A health in all policies (HIAP) conceptual framework to facilitate the profiling of public servants’ health statuses in the Namibian public service
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Date
2024
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Publisher
University of Namibia
Abstract
Background: The Namibian Public Service (NPS) makes no provision to profile the
health statuses of its employees/public servants, despite being a legislative requirement.
As a result, government will not be able to, for instance, predict work incapacities due
to ill-health absence which is a major measurement of performance/productivity.
Worldwide, governments have instituted different approaches, within/outside the
Occupational Health and Safety continuum, to profile employees ‘health/ill health to
inform promotion of health in workplaces.
Aim: This study sought to develop a conceptual framework and an implementation guide
to enable the profiling of Namibians public servants’ health statuses entrenched in the
principle of the Health in All policies (HiAP) approach.
Methods: A multi-phased pragmatic study was conducted.
Phase 1 employed an explorative descriptive convergent parallel mixed method design
using document reviews, a Focus Group Discussion, a Discourse Analysis, a Cross sectional and a Knowledge, Attitude and Practice (KAP) surveys. Max Weber Qualitative
Data Analysis and the Statistical Package for Social Sciences enabled analysis of data,
respectively, herein synthesised by means of triangulation.
Findings: Documents reviewed revealed the existence of public servants’ health
information sources such as the employees’ health recruitment questionnaires, sick leave
systems and medical aid, appropriate for profiling. Key Informant’s perspective that the
HiAP framework was appropriate to facilitate profiling of public servants’ health statutes
was further echoed by result of the Discourse Analysis. The cross-sectional survey,
conducted among 346 public servants’ participants established that 83.3% of the survey
participants self-reported ‘a good’ health status. The remainder 16.7% self-reported ‘a
poor’ health status citing the prevalence of Hypertension (27%), Musculoskeletal
disorders (30.6%), Stress (55%), Physical in-activeness (38%) and a High Body Mass
Index (BMI) (27%). A Chi-square logistic regression test, pegged to a p-value of less than
5% and using: 1. Good health = self-reported score for Excellent/Very Good/Good; 2.
ii
Poor health = Fair/Poor/Very Poor: reveals significant statistical associations to poor
health in relation to Hypertension (p-value=0.001), Mental conditions (p-value=0.009)
and access to electricity (p-value=0.045). No significant statistical association was
observed with elevated blood sugar (p-value=0.258≤5%), BMI and income. The KAP
study, conducted among 51 Wellness Officers, reported very low HiAP knowledge citing
a lack of information and henceforth no application of the HiAP approach, overall.
Phase II focussed on the design, and development of the above-mentioned framework
using results emanating from Phase I; enlisting elements of the World Health
Organization’s (WHO) HiAP Analytical framework alongside elements of the Systems
and Practice Oriented Theories, namely: [input (procedures, agent, recipient and
dynamics); output (terminus); synergies (agent, recipient, procedures and dynamics) and
feedback (context, inputs, outputs, terminus)]. Five purposely selected subject experts
who validated the suitability of the developed conceptual frame recommended amongst
others aligning it to the legislative provisions of the Public Health and Environmental Act.
Phase III enlisted the WHO’s Handbook on developing guidelines and the Public Service
Staff Rule format to inform the design of an implementation guide.
Conclusions: The study encapsulates evidence that proofs the gap identified as well
devised approach to fill the gap: a conceptual framework to profile Namibian public
servants’ health statuses embedded in the HiAP principles. Evidence of poor HiAP
knowledge could implicate successful implementation. Henceforth a recommendation that
the NPS adopts the designed conceptual framework, the introductory and ensued
implementation guide using a policy brief, attached hereto, to ensure compliance with the
law
Description
A Dissertation submitted in fulfilment of the requirements for the Degree of Doctor of Philosophy in Public Health
Keywords
Health in all policies approach, Conceptual framework, Public servants, Health statuses, Namibian public service, Namibia, University of Namibia