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Sexual Harassment Whistleblowing in the Uganda Health Workforce By Sexual Harassment Whistleblowing in the Uganda Health Workforce By Erica Virginia Brierley A Master’s Paper submitted to the faculty of the University of North Carolina at Chapel Hill in partial fulfillment of the requirements for the degree of Master of Public Health in the Public Health Leadership Program Chapel Hill Fall 2018 @ 2018 Erica Virginia Brierley ALL RIGHTS RESERVED ii ACKNOWLEDGEMENTS This Master’s Paper was supported by IntraHealth International, an international organization whose mission is to improve the performance of health workers and strengthen the systems in which they work. As a 2018 Summer Fellow, not only did they provide me the opportunity and patience to spend a generous time researching this topic, but they also made crucial documents available to me. This has allowed for this paper to be as informed and detailed as it is. I appreciate all staff members, organizations, and participants for the time and work they have dedicated to researching this topic. I would particularly like to acknowledge and thank Constance Newman and David Potenziani, my supervisors while at IntraHealth International, who continue to work with the Uganda Ministry of Health on this challenge of sexual harassment in the Uganda health workplace. I thank Karine Dubé, DrPH and Dorothy Cