A study led by the University of Cape Town’s (UCT) Dr Itumeleng Ntatamala and published in BMC Health Service Research has revealed that South African healthcare workers (HCWs) exhibited lower levels of resilience compared to similar studies conducted globally.

The authors suggest that this disparity could be attributed to various factors specific to the South African healthcare system and workforce.

The South African healthcare system is grappling with myriad challenges, placing immense pressure on healthcare workers who require exceptional resilience to navigate these difficulties. Psychological resilience is imperative for enabling effective adaptation in the face of such demanding environments.

The study utilised secondary data from two separate studies conducted among HCWs in 2019 and 2022. Both studies were supervised by Associate Professor Shahieda Adams of UCT’s Occupational Medicine Division.

Both studies revealed that HCWs with higher levels of resilience were less likely to screen positive for post-traumatic stress disorder and burnout. These findings piqued the interest of the research team, prompting them to delve deeper into the specific personal and work-related determinants of resilience in HCWs.

A total of 647 HCWs were included in the study, of which 259 were doctors and 388 were ambulance personnel. The researchers estimated the prevalence of resilience and determinants of psychological resilience among this group of HCWs in South Africa.

The study revealed a concerning trend of low resilience scores across the board, with ambulance personnel showing slightly higher resilience at 28% compared to doctors at 27,1%. Interestingly, the data demonstrated that female gender, job category, and overtime work significantly increased the likelihood of low resilience for doctors – while higher salary and current smoking status had the opposite effect. Additionally, for ambulance personnel and the overall sample, previous alcohol use emerged as the sole factor significantly reducing the likelihood of low resilience.

“While HCWs were rightly recognised as heroes during the Covid-19 pandemic, it is important for the same recognition and momentum to be kept up to ensure that the protection of all HCWs continues during this post-pandemic period,” says Dr Ntatamala. “This study on resilience in HCWs has demonstrated that it is important to have occupational health measures in place that focus on ‘caring for the carers’.”

Ntatamala says that the study showed the importance of directing resources toward building resilience in all HCWs, focusing on specific groups. These groups include those who work long hours, earn lower income, are female, have mental health conditions, and use substances to cope with their job.

“While we found that high resilience was associated with substance use, we believe that this likely reflects the maladaptive substance use practices adopted by some HCWs to cope with workplace stressors,” he says. “There is a need to support HCWs build stronger resilience by providing training and support and, importantly, making changes at an organisational/health facility level to support HCWs. In addition, support such as psychological counselling should be offered to HCWs who have been diagnosed with mental health conditions.”

Thandokazi Mcizana, lead author and UCT master’s in public health graduate, adds: “Research on resilience in working populations is an important concept to study in South Africa, particularly amongst HCWs affected by work-related stressors evidenced by the ongoing brain drain. It is important to support the limited HCWs we have in the country as a precious resource important in advancing the healthcare for all.”

Mcizana says further research involving larger groups of different HCWs was needed to characterise better the personal, social, and work-related factors impacting the psychological resilience of HCWs in South Africa.

“Qualitative research involving groups and interviews would assist in understanding determinants of psychological resilience and may inform intervention strategies that would build psychological resilience in the healthcare workforce in South Africa,” she says.