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Frontline Fallout: Addressing the Surge of Violence in Primary Healthcare Settings

Workplace violence (WPV) in the healthcare sector is an escalating concern that can no longer be brushed under the carpet. Recent data suggests an alarming prevalence of violent incidents, especially in Primary Healthcare Centres (PHCs). As the front line in health service delivery, these settings should be sanctuaries of care but are increasingly becoming arenas of distress for healthcare workers. This very concern was the basis of a recent study published in the esteemed journal Human Resources for Health, a publication backed by BioMed Central in collaboration with the World Health Organization (WHO).

The core mission of healthcare workers is to provide patients with the best care possible, ensuring their well-being and recovery. But what happens when the people responsible for our health face threats to their well-being? The study in Human Resources for Health brought to light some alarming statistics and facts:

Types of Violence: While many types of WPV exist, physical violence stands out for the potential harm it inflicts on healthcare workers. Disturbingly, the study highlights that such incidents are not limited to emergency healthcare settings but are rampant in PHCs, too. Type II violence, also known as client-on-worker violence, is particularly prevalent and concerning. What makes Type II violence especially alarming in Primary Healthcare Centres is the close and frequent interaction between patients and healthcare professionals in these settings. Patients may become aggressive due to frustration with long wait times, dissatisfaction with the care provided, or anxiety related to their health condition. In some cases, underlying mental health issues or medication or substance use effects can lead to unpredictable and aggressive behaviours.

Underreporting: It is noteworthy that many instances of workplace violence might not make it to official records. Healthcare professionals may sometimes choose not to report for a variety of reasons. The study highlights a need for understanding and perhaps strengthening the faith in the institutional systems designed to address workplace violence. It underscores the importance of ensuring healthcare workers feel safe, supported, and confident that their concerns will be appropriately addressed when raised.

The Varying Global Prevalence: Although WPV in PHC is undoubtedly a global issue, its prevalence differs dramatically across regions. Strikingly, rates were as high as 91% in Germany, while China reported a rate as low as 14%. Western, developed countries, particularly European and American regions, consistently recorded higher WPV prevalence rates, possibly due to more effective reporting systems.

The Consequences on Healthcare Workers: Physical violence does not just leave physical scars. It affects healthcare workers' mental and emotional health, leading to stress, anxiety, and in some cases, post-traumatic stress disorder (PTSD). The ripple effects of these incidents are vast and multi-faceted:

  • Absenteeism: Many healthcare professionals are compelled to take leave, reducing productivity. In one highlighted case, WPV events led to an astounding 3757 days of absence in a single hospital over 1-3 years (Guay & Lanctot, 2014).

  • Job Turnover: The constant threat of violence drives many passionate professionals away from the industry. There is a real concern about dedicated and experienced personnel potentially choosing to leave their profession in the PHC sector, depriving the healthcare system of valuable human resources.

  • Compromised Patient Care: With healthcare workers under duress, the quality of care they provide can be compromised, affecting patient health outcomes.

  • Economic Implications: Beyond the personal toll, there are broader financial ramifications, including potential costs from lawsuits and increased insurance premiums. The study highlighted that workplace violence incidents in just one hospital led to many absent days, with an associated cost in the billions, primarily due to reduced productivity (Guay & Lanctot, 2014).

  • Morale and Team Dynamics: Continuous exposure to such threats can significantly dampen morale. It might also influence team dynamics, with staff becoming more cautious or apprehensive in certain situations.

Addressing workplace violence in Primary Healthcare Centres requires a collaborative effort. It is essential to prioritise the safety and well-being of healthcare professionals without undermining the trust and collaboration between the healthcare providers and those they serve. Here are some potential solutions, focusing on immediate protective measures and fostering a safer environment:

  • Promoting Awareness: It is essential to keep the lines of communication open. Workshops and training sessions can educate staff about the risks they might face and the best practices for handling volatile situations.

  • Support and Counselling: Providing support systems for healthcare workers, such as counselling or debriefing sessions post incidents, can aid in mental and emotional recovery. It also communicates to the staff that their well-being is a top priority.

  • Review and Refinement: Senior officials play a pivotal role in ensuring workplace safety. Regular reviews of incidents, feedback sessions with staff, and an open-door policy can lead to the continuous refinement of safety measures in place.

  • Adopting Protective Clothing: One of the most immediate and effective solutions is adopting protective clothing tailored to healthcare environments. BitePRO® is pioneering protective wear that protects healthcare workers from physical harm without compromising their comfort and flexibility. Such clothing not only offers direct protection but also serves as a confidence booster for staff, knowing they have an added layer of safety.

The challenges presented by workplace violence in Primary Healthcare Centres are profound, but they are not insurmountable. By acknowledging the issue and taking proactive steps, we can fortify the front lines of our healthcare system. For senior officials and decision-makers, recognizing and investing in these protective measures is not just about mitigating risk but valuing and preserving the human assets of the healthcare system. As we look ahead, the vision is clear: a healthcare environment where professionals can focus solely on their mission of care, free from the threat of harm.

For those dedicated to ensuring safety in healthcare, take a moment to explore the BitePRO® clothing range and see how proactive measures are making a difference.


Lanctôt, N., & Guay, S. (2014). The aftermath of workplace violence among healthcare workers: A systematic literature review of the consequences. Aggression and Violent Behavior, 19(5), 492-501.

Yusoff, H.M., Ahmad, H., Ismail, H. et al. (2023). Contemporary evidence of workplace violence against the primary healthcare workforce worldwide: a systematic review. Human Resources for Health, 21, 82