Factors influencing healthcare workers' perception of South African health system capability for managing COVID-19 pandemic

During the emergence of the COVID-19 pandemic in South Africa in March 2020, there was an urgent mobilization of healthcare workers (HCWs) who had to adapt quickly to a challenging health system. Therefore, this paper examines factors associated with HCWs' perceptions of the South African health system's capability for managing COVID-19 during the early stages of the pandemic. Data utilised in this paper were obtained from an online survey conducted among HCWs using a structured questionnaire on a data-free online platform. The study population included all HCWs in South Africa. Bivariate and multivariate logistic regression models were used to examine the factors influencing HCWs' perceptions of the South African health system capability for managing COVID-19. Of the 5,274 respondents, 22.0% indicated that the South African health system would manage the COVID-19 pandemic. Increased odds of perceiving that the South African health system was capable of managing COVID-19 were significantly associated with being male (aOR = 1.5595%CI [1.22-1.97], p<0.001), being 50-59 years old (aOR = 1.94 [1.31-2.87], p=0.001) and 60 years and older (aOR = 2.27 [1.34-3.84], p=0.002), working in other sector (aOR = 1.42 [1.10-1.84], p=0.007), and having confidence in their overall knowledge about COVID-19 (aOR = 1.92 [1.52-2.41], p<0.001). Decreased odds of perceiving that the South African health system was capable of managing COVID-19 were significantly associated with HCWs being White (aOR = 0.29 [0.22-0.38], p<0.001) and Indian/Asian (aOR = 0.45 [0.33-0.62], p<0.001), being medical practitioner (aOR = 0.55 [0.41-0.73], p<0.001), and having moderate (aOR = 0.70 [0.50-0.99], p=0.042) or high risk perceptions (aOR = 0.55 [0.39-0.77], p<0.001) of contracting COVID-19. In the early days of the pandemic, most HCWs felt that the health system would not cope with COVID-19. Healthcare workers' experience (a proxy for HCWs' age), work sector, confidence in their knowledge about COVID-19, and their risk perceptions were key factors affecting their perception of the health system's capability.