"There is something that deals with HIV or AIDS but I am not sure how exactly it operates " (FG I).
"Yaaa ...People are always told that they need to go and test for HIV, so yes it's there " (FG1).
Occupational health and safety act
For other participants the existing health promotion policy was guided by the OHS Act. It was not a stand alone policy:
"We are guided by the OHSACT-which is a policy in itself. Apart from that, we have an HIV policy " (FG 2)
No awareness of policy
Other participants were not aware of any existing policy on health promotion in this workplace:
"I do not think all of us are aware of that policy. They come and give awareness on HIV every now and then, but they do not really discuss the policy as such " (FG I).
"I do not know of any policy in this work of mine. I suppose a policy should be known by everyone in a particular workplace. I personally have never heard of any such policy or even seen it" (FG 2).
Qualitative data from the managers showed that a health promotion policy was in place.
According to the managers the organization had a very clear policy which was based on the existing Governments OHS Act. This policy addresses all wellness issues, but specifically HIV/AIDS related issues.
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"The Occupational health and safety policy that has been developed by the company is based on the OHS act. We need to provide a safe environment for the employees. We have audits with regard to safety issues " (M1).
"Yes, we have a wellness policy which addresses HIV/AIDS. There is a document which is used for induction which covers health related issues. There is also EAP which addresses social problems, alcohol abuse, stress and depression " (M2).
From the occupational health practitioner's data it emerged that this organization had a policy on HIV/AIDS and also a policy on rehabilitation. The rehabilitation policy was for employees who abuse alcohol and/or drugs.
"Yes there are policies. One is for HIV and the other is for rehabilitation. They are mostly run by HR.
With the rehabilitation policy, if a person is an alcoholic they are referred through EAP. From here, they are then referred to the centres where they are detoxified and rehabilitated. This is initially done with the employee paying for all the expenses. After 6 months this is paid back if the employee abstains from taking alcohol. The employee gets back his leave days and money spent on the program .EAP falls
under this company."
From the employees quantitative data all 44 respondents (100%) responded to this question.
Twenty four (55%) of these 44 respondents were aware of a health promotion policy in this workplace while 20 (45%) were not aware of such a policy. Twenty one of the 24 respondents responded to the question on explaining the policy. In explaining the policy, 11 (53%)
respondents explained it as an HIV/AIDS awareness program, 5 (24%) explained it as an
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occupational health and safety policy. Other respondents gave explanation such as First aid policy and annual medical check up (9%), respectively (table 4.15).
Table 4.15: Explanation of policy in case 4 Explanation of policy
First aid policy
HIV/AIDS awareness program Back training / fitness training Health and safety policy (OHS act) Annual / general medical check-up Total
Frequency 2 11 1 5 2 2 1
Percent ( % ) 9%
53%
5%
24%
9%
1 0 0 %
Health promotion programs (activities)
From the qualitative data of the trade union representatives it emerged that there were health promotion programs in this workplace, but they lacked coordination. Two categories emerged from this data.
Targeted once off programs
The participants felt that even though the programs were in place there would always be a once-off program which targeted one problem at a time. Sometimes there would be posters just addressing that specific program:
"Yes there are programs; we had a health day here where they checked our BP, weight and eyes. But it was only for that one day, and it was the first time they did it this year" (FG 1).
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"Also, we have posters like these (pointing on the wall) where they tell us about good nutrition to raise awareness on healthy eating" (FG I).
"Once a year we have celebrations when we talk about HIV, that is during the end of the year when it is AID day. But that is only once a year. We get addressed on HIV issues on that day. " (FG 2).
"Sometimes we get health education when we are just in the queue but not as a planned session. I'll tell you one thing; this issue of health programs is not well addressed. If you come to me and say you will give me an apple, you must eat it now because you have given it to me now. They should organize this properly and say ok at such and such a time we will sit and discuss this, it will be effective. If you just
see me while I am in the queue and you tell me this type of food has vitamins and this one does not have, immediately when I walk out that door I will forget what you told me "(FG 2).
HIV/AIDS related programs
It also emerged that there were HIV/AIDS programs offered by the company, based on the OHS act:
"It's not at all like the planned sessions; it just happens that we start talking about AIDS especially when we talk about the company's health and safety act" (FG 2).
"Safety and health issues are also discussed now and then. That is related to the OHS act. Such discussions about the issues related to HIV will come up now and then when we discuss the act. That's the HIV management program that the company has "(FG 2).
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Uncoordinated health promotion programs
The other view was that the existing health promotion programs were not well coordinated, they just happened, which results in employees not being aware of them:
"Let me say this, my feeling is that we do have programs but the people who are involved in this are not doing it properly. They do not do it. We have AIDS training, there are documents, and there was a plan on who will cater for what. But the way I see it, the coordinating
committee is just dead, it's not there "
"The company had a plan to send people for HIV counselling and what have you, but those things have not been done until today. There was training on AIDS awareness which was organized. I did not hear about it before, but only a few people went there, some were even turned back. It was never revived. The program is not well coordinated".
