Empowering Health Workers to Protect Their Own Health: A Study of Enabling Factors and Barriers to Implementing HealthWISE in Mozambique, South Africa, and Zimbabwe

Abstract

Ways to address the increasing global health workforce shortage include improving the occupational health and safety of health workers, particularly those in high-risk, low-resource settings. The World Health Organization and International Labour Organization designed HealthWISE, a quality improvement tool to help health workers identify workplace hazards to find and apply low-cost solutions. However, its implementation had never been systematically evaluated. We, therefore, studied the implementation of HealthWISE in seven hospitals in three countries: Mozambique, South Africa, and Zimbabwe. Through a multiple-case study and thematic analysis of data collected primarily from focus group discussions and questionnaires, we examined the enabling factors and barriers to the implementation of HealthWISE by applying the integrated Promoting Action on Research Implementation in Health Services (i-PARiHS) framework. Enabling factors included the willingness of workers to engage in the implementation, diverse teams that championed the process, and supportive senior leadership. Barriers included lack of clarity about how to use HealthWISE, insufficient funds, stretched human resources, older buildings, and lack of incident reporting infrastructure. Overall, successful implementation of HealthWISE required dedicated local team members who helped facilitate the process by adapting HealthWISE to the workers' occupational health and safety (OHS) knowledge and skill levels and the cultures and needs of their hospitals, cutting across all constructs of the i-PARiHS framework.

Keywords: HealthWISE; health workers; i-PARiHS framework; implementation science; occupational health.

Figure 1

HealthWISE workbooks—the Action Manual and Trainers’ Guide—and a list of the eight modules that cover key areas of occupational health and safety (OHS) for health workers (HWs).

Figure 2

A timeline of the implementation of HealthWISE in seven selected hospitals in Mozambique, South Africa, and Zimbabwe.

Figure 3

Before (not shown), the physician’s desk was positioned next to the window, with the patient to their right. After, the patient is positioned next to the window and the physician is seated on the opposite side of the desk, allowing the air to flow from the door outside. Ripped flooring has been removed.