Workplace violence and gender discrimination in Rwanda's health workforce: Increasing safety and gender equality

BACKGROUND: Workplace violence has been documented in all sectors, but female-dominated sectors such as health and social services are at particular risk. In 2007-2008, IntraHealth International assisted the Rwanda Ministries of Public Service and Labor and Health to study workplace violence in Rwanda's health sector. This article reexamines a set of study findings that directly relate to the influence of gender on workplace violence, synthesizes these findings with other research from Rwanda, and examines the subsequent impact of the study on Rwanda's policy environment. METHODS: Fifteen out of 30 districts were selected at random. Forty-four facilities at all levels were randomly selected in these districts. From these facilities, 297 health workers were selected at random, of whom 205 were women and 92 were men. Researchers used a utilization-focused approach and administered health worker survey, facility audits, key informant and health facility manager interviews and focus groups to collect data in 2007. After the study was disseminated in 2008, stakeholder recommendations were documented and three versions of the labor law were reviewed to assess study impact. RESULTS: Thirty-nine percent of health workers had experienced some form of workplace violence in year prior to the study. The study identified gender-related patterns of perpetration, victimization and reactions to violence. Negative stereotypes of women, discrimination based on pregnancy, maternity and family responsibilities and the 'glass ceiling' affected female health workers' experiences and career paths and contributed to a context of violence. Gender equality lowered the odds of health workers experiencing violence. Rwandan stakeholders used study results to formulate recommendations to address workplace violence gender discrimination through policy reform and programs. CONCLUSIONS: Gender inequality influences workplace violence. Addressing gender discrimination and violence simultaneously should be a priority in workplace violence research, workforce policies, strategies, laws and human resources management training. This will go a long way in making workplaces safer and fairer for the health workforce. This is likely to improve workforce productivity and retention and the enjoyment of human rights at work. Finally, studies that involve stakeholders throughout the research process are likely to improve the utilization of results and policy impact.