Rethinking How We Address Gendered Workplace Violence in Primary Healthcare Settings: A Dialogue with Abi Badru

Primary care workers can best be protected, or best protect themselves from gendered workplace violence by leveraging collective bargaining, structural reporting system, risk assessment, and active participation in policy dialogue. - Abi Badru

Held during the 16 Days of Activism against Gender-Based Violence campaign, the Imarisha consortium, in collaboration with Public Services International (PSI), convened a webinar, “Rethinking How We Address Gendered Workplace Violence in Primary Healthcare Settings”, on December 10th, 2025. This webinar was an open dialogue with Moradeke Abiodum-Badru (Abi Badru), PSI’s project coordinator responsible for implementing its health sector projects in West Africa. Drawing on her extensive experience as a registered nurse and union leader in Nigeria, as well as through her international role, Abi Badru offered insights situated at the intersections of labour rights, health policy development and gender equality at both national and international levels. With this background, the dialogue aimed to introduce PSI and share its success stories and challenges in addressing gendered workplace violence across African countries.

Gendered workplace violence among health workers – the elephant in the room

Recent estimates indicate that more than 60% of health workers experience some form of workplace violence (WPV). Given the scale and severity, WPV constitutes a global systemic crisis within healthcare, undermining the safety, well-being, and agency of healthcare workers, especially at the primary healthcare (PHC) level. Women, who comprise the majority of the PHC workforce, are further exposed to gendered workplace violence driven by gendered occupational hierarchies, societal restrictive norms, and entrenched power inequalities replicated and reinforced within health systems. Despite its prevalence and substantial impacts, workplace violence and its gender dimensions remain under-documented, under-problematised, and excluded from programmatic action and institutional agendas at global, national, and local levels.

As policy attention on WPV remains limited and measures to protect the workforce – where existent – are often fragmented and insufficient, there is an urgent need to move beyond top-down procedural and technocratic frameworks toward transformative approaches rooted in decolonial feminist epistemologies. Reimagining prevention, reporting, accountability to address WPV in health settings needs a more deliberate transformation of institutional conditions, norms, and power relations that enable, normalise, and sustain violence in the first place.

Public Services International and its fight against gendered workplace violence in public health systems across Africa

PSI, a global federation of more than 700 trade unions representing 30 million workers in public services across 160 countries, is setting a precedent in challenging gendered workplace violence in the health system and making it safe for health workers. Alongside defending quality public services, promoting workers' rights and enforcing democracy, it strongly advocates for equality and social justice at both the national and international level (ILO, WHO, and UN) and strives to improve working conditions. These commitments are reflected in its campaigns on gender equality, decent work, and climate justice.

Abi Badru described how PSI, along with its affiliates, is strategically intervening at multiple levels to challenge gendered WPV in public health systems across Africa. One of these strategies includes a strong and sustained campaign that has resulted in the implementation of legal reforms aimed at ensuring safety of health workers in Senegal, DRC, Nigeria. Another strategy involves supporting and empowering trade unions through gender-sensitive strategies that ensure protection and policy development.

She emphasized that PSI actively engages with projects and conferences that are focused on combating gender-based violence in several countries. Through capacity building, it equips trade unions in the prevention and mitigation of gender-based violence, and creates awareness about ​​the ILO General Convention, Convention No. 190 and encourages its ratification by governments, supported by evidence generated through participatory processes. Abi elaborated on the importance of democratic participation in evidence generation and highlighted that PSI has established participatory monitoring and reporting systems that allow for the documentation of concrete cases of dispute resolution, including legal actions and membership applications. She further affirmed that PSI actively promotes the participation of women in trade unions while strategically developing their skills and encouraging them to take on positions of responsibility.

Regarding the shaping of the regional and international agenda, she recounted that the evidence, in the form of case studies, developed by PSI has been used by the ILO and the WHO to develop standards and guidelines on worker protection. The sharing of experiences has contributed to shaping African Union documents on gender-based violence and occupational issues. She further underscored that today, PSI is recognized as a key player in the development of global standards for worker protection.

In the context of the healthcare sector in Nigeria, Abi pointed out that labour unions have been putting pressure on the government to improve working conditions of the health workforce and to implement corrective measures to enhance quality of care. She further added that unions have also been designing innovative strategies to protect workers. For instance, during the COVID-19 pandemic, Nigerian trade unions established a WhatsApp platform, commonly referred to by healthcare professionals as the "crisis room," where people could share their experiences and report shortages of staff, equipment, and protective gear. Additionally, to protect themselves from attacks, healthcare workers in some areas of Nigeria had to remove their protective clothing and blend in with patients. She underlined the importance of these platforms for exchanging ideas, experiences, mutual motivation, and demands, encouraging employers and the government to review the situation of workers. She emphasized that in several cases the voices of workers coming together yielded very positive reports in their collective bargaining.

Evidence as a key to strengthen the response to gendered WPV in primary healthcare

In the webinar, Abi Badru highlighted that a critical way to strengthen the response to gendered WPV is by generating evidence rooted in the lived experiences of health workers. She shared how in healthcare facilities, implementing and integrating a reporting system into routine procedures can facilitate this response. She stressed that regardless of size, every healthcare facility should have a health and safety committee to centralize cases. For example, in East Africa, the National Nurses Association, based on factual data, revealed that the rate of harassment is higher during on-call hours. Such evidence could then be utilized to design public awareness campaigns, serving as a catalyst for change and increasing pressure on the government. She reiterated that, to achieve this, the mobilization of all stakeholders is essential, and the struggle must continue until victory is secured.

Proposed strategies to strengthen response to gendered WPV

As the webinar drew to a close, Abi stated that while PSI and its affiliates are challenging gendered WPV in public health systems by intervening at multiple levels, and have achieved a number of successes, much remains to be done. To ensure health systems are safe and gender-responsive, she reflected on a range of strategies that could be adopted at two levels. These include:

At the institutional level:

• Health system reforms in primary healthcare (provide the necessary safety for women, safety and dignity)
• Advocate for the inclusion of the principles of ILO Convention 190 in institutional agreements to combat violence and mitigate its effects on survivors
• Implement a zero-tolerance policy regarding harassment
• Integrate policies that take into account the situation of women (involving women in policy design, implementation, evaluation)
• Establish a risk assessment mechanism that takes into account gender-specific issues, with a particular focus on violence against women in healthcare facilities.
• Establish a mechanism for reporting and protecting workers
• Establish a psychological support service for victims
• Transfer responsibility to the government, institutions, and employers capable of providing the necessary support to workers
• Develop a protocol to support survivors
• Ensure safe transport and staffing needs

At workers’ level:

• Participation in open and inclusive social dialogues and policy reform discussions
• Strengthening collective bargaining and the voice of workers to guarantee effective protection for workers
• Encourage and safe-guard women’s participation in decision-making spheres
• Commitment to change harmful and exclusionary social norms with the active involvement of community leaders

Ultimately, PSI is deploying resources to address, to some extent, the violence within healthcare facilities. These are all strategies that many countries could adopt and implement, which would surely contribute to reducing the problem of violence in healthcare settings.

The webinar demonstrated that, even though gendered WPV in the health system continues to endanger health workers' safety and well-being, it largely remains under-addressed. At the same time, it brought to the fore the powerful role trade unions have been playing in challenging this issue. It reinforced that interventions guided by democratic participation have the potential to create a safe and gender-responsive health system.