Research consultancy

FACTORS CONTRIBUTING TO HEALTH AND SAFETY HAZARDS AMONG HEALTHCARE WORKERS AT UGANDA CANCER INSTITUTE

CHAPTER ONE

INTRODUCTION

1.0 Introduction

This chapter presents the background of the study, problem statement, objectives of the study, research questions, scope and significance of the study.

1.1 Background to the Study

Definition of occupational health and safety hazards

Maier (2009) defines health and safety hazards as the potential risks to health and safety for workers who work outside the home. Health workers can develop health conditions or sustain injuries if exposed to certain risks at their workplaces. World Health Organization ([WHO, 2009]) defined hazards as a serious phenomenon, substance, personnel activity or condition that may cause loss of life, injury or other health impact, property damage, loss of services, financial and psychosocial disruption, or environmental damage. In other words, Kalokairinou et al. (2011) defined hazards as an inherent characteristics of a substance, agent, origin of energy or situation that has the possibility of causing undesirable outcomes while risk is the probability that cause damage to ‘life, health, and or the environment’ may occur from a hazard. As stated by Safeopedia, occupational health and safety relates to health, safety, and welfare issues in the workplace and is a multidisciplinary field concerned with the safety, health, and welfare of people at work. it includes the laws, standards, and programs that are aimed at making the workplace better for workers, along with co-workers, family members, customers, and other stakeholders

Common.unique OHS hazards in health care (globally, in low and middle income countries, in Uganda, in Kampala)

Sterling noted that healthcare globally by the nature of their work have both unique and common health hazards categorized in to physical and psychological risks. The physical risks factors and agents include communicable diseases, exposure to chemicals and biological toxins, carcinogens, ionizing and non-ionizing radiations and ergonomic/human factor hazards, the psychological hazards include stress-induced disorders, chemical dependency, martial dysfunction and suicide (Sterling, 2009). Studies conducted in low middle-income countries of Philippine (De Castro, et al, 2009) and Nigeria (Orij, et al 2002) by De Castro and Orij respectively concluded that sharp related injuries and stress are the major hazards healthcare workers are exposed to. Ndejjo, in a study This highlighted that 50 % Uganda’s of healthcare workers, like in other low middle income countries have experienced an occupational health hazard, mostly sharp related injuries and stress (Ndejjo, 2015)

Common/unique OHS in cancer care (globally, in LMIC, in Uganda – the gap)

Factors that influence OHS and theoretical frameworks commonly used to study and describe these

Common individual factors – in general; in health care

Common institutional factors – in general, in health care

UCI – institutional history, set up. Staffing norms, levels

Staff health status and its monitoring

Staff health and safety issues

Experiences in other cancer care centres

Globally, health and safety hazards continue to be a serious public health problem affecting workers from different departments in the healthcare organization (World Health Organization, [WHO2015). According to WHO, more than 10.5 million health workers are exposed to occupational hazards such as biological hazards, physical hazards, mechanical, environmental and ergonomic hazards, chemical hazards and psycho-social hazards annually. This is attributed to various factors such as worker’s demographic characteristics, negative attitude towards protective gears, inadequate staffing and ineffective supervision among others (WHO, 2015).

Healthcare organizations are characterized by multidimensional and complex environments that make their workers prone to occupational hazards and injuries. Beside the nature of health workers’ working environment, duties and responsibilities, they are facing numerous health and safety hazards such as chemical, biological, environmental, physical and psychological risks (Anandh et al., 2015). Health and safety hazards can cause various forms of disabilities; loss of manpower that can lead to decreased productivity and in serious cases may lead to inevitable death of workers, which consequently lead to loss of skilled personnel. Also, occupational vulnerability of health care providers may threaten the quality of health care delivery in developing countries, especially among physicians, nurses and nursing aids (Abidoye et al., 2016).

In developed countries such as in Europe and Western world, studies indicate that only 5.9 million health workers are experiencing health and safety hazards and this is because of the advanced use of technological aided equipment during service delivery (WHO, 2016). This implies that, health and safety hazards are less prevalent in developed countries than in developing countries and this could be explained by the different levels of modalities in the health facilities coupled with the nature of training attained by the service providers and availability of technological aiding equipment among others (Occupational Safety and Health Administration report, 2016)

In developing countries, more than 12.5 million health workers do experience some health and safety hazards such as wounds, cuts, sharp related injuries, direct contact with infected specimens/biohazardous materials, blood borne disease, infectious diseases/infections, airborne diseases, pollution from soiled materials, physical/ergonomic, chemical and psychosocial health hazards among others (WHO, 2016, Bazeyo et al., 2016; Abideye et al., 2016). In addition, Cardoso, Mascaren and Oliveira (2010) mentioned that factors that contribute to health and safety hazards and risks may include lack of time and knowledge, forgetfulness, lack of means, negative influence of the equipment on workers’ skills, uncomfortable equipment, lack of training, conflict between the need to provide care and self-protection and distance to vital/essential supply, equipment or facility.

Additionally, Aliyu and Auwal, (2015) reported that health and safety hazards might results from poor supervision, insufficient experience on the job. In Egypt, at a university hospital a study carried by (Abou El-enein and El Mahdy, 2011) emphasized that the factors and barriers that influenced safety practice measures and that interfere with the safe practice of care include: absence of role model from colleagues or superiors, and the high work load or lack and inaccessibility of sinks.

