenges on the ground. “Insourcing of security will help as well since it will address the issue of security withholding their services as they have not been paid, and security being given proper gear for work,” he said.

Jack Bloom, the Democratic Alliance’s health spokesperson in Gauteng, says the department is failing in its basic responsibility to provide a safe working environment for staff and patients in public hospitals.

“A huge amount of money is spent on security companies that don’t do their job, and it is high time that new security contracts are awarded to competent providers,” he said.

Bloom said that healthcare providers should not have to defend themselves against attacks because that is what security guards are supposed to do. “There needs to be a complete overhaul of security arrangements at our hospitals, with a professional assessment of what should be provided at a reasonable cost,” he said.

*This article was published by Spotlight – health journalism in the public interest.