Views of frontline service providers on the accreditation of occupational health services in South Africa

Background: In South Africa, occupational health services are delivered in a fragmented and complex environment. There is, however, a global emphasis on high-quality, universal occupational health coverage. Objective: To describe occupational health practitioners' perceptions of the accreditation of occupational health services. Methods: We used a mixed methods approach, which combined a self-administered web-based survey of 475 occupational health nurses and 11 semi-structured focus group discussions, which included a broad selection of occupational health stakeholders. Results: The majority of respondents supported the statutory accreditation of healthcare services for workers, provided that a phased approach is used. Challenges that need to be addressed for a successful and sustainable accreditation system include the current lack of national standards for occupational health, human resource shortages, potentially high costs of accreditation, and the suboptimal and fragmented governance of occupational health services. Conclusion: The majority of respondents were of the opinion that statutory accreditation of occupational health services will improve the quality-of-service delivery. However, prerequisites for successful and sustainable implementation of accreditation include improved collaboration between Government departments, coalition building with all stakeholders, the development of specific standards against which a service can be assessed, and education and training of occupational health practitioners to meet the established standards

Governance of occupational healthcare services in South Africa: Cohesion or conflict?

Background: Effective governance of healthcare services is essential for achieving national health objectives and safe quality care. The governance of occupational healthcare services has received scant scholarly attention both globally and in South Africa. This paper uses ILO Convention 155 as a conceptual framework for the review of the governance ofoccupational healthcare services in South Africa.Objectives: To investigate the nature and extent of involvement of legislated bodies in the governance of occupational healthcare services in South Africa and explore stakeholders' perceptions of occupational healthcare services governance.Methods: There were three components to the study: a review of relevant legislation and policy documents; 12 keyinformant interviews; and 11 focus group discussions in three South African provinces. The data were analysed using thematic content analysis.Results: Occupational healthcare services occupy a relatively low priority on the health reform agenda and are delivered in a fragmented and complex legislative framework with multiple government departments tasked with various occupational health functions. The results suggest that there are gaps in governance because of conflicting or overlapping relationships, and poor cohesion among the statutory departments. These, in turn, contribute to poor quality control of occu-pational healthcare service delivery and insufficient accountability.Conclusion: The improvement of occupational healthcare services governance requires intersectoral collaboration,enforcement of existing legislation, and involvement of all relevant stakeholders