Data from managers revealed that there was a variety of health promotion programs that existed in this workplace. The existing programs were addressing employee's health in a holistic approach in that they addressed the physical and the social problems of an employee.
The health programs were also targeting occupational risks in order to prevent disease. The following categories emerged from this data:
Disease preventive programs
The organization aimed at preventing diseases through a primary health care clinic situated on site, and conducting risk assessment:
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"We have the medical surveillance programs to identify the nature of risk and deal with it as early as possible. Periodical tests are conducted based on the nature of the risk, such as lung function tests for employees working in dust areas " (MI).
"There is a primary health care clinic on site where employees can go for any health related issue" (M2).
Programs for specific health programs
The organization offered other programs that were specific problems such as HIV/AIDS and other social programs. These were in the form of EAP and HIV/AIDS programs that the company offered:
"The company employs a social worker who works on EAP, and provides counselling for employees.
There is also a continuous HIV/AIDS program which is working very well, where employees are provided with VCT and treatment for HIV related diseases. "
The occupational health practitioner also identified the HIV/AIDS program as the existing health promotion program. Another program was the DOTS program for employees with Tuberculosis.
"Besides the EAP program, the other program is the HIV/AIDS lifestyle management program. In this program, the company takes full responsibility for the HIV positive employee. They pay for everything,
VCT, ARV, Blood tests. The employee does not pay anything. It does not matter even if you are on medical or not. The family members also do get benefits . We also have a TB DOTS program for
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employees with TB. They come to the clinic for monitoring and we do weighing and they get their treatment."
For employees' quantitative data on the existing health promotion programs, 42 out of 44 respondents (96%) responded to this question. Of these 42 respondents, 25 (60%) were not aware of any health promotion programs in this workplace, while 16 (36%) were aware of such programs. Of the 16 respondents, 7(44%) described the program as HIV/AIDS awareness program, 2 (13%) described the program as medical check-ups and blood pressure checks respectively (table 4.16).
Table 4.16: Employee description of health promotion programs in case 4 (n=16)
Description of health promotion program HIV awareness program
Health and safety working environment Back training, HIV program, safety & stress management
Training / talks about health program Cholesterol, HIV/AIDS & TB programs Eating in the workshops forbidden Participate in medical checks-up Blood Pressure, TB and AIDS Total
Frequency 7 1 1 1 1 1 2 2 16
Percent ( % ) 44%
6%
6%
6%
6%
6%
13%
13%
1 0 0 %
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When respondents were asked to identify the existing health program in their workplace from the provided list, similar programs were identified, but there were some additional ones (table 4.17).
From the trade union representatives' data it emerged that several programs were in place but some of these programs were not health promotive in nature, and some of them were not very active at this stage.
The first program that was identified was EAP. There were slightly differing views on the functioning of this program from the two focus groups. One group felt that the program was operating well but the problem is that it was not preventive in nature; it focused on solving the problems that were already there. For the other group, the feeling was that the program
structure was there but they were not convinced that it was doing what it was supposed to be doing:
"We do have EAP. It's not purely health though, but it has to do with social problems, such as financial problems. They also help you if you have family problems and they affect your work. Basically, you can go there with any problem and they can assist you wherever they can, or give you advice on where to go. The thing is, you have to go there only when you have a problem, not to prevent it. "
"About EAP, all I can say is that we do have a structure but I am not sure if it is happening. I would like to know what it's doing. Its only people who want to stop alcohol or drug abuse or have family problems that go there ".
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Participants in both groups identified the HIV /AIDS -Lifestyle management program as an existing program.
"They can assist you in that, say you work here and you have HIV virus, you can get your assistance withARVs, but not your family members, only you. They have a budget for employees with HIV. They will do anything to assist you but unfortunately, not your family members, only you".
With regard to physical fitness program, there appeared to be no formal fitness program, but employees were involved in a variety of activities to keep themselves fit.
"We do not have such a program but we make it up because we work very hard here. Also, some of us jog when we come to work to keep fit. "
"We do not have anything like a gym, but some of us are playing for a soccer team, the girls are playing in the netball team to keep ourselves fit. "
On nutrition and lifestyle program, it emerged that the organization did not have a separate program that focused on nutrition but this was addressed in the HIV lifestyle management program:
"We do not have a separate program for that, but it is covered in the HIV program, when they talk to employees about nutrition, it's part of the HIV program ".
Chronic disease management was identified as part of the primary health care services offered at the clinic:
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"The sister at the clinic makes sure that you take your TB treatment at the clinic and finish it. Also, people like me, with hypertension, can go to the clinic for a check-up ".
"People with chronic diseases go to the clinic for testing their blood laves and collect medicines. Some people collect their medicines outside the clinic "
It also emerged from the data that the organization offered counselling services through the social worker. The participants did not think of this service as stress management though.