Evidence from sub-Saharan Africa indicates that healthcare workers are frequently exposed to chemical, biological, physical, and psychosocial health and safety hazards (Nsubuga and Jaakkola, 2015; Tinubu, Mbada, Oyeyemi and Fabunmi, 2010). They are constantly in contact with patients that expose them to infections and thus require proper protective measures to reduce their risk of acquisition of disease or injury (Tinubu et al., 2010). Data on health and safety hazards among healthcare workers and their mitigation measures remain scarce in most of sub-Saharan Africa and Uganda in particular. In Uganda, the Ministry of Gender, Labour and Social Development, through the department of Occupational Safety and Health is responsible for administration and enforcement of the Occupational Safety and Health (OSH) Act, No 9,2006. Despite government effort to improve safety and health of all workers in the country through funding enforcement of OHS activities, repealing of the Factories Act, 1964 that led to the enactment of the OHS Act, 2006 and statutory instrument No. 87 (2014), limited impact has been registered due to inadequate enforcement of the OHS Act,2006. Although Uganda’s economy has registered several achievements, various aspects of occupational health and safety have not been adequately addressed (Office of Auditor General, 2016). On top of the OHS Act, 2006, other legal and policy framework that guides on management of occupational health and safety of the workforce including healthcare workers include;

The International Labour Organisation (ILO) Conventions and the World Health Organisation (WHO) Resolutions on Occupational Safety and Health.
Policy for Occupational Health and Safety in the Health Services Sector (2008),
The Constitution of Uganda, 1995 that has several Articles relating to the concept of decent work and entitlement to a clean, healthy work environment.
The Workers’ Compensation Act 2000.
The National Gender Policy (1997).
The National Health Policy (Sept. 1999).
The second Health Sector Strategic Plan (HSSP II 2005/6 – 2009/2010).
The Human Resources for Health Policy (April 2006).
The IFC/World Bank Group, Environmental, Health and Safety Guidelines for Health Care Facilities
Guidelines for Occupational Safety and Health, including HIV in Health Services Sector, 2008
Ministry of Health Occupational Safety and Health Implementation Strategy, 2011

The draft Uganda National AIDS Policy (July 2005).
Draft National Policy on HIV/AIDS.
The World of Work (Dec. 2003)

At Uganda Cancer Institute (UCI), there is no documented work regarding factors contributing to health and safety hazards among health workers at UCI. It should be noted that, understanding the predisposing factors for health and safety hazards among workers in the hospital is needed to inform occupational health and safety policy and programs for healthcare workers.

The theory of reason action will guide the study, Ajzen and Fisbein formulated this theory in 1980 based on the fact that a person’s behavior is determined by their intention to perform the behavior in question of which the intention is determined by their attitude towards the behavior, the intention is looked at as the persons readiness to perform which is determined by attitude, subjective norms and perceived behavioral control.

1.2 Problem Statement

Health and safety hazards among health workers continue to be a serious health problem affecting effective execution of their services worldwide. Health and safety hazards for example, back injuries and back pain are an important concern for the health workers working in the healthcare organization at large (WHO, 2015). It has a negative impact on the well-being and quality of life of the worker, and affects the productivity of the organization as well (Gropelli, 2011). Healthcare workers are more likely to experience a musculoskeletal disorder (MSD) and 52% complain of chronic back pain and there is a lifetime prevalence up to 80% globally (WHO, 2015). Thirty-eight percent (38%) of health workers in sub-Saharan countries report having occupational health-related back pain severe enough to require leave from work compared to (12%) from developed countries (WHO, 2016). Despite the training on various aspects on how to execute duties, an estimated 100,000 health workers die from health and safety hazards, while about 400,000 new cases of occupational health related diseases are diagnosed every year among health workers (Occupational Safety and Health Administration report, 2016).

. It should be noted that, the multiplying effects of health and safety hazards among service providers include economic loss, physical loss and psychological disorders such as depression and stress. Consequently, these have negative effect on the employees, their families and the nation at large. It must be understood that, there is no documented work regarding factors contributing to health and safety hazards among health workers at Uganda Cancer Institute.

1.3 Purpose of the Study

The purpose of this study is to identify factors contributing to health and safety hazards among health workers at Uganda Cancer Institute to device measures to mitigate health and safety hazards among health workers.

1.4 Objectives of the Study

i). To establish the health and safety hazards being experienced by health workers at Uganda Cancer Institute.
ii). To assess the individual related factors contributing to health and safety hazards among health workers at Uganda Cancer Institute.
iii). To identify institutional related factors contributing to health and safety hazards among health workers at Uganda Cancer Institute.

1.5 Research Questions

Which health and safety hazards are being experienced by health workers at Uganda Cancer Institute?
What individual related factors are contributing to health and safety hazards among health workers at Uganda Cancer Institute?
What institutional related factors are contributing to health and safety hazards among health workers at Uganda Cancer Institute?

It will be useful to have a hypothesis here, that you want to test in your research.

1.6 Significance of the Study

A study on this subject matter will help the management of UCI to know which individual and institutional related factors do contribute to health and safety hazards among health workers at Uganda Cancer Institute. It will eventually help in identifying the areas of weakness and based on the findings, strategies to mitigate health and safety hazards may be devised, implemented and evaluated ultimately reducing the problems arising due to the health and safety hazards.

The information got will be used as a future reference for other studies. The study results will help the Ministry of Health and administration of UCI to improve on the sensitization programs on measures aimed at mitigating the occurrence of health and safety hazards and this may be done through continuous education and training among healthcare workers.

The results will also help the government to identify areas in which to put much emphasis during sensitization programs and health education seminars among others.

The results will also help medical workers to identify the area of concern regarding health and safety hazards so that they can execute their services effectively. The study when completed will also help the researcher to acquire his Master of Science in Public Health.