Realizing the full potential of the PHC workforce: Addressing gendered workplace violence

Background: Primary health workers are the backbone of a strong health system, without whose effort and dedication, the Universal Health Coverage (UHC) agenda cannot be met. Despite their significance to achieving UHC, health workers are underpaid and unsupported by workplace regulations and policies. Female health workers, who constitute the majority of the primary health workforce worldwide, face greater disadvantage due to societal gender restrictive norms and inequalities that replicate inside health systems. The experience of workplace violence (WPV) is one of the most profound concerns around lack of safety and well-being. While violence affects both male and female health workers, the prevalence and consequences are worse for women. A recent global review shows 61.9% of health workers report any form of WPV, 42.5% report exposure to non-physical violence, and 24.4% reported experiencing physical violence in the past year. Workplace violence is pervasive and contributes to low well-being such as low motivation and internalization of fear. There is insufficient data on the gendered dimensions of workplace violence and the needs of health workers and a paucity of policies in the health sector on workplace violence protection in Africa. Aims & Objectives: This consortium aims to fill an urgent and widespread gap to understand the nature of workplace violence and its gendered dimensions experienced by the PHC workforce in three countries— Burkina Faso, South Africa and Tanzania—where high proportions of women work as health workers and have reported high levels of violence. The objectives are to undertake policy-relevant research to document the nature of PHC workplace violence and its gendered dimensions, and address the conceptual and intervention gaps in the three countries. Our thesis is that building a learning consortium to study gendered dimensions of workplace violence infused with decolonial and feminist approaches (i.e, anchor research in communities, encourage diverse disciplines and points of views,and focus on solutions) will help identify context relevant health system actions that can be implemented as adaptive learning and sustained beyond the life of the project. Methods: Using desk reviews of policies, ethnographic and participatory action research methods and a survey (one site), with approaches to engage communities to co-produce and co-design actionable interventions, we hope to iteratively implement and adapt interventions to address the problem in each site. We will invite health workers to be a part of the research team, thoughtfully navigate sensitivities of researching violence within an active workplace, collect data with deep commitment and practice of ethics, iteratively interrogate the data to deepen the insights, use emancipatory methods, like body maps and picture codes to get to the tacit and hidden scripts and meanings, and co-design with community engagement actionable interventions for adaptive learning. Anticipated Impact: We hope that this research will generate compelling evidence and extrapolate it out to lessons learnt, actionable case studies on shifts in workforce management, to take to other settings. The emphasis on inclusive and equitable relationships, capacity building, sharing learning and facilitating exchange across the partners will seed foundations of a strong consortium, the impact of which will go beyond geographic boundaries and the time bound nature of the funding.