The data from the managers showed that the managers identified programs similar to those identified by the trade union representatives. The difference was that the managers did not identify fitness programs but identified the stress management program as one of the programs which is offered to the executive members of the organization.
The occupational health nurse also identified similar programs as identified by the previous participants. According to the occupational health nurse though, the counselling services offered by the social worker form part of the stress management for employees.
With regard to the women's health program some issues were raised by the occupational health nurse and the trade union representatives. According to the trade union representatives,
women's needs are not catered for and they have to go outside the workplace if they need help with their health related problems.
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"Women's health program— no, because they have to go to outside this place to see doctors. Sometimes this creates problems with their supervisors. They are not catered for properly for their specific
problems "
The OHP also identified this problem, but she attributed it to the fact that this organization used to have mostly male employees and there was no need for programs pertaining to women's health. According to the OHP there are such programs as family planning programs in the pipeline.
In identifying the existing health promotion programs from the given options, 42 respondents (96%) responded to the question. Of the 38 respondents, all 38 (91%) identified HIV/AIDS program as an existing program in this workplace, 25 (60%) identified the EAP, and only 1 (2%) identified the weight control program (table 4.17).
Table 4 . 1 7 : Health programs identified by employees in case 4 . ( n = 4 2 ) Identified programs
Employee assistance program HIV/AIDS program
Physical fitness program
HIV/AIDS program, physical fitness & stress management program
HIV/AIDS program & weight control program HIV/ AIDS program & stress management program Employees assistance & HIV/AIDS program
weight control program &chronic disease management Total
Frequency 1 7 2 4 1 2 24 1 4 2
Percent ( % )
2%
17%
5%
10%
2 % 5%
5 7 % 2%
1 0 0 %
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Involvement in health promotion programs
From the trade union representatives' data it emerged that there was very limited or no
involvement in health promotion programs. There was, however, an indication that if relevant health promotion programs were in place, there would be participation or involvement. The following categories on involvement in health promotion program emerged:
Limited involvement
"Yes, some of us went to the health day. To tell you the truth, other than that and involvement in HIV committees, not really "
"Yes, some. I am involved in a soccer team here at work. We only play when necessary though. Ah, yes there is also a netball team for girls but it also plays once, if there are tournaments. All sports are open for everyone but some people are just lazy".
Lack of time and resources
Some participants felt that the type of work that they were doing did not give them enough time to get involved in these, but they might also get involved if the programs were in place.
"We do not have enough time to go there because of the work we do. If they were available we would go, but we do not have such things as the fitness centre here ".
In the quantitative data from employees 43 out of 44 respondents (98%) responded to this question. Of these 43 respondents, 37 (86%) were not involved in any of the health promotion
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programs. The other 6 (14%) respondents were involved in some of the health promotion programs.
Of the 6 respondents who were involved in health promotion programs, only 4 (67%) could identify the programs they were involved in. Two out of 4 respondents (50%) were involved in health and safety programs, while the remaining 2 (50%) respondents were involved in sports activities.
Importance of health promotion programs
All the trade union representatives felt that health promotion programs in the workplace were
"very important". The reasons given for this response were that having healthy employees will benefit both the employees and the organization:
"Yes, the organization needs healthy employees to increase production. We say so because if employees are not healthy, it can affect production negatively. "
"HP is very important for us and our members. We believe that employees should have regular checkups, so that they can stay healthy. For example if you are working in a place with chemicals, they affect your lungs, also if you are in a noisy area you must have your ears tested early so that they can pick up hearing loss ".
Availability of Infrastructure
According to both managers the company provided support to their employees in terms of health related programs. This support was provided in the form of on-site clinic and training on
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health related issues. The clinic was identified as one of the measures taken by the company to provide primary care for employees not on a medical aid scheme.
"There is an on-site clinic for all primary health care needs. People are sent to hospitals for treatment if they develop occupational illnesses ".
'We provide training on HIV/AIDS for our employees. In this manner we increase their awareness and therefore prevent occurrence of the disease. They are also trained on safety issues, on how to render their workplace a safe working environment"
Both managers agreed that there are enough resources for health promotion programs in this company financially, and in term of management support and space. They also agreed that it was the organization's duty as an employer to put health promotion programs in place.
From the employees' data, all 44 respondents (100%) responded to this question. Seventeen (39%) agreed to the statement "There are enough resources for health promotion programs in this workplace ", while 5 (11%) respondents said they strongly agreed with the statement. Eight (18%) said they disagreed, while 10 (23%) said they were undecided on this statement (table 4.18).
Table 4.18: Employees' views on the availability of health promotion resources in case 4 ( n = 4 4 )
Response
strongly disagree disagree
undecided agree
strongly agree T o t a l
F r e q u e n c y 4 8 10 17 5 4 4
P e r c e n t ( % ) 9 % 1 8 % 2 3 % 3 9 % 1 1 % 1 0 0 %
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