In 2007, the IntraHealth-led Capacity Project conducted a study in 44 health sites in Rwanda to determine the nature, prevalence, causes and consequences of workplace violence on human resources for health. This study is intended to assist government ministries and other interested institutions develop policy and programmatic responses to the problem. The study explored gender-based discrimination, as female dominated professions such as nursing are more at risk for violence than other professions, and gender-based discrimination is one of the causes of workplace violence.*  Rwanda’s ministries of health, labor, justice and gender and the Rwanda Health Workers’ Union have validated the study results. The Capacity Project is funded by USAID and IntraHealth staff presented the study’s results to USAID’s Interagency Gender Working Group in May 2008.

Findings showed that 39% of health workers in the sample had experienced some form of workplace violence in the last year, with verbal abuse being the most prevalent form (27%). Other forms of workplace violence included bullying (16%), sexual harassment (7%), physical assault (4%) and sexual assault (2%).  The most important risk factors for workplace violence included gender inequality, the lack of a culture of mutual respect, the level of workplace and community insecurity, and the absence and non-application of workplace policies. In 40% of cases the victim of sexual harassment—overwhelmingly female—told no-one. The study concluded that workplace violence affects psychological health, energy level, absenteeism, performance, productivity and interpersonal relations. Many respondents spoke of feeling traumatized or haunted by the experience.

The study found a relationship between workplace violence and forms of gender-based discrimination such as sexual harassment, negative stereotypes about female health workers and over-representation of men in top management jobs. The perception of discrimination was associated with higher odds of experiencing violence at work.  Conversely, when health workers perceived conditions of gender equality, the odds of being a victim of workplace violence were five to six times lower than when they perceived gender inequality.

The Rwanda Ministry of Health and other stakeholder institutions have developed memoranda in response to study results. Recommendations include:

• Undertake an in-depth study of maternity-based discrimination
• Develop a gender-sensitive health sector policy on workplace safety and security
• Organize a program to eliminate workplace violence at health facilities through sensitization and training
• Disseminate Rwanda’s Labor Code to labor inspectors and union representatives, along with to help protect workers’ safety and security.

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^{*International Labor Organization. Introduction to Violence at Work: Sex, Age, and Precarious Employment as Risk Factors [accessed 11 July, 2008]. http://www.ilo.org/public/english/protection/safework/violence/intro.htm#sex_age}