Abstract
IntroductionSexual harassment is a ubiquitous problem that prevents women’s integration and retention in the workforce. Its prevalence had been documented in previous health sector studies in Uganda, indicating that it affected staffing shortages and absenteeism but was largely unreported. To respond, the Ministry of Health needed in-depth information on its employees’ experiences of sexual harassment and non-reporting.MethodsOriginal descriptive research was conducted in 2017 to identify the nature, contributors, dynamics and consequences of sexual harassment in public health sector workplaces and assess these in relation to available theories. Multiple qualitative techniques were employed to describe experiences of workplace sexual harassment in health employees’ own voices. Initial data collection involved document reviews to understand the policy environment, same-sex focus group discussions, key informant interviews and baseline documentation. A second phase included mixed-sex focus group discussions, in-depth interviews and follow up key informant interviews to deepen and confirm understandings.ResultsA pattern emerged of men in higher-status positions abusing power to coerce sex from female employees throughout the employment cycle. Rewards and sanctions were levied through informal management/ supervision practices requiring compliance with sexual demands or work-related reprisals for refusal. Abuse of organizational power reinforced vertical segregation, impeded women’s productive work and abridged their professional opportunities. Unwanted sexual attention including non-consensual touching, bullying and objectification added to distress. Gender harassment which included verbal abuse, insults and intimidation, with real or threatened retaliation, victim-blaming and gaslighting in the absence of organizational regulatory mechanisms all suppressed reporting. Sexual harassment and abuse of patients by employees emerged inadvertently.Discussion/conclusionsSex-based harassment was pervasive in Ugandan public health workplaces, corrupted management practices, silenced reporting and undermined the achievement of human resources goals, possibilities overlooked in technical discussions of support supervision and performance management. Harassment of both health system patients and employees appeared normative and similar to “sextortion.” The mutually reinforcing intersections of sex-based harassment and vertical occupational segregation are related obstacles experienced by women seeking leadership positions. Health systems leaders should seek organizational and sectoral solutions to end sex-based harassment and make gender equality a human resource for health policy priority.
Highlights
Sexual harassment is a ubiquitous problem that prevents women’s integration and retention in the workforce
In a 2003 Uganda Ministry of Health (UMOH) study on health worker retention, around 24% of workers the majority of whom were female nurses reported that they had been subjected to sexual “abuse” by a supervisor [4]
Not everything that counts can be counted [11], so additional UMOH research in 2017 involved a new descriptive approach employing multiple qualitative data collection techniques to address key questions: What are UMOH employees’ experiences of sexual harassment? Why is non-reporting of sexual harassment pervasive? What are the consequences? What is the cross-cultural relevance of current theories, definitions and dynamics for UMOH human resources for health policy and human resources management (HRM)? The 2017 research aimed to describe the workings of sexual harassment and non-reporting in UMOH workplaces and assessed the relevance of current sexual harassment theory and definitions, at a minimum, to increase the consistency of measurement across settings
Summary
Sexual harassment is a ubiquitous problem that prevents women’s integration and retention in the workforce. Its prevalence had been documented in previous health sector studies in Uganda, indicating that it affected staffing shortages and absenteeism but was largely unreported. Background Sexual harassment is a ubiquitous problem that prevents women’s integration and retention in the workforce [1,2,3]. The prevalence of sexual harassment in Uganda’s public health sector had been documented and linked to staffing shortages and absenteeism. In a 2003 Uganda Ministry of Health (UMOH) study on health worker retention, around 24% of workers the majority of whom were female nurses reported that they had been subjected to sexual “abuse” by a supervisor [4]. One in five reported sexual abuse by patients or their relatives (21%).
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