Keywords
health professionals
organized labor
community Health centers
rural health
labor relations
interprofessional partnership
South Africa
How to Cite
Abstract
Introduction
Collaborative relationships between health professionals and organized labor are essential for securing safe, effective, and sustainable healthcare delivery in rural community health centers (CHCs). However, challenges such as dysfunctional union representation, labor disputes, and poor communication undermine these partnerships, affecting service quality and staff well-being.
Purpose
This mixed-methods study aimed to explore the lived experiences of health professionals and trade unions regarding collaboration in rural and semi-rural CHCs in South Africa. It sought to identify barriers and enablers to positive collaboration, elucidate the role of unions, and develop evidence-based guidelines and a conceptual model to strengthen sustainable partnerships.
Methods
A sequential explanatory mixed-methods design was employed. Quantitative data were collected through surveys evaluating communication, leadership, conflict management, and discrimination among health professionals. These data were analyzed using descriptive statistics to summarize response patterns. Qualitative data were gathered through ten in-depth interviews and focus group discussions followed by manual thematic analysis focusing on union representation, commitment, and compliance with labor legislation. Data integration was performed using a meta-inference approach to guide model development.
Results
Findings revealed that unclear union representation, limited engagement of health professionals, and non-compliance with labor laws were key barriers to effective collaboration. Positive collaboration was facilitated by trust-based leadership, open communication, and inclusive training initiatives. The study culminated in the development of the Interprofessional Union Collaboration Partnership (IPCUP) model, which integrates Maslow's Hierarchy of Needs, Watson’s Theory of Human Caring, Interprofessional Competencies (IPEC), and contemporary Labor-Management Partnership practices.
Conclusion
Improving collaboration between health professionals and organized labor requires systemic interventions addressing communication breakdowns, leadership gaps, and weak policy enforcement. The IPUCP model model provides a structured, evidence-based framework designed to rebuild trust, strengthen workplace safety, and promote sustainable collaboration to foster mutually secure and equity-driven rural CHCs.
References
Ahmed, S. K. (2024). The pillars of trustworthiness in qualitative research. Journal of Medicine, Surgery, and Public Health, 2, Article 100051. https://doi.org/10.1016/j.glmedi.2024.100051
Alamgir, F., & Banerjee, S. B. (2019). Contested compliance regimes in global production networks: Insights from the Bangladesh garment industry. Human Relations, 72(2), 272–297. https://doi.org/10.1177/0018726718760150
Bhaumik, S., Moola, S., Tyagi, J., Nambiar, D., & Kakoti, M. (2020). Community health workers for pandemic response: A rapid evidence synthesis. BMJ Global Health, 5(6), Article e002769. https://doi.org/10.1136/bmjgh-2020-002769
Braun, V., & Clarke, V. (2021). Can I use TA? Should I use TA? Should I not use TA? Comparing reflexive thematic analysis and other pattern-based qualitative analytic approaches. Counselling and Psychotherapy Research, 21(1), 37–47. https://doi.org/10.1002/capr.12360
Brown, P. R., & Stark, A. (2022). Policy inaction meets policy learning: Four moments of non-implementation. Policy Sciences, 55(1), 47–63. https://doi.org/10.1007/s11077-021-09446-y
Creswell, J. W., & Creswell, J. D. (2017). Research design: Qualitative, quantitative, and mixed methods approaches (5th ed.). Sage Publications.
Creswell, J. W., & Plano Clark, V. L. (2023). Revisiting mixed methods research designs twenty years later. Journal of Mixed Methods Research, 17(1), 21–36. https://doi.org/10.1177/15586898221133445
Department of Health. (2011). A long and healthy life for all South Africans: NDoH Annual Report 2010/11. National Department of Health. https://www.gov.za/documents/national-department-health-annual-report-201011
Emerson, R. W. (2021). Convenience sampling revisited: Embracing its limitations through thoughtful study design. Journal of Visual Impairment & Blindness, 115(1), 76–77. https://doi.org/10.1177/0145482X21990927
Farrenkopf, B. A., & Lee, C.-W. (2019). Mapping health workforce development strategies across key global health agencies: An assessment of objectives and key interventions. Health Policy and Planning, 34(6), 461–468. https://doi.org/10.1093/heapol/czz062
Forza, C., & Sandrin, E. (2023). Surveys. In Research methods for operations and supply chain management (pp. 76–158). Routledge.
Gauthier, R. P., Pelletier, C., Carrier, L.-A., Dionne, M., Dubé, È., Meyer, S., & Wallace, J. R. (2023). Agency and amplification: A comparison of manual and computational thematic analyses by public health researchers. Proceedings of the ACM on Human-Computer Interaction, 7(GROUP), 1–22. https://doi.org/10.1145/3567556
Goodluck, M. J., Okorie, V. N., & Oyewole, A. O. (2025). Effects of inadequate compliance with health and safety regulations in the Nigeria construction industry. International Journal of Educational Benchmark, 25(1), 45–58.
Grove, S. K., & Gray, J. R. (2019). Understanding nursing research: Building an evidence-based practice (1st South Asia ed.). Elsevier Health Sciences.
Karadencheva, S. (2025). Integrating Maslow's hierarchy of needs into contemporary management practice. Journal of Science: Lyon, 63, 50–55.
Karuga, R. N. K. (2024). Factors influencing community health committees in performing their community participation roles in a devolved health system. Kenyatta University.
