Creating positive practice environments to prioritize occupational health (continued)
Unifying health workers and addressing workplace stress in Morocco
The work environment analysis from Morocco as part of the PPE Campaign highlighted the health risks associated with hazardous health workplaces and the stress resulting from work overload—especially within the emergency, maternity, and surgery wards—augmented by lack of resources, recognition, and management support. Motivating health workers and emphasizing their preparedness to better distribute the services provided within catchment areas, health facilities used strategic mapping and planning tools to revise the institutional hierarchies at health facilities. Health workers identified informational and training needs related to OSH and gradually filled the gaps. These same activities achieved both objectives for health worker safety and service quality improvement (Semlali 2010).
Prioritizing sanitation in Kenya
The Work Climate Improvement Initiative in 10 rural facilities piloted by the Ministry of Health in Kenya demonstrated marked improvements in four key areas: patient/health worker relationship; health worker/supervisor relationship; workplace environment; and worker wellness. Notably, simple measures such as regular cleaning of health facilities, handwashing practices, and proper disposal of medical waste were emphasized, and benefited not only the health workers but also their patients (Capacity Project 2009).
Empowering managers to prioritize performance in Uganda
In Uganda, poor working conditions were identified as a major reason for public health worker attrition. Uganda’s health management was decentralized to empower health subdistricts to create healthy work environments, using a participatory approach and an evaluation tool to assess the probability that a hazard would result in injury and the severity of consequences if injury occurred. The evaluation tool assessed risks by location, process, job description, and gender. As a result, facility teams had a common comprehension of the risks identified, and were better positioned to implement local improvements. In addition, the facilities recognized that by reducing occupational hazards and ensuring adequate pay, health workers would no longer be motivated to charge illegal user fees (Matsiko 2010).
Instituting personal and professional accountability for safer work environments in Zambia
In Zambia prior to the PPE Campaign, high levels of health worker migration, low preservice enrollment, and economic hardship contributed to the “vicious cycle” of poor health worker safety. Occupational risks had increased as protective work clothing was removed from the health budget. Health workers were burdened with unreasonable workloads due to staff shortages, and often faced physical or psychological violence from managers and patients (Ngulube 2011). Under the PPE Campaign, health workers were empowered with standards for personal accountability (e.g., committing to excellence and honesty), professional accountability (e.g., participating in standard-setting, performance measurement, and knowledge of good safety practices), and system accountability (e.g., achieving better supply management, supervisory systems, and health worker retention schemes). The results observed at the organizational level were so compelling that the national strategic health plan for 2011-2015 prominently featured human resources for health as a central component (ibid.).