WORKPLACE SAFETY, UNION ENGAGEMENT, AND INTERPROFESSIONAL COLLABORATION IN RURAL SOUTH AFRICAN COMMUNITY HEALTH CENTRES: A SEQUENTIAL EXPLANATORY MIXED-METHODS STUDY

Abstract

Introduction: Interprofessional collaboration is essential for safe and effective primary health care delivery, particularly in rural and semi-rural Community Health Centers (CHCs). This study explored health professionals’ experiences of workplace safety, interprofessional collaboration, and organised labour engagement in rural and semi-rural CHCs across 3 South African provinces. Methods: We used a sequential explanatory mixed-methods design grounded in pragmatism. In the quantitative phase, purposive non-probability sampling was used to recruit health professionals from 6 CHCs across Gauteng, Mpumalanga, and North-West provinces. Sixty-nine questionnaires were distributed, of which 42 completed questionnaires were analysed, yielding a response rate of 61%. Results: Quantitative findings indicated that 69% of respondents linked staff shortages to workplace conflict, 85.7% reported that shortages of equipment and resources strained professional relationships, and 88.1% reported poor interprofessional relations contributing to an insecure working environment. Qualitative findings explained these patterns by illustrating how unsafe infrastructure, inadequate staffing, uneven skill mix, poor communication, professional hierarchies, and limited union visibility collectively undermined workplace safety and interprofessional collaboration. Integrated analysis identified 3 interrelated themes: resource deficits undermining safe collaboration, fragmented interprofessional relationships and status-based divisions, and weak union engagement. Conclusion: Workplace safety and interprofessional collaboration in participating rural CHCs were shaped by interacting material, relational, and governance challenges. Strengthening collaboration requires sustained investment in staffing, infrastructure, communication systems, leadership practices, and effective labour-management engagement. These findings informed the conceptual development of the Interprofessional Union and Collaborative Partnership (IPUCP) framework for rural CHCs.