Kennedy, I. (2022). Sample size determination in test-retest and Cronbach alpha reliability estimates. British Journal of Contemporary Education, 2(1), 17–29. https://doi.org/10.20431/2347-3129.0201003
Labor Research Service. (2019). Bargaining benchmarks: A resource for negotiators in South Africa. LRS. https://www.lrs.org.za/resource/bargaining-benchmarks-2019/
LeBan, K., Kok, M., & Perry, H. B. (2021). Community health workers at the dawn of a new era: 9. CHWs’ relationships with the health system and communities. Health Research Policy and Systems, 19(Suppl 3), Article 116. https://doi.org/10.1186/s12961-021-00756-3
Lines, T., Burdick, C., Dewez, X., Aldridge, E., Neal-Williams, T., Walker, K., Akhlaghi, H., Paul, B., & Taylor, D. M. (2022). Nature and extent of selection bias resulting from convenience sampling in the emergency department. Emergency Medicine Journal, 39(4), 325–330. https://doi.org/10.1136/emermed-2020-210356
Louche, C., Staelens, L., & D’haese, M. (2020). When workplace unionism in global value chains does not function well: Exploring the impediments. Journal of Business Ethics, 162(2), 379–398. https://doi.org/10.1007/s10551-018-3995-1
Maake-Malatji, M. I. (2023). The role of collective bargaining in business sustainability and the future of work: A South African perspective (Unpublished doctoral dissertation). University of Pretoria.
Maphumulo, W. T., & Bhengu, B. R. (2020). Perceptions of professional nurses regarding the National Core Standards tool in tertiary hospitals in KwaZulu-Natal. Curationis, 43(1), 1–9. https://doi.org/10.4102/curationis.v43i1.2171
Mausz, J., Donnelly, E. A., Moll, S., Harms, S., & McConnell, M. (2022). Mental disorder symptoms and the relationship with resilience among paramedics in a single Canadian site. International Journal of Environmental Research and Public Health, 19(8), Article 4879. https://doi.org/10.3390/ijerph19084879
National Department of Health. (2011). Primary Health Care Re-engineering Policy. Government Printer.
National Department of Health. (2017). District Health System planning and monitoring framework. Government Printer.
National Department of Health. (2020). National Department of Health Annual Report 2019/20. Government Printer.
Rayner, C., & Lewis, D. (2020). Managing workplace bullying: The role of policies. In Bullying and harassment in the workplace (pp. 497–519). CRC Press.
Republic of South Africa. (1993). Occupational Health and Safety Act No. 85 of 1993. Government Gazette.
Republic of South Africa. (1995). Labour Relations Act No. 66 of 1995. Government Gazette.
Republic of South Africa. (2003). National Health Act No. 61 of 2003. Government Gazette.
Republic of South Africa. (2024). National Health Insurance Act No. 20 of 2023. Government Gazette.
Sajko, R. L. (2024). On survey questionnaire testing. Central European Journal of Paediatrics, 20(2), 112–120.
Sakaria, N. E. (2022). Access to justice for black women in South Africa: A feminist social justice perspective (Master's thesis). University of Pretoria.
Saridi, M., Panagiotidou, A., Toska, A., Panagiotidou, M., & Sarafis, P. (2021). Workplace interpersonal conflicts among healthcare professionals: A survey on conflict solution approach at a General Hospital. International Journal of Healthcare Management, 14(2), 468–477. https://doi.org/10.1080/20479700.2019.1658162
Serapelwane, M. G., & Manyedi, E. M. (2022). Unfair labour practice on staff in primary health care facilities, North West province, South Africa: A qualitative study. Curationis, 45(1), Article e2171. https://doi.org/10.4102/curationis.v45i1.2171
Songstad, N. G., Rekdal, O. B., Massay, D. A., & Blystad, A. (2011). Perceived unfairness in working conditions: The case of public health services in Tanzania. BMC Health Services Research, 11(1), Article 34. https://doi.org/10.1186/1472-6963-11-34
Sürücü, L., & Maslakci, A. (2020). Validity and reliability in quantitative research. Business & Management Studies: An International Journal, 8(3), 2694–2726. https://doi.org/10.15295/bmij.v8i3.1540
Tuval-Mashiach, R. (2021). Is replication relevant for qualitative research? Qualitative Psychology, 8(3), 365–377. https://doi.org/10.1037/qup0000214
Ugwu, C. N., Ugwu, O. P.-C., Alum, E. U., Eze, V. H. U., Basajja, M., Ugwu, J. N., Ogenyi, F. C., Ejemot-Nwadiaro, R. I., Okon, M. B., & Egba, S. I. (2025). Sustainable development goals (SDGs) and resilient healthcare systems: Addressing medicine and public health challenges in conflict zones. Medicine, 104(7), Article e41535. https://doi.org/10.1097/MD.0000000000041535
Van Ginkel, J. R., Linting, M., Rippe, R. C., & Van Der Voort, A. (2020). Rebutting existing misconceptions about multiple imputation as a method for handling missing data. Journal of Personality Assessment, 102(3), 297–308. https://doi.org/10.1080/00223891.2018.1530662
World Health Organization. (2022). World health statistics 2022: Monitoring health for the SDGs. WHO Press. https://www.who.int/publications/i/item/9789240051157
Wright, L. K., Jatrana, S., & Lindsay, D. (2024). Remote area nurses' experiences of workplace safety in very remote primary health clinics: A qualitative study. Journal of Advanced Nursing, 80(8), 3298–3308. https://doi.org/10.1111/jan.16012
Younas, A., & Durante, A. (2023). The logics of and strategies to enhance generalization of mixed methods research findings. Methodology, 19(2), 170–191. https://doi.org/10.5964/meth.10405
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