Why does workplace safety matter?
Unsafe and unhealthy working conditions affect service delivery quality and health worker productivity and retention. OSH issues should be an integral part of human resources management systems and not limited to the realm of quality assurance nor siloed into vertical programs such as HIV and AIDS or maternal health. From a health systems perspective, hazardous environments increase health workers’ absenteeism, turnover, risk of abandoning the profession, short-term sick leave, longer-term disability, and even death (PPE 2012; Deussom et al. 2012; Baleta 2008; Gold et al. 2004; Wilburn and Eijkemans 2004). Among Malaysian nurses, musculoskeletal disorders related to poor ergonomics and physical strain was the primary cause of disability (Lugah et al. 2010). In Zambia, unacceptable working conditions and the advent of the AIDS epidemic resulted in high levels of health worker attrition, despite increased pay packages (Ngulube 2011).
In rural and remote areas, occupational risk is even higher due to harsher working conditions, greater isolation and insecurity, poorer infrastructure, inadequate equipment, and work overload (Matsiko 2010), and thus rural health workers may be more likely to be sick or disabled. An already reduced and maldistributed health workforce coupled with an excess of excused (e.g., sick and disability leave) and unexcused absences (e.g., demotivated and unsatisfied health workers fail to come to work or reduce their hours) further increases the physical and psychosocial burden on those who are present. A negative or unsafe work environment does not attract a health worker to a posting in a rural or remote area nor motivate the health worker to stay, resulting in a downward spiral of higher turnover and understaffed facilities, which negatively affects service access, quality patient outcomes, and health system performance (WHO 2007; Papp 2007; Matsiko 2010). Notwithstanding other issues that affect retention and productivity, human resources management systems should prioritize supporting health workers by assuring their occupational safety, health, and well-being on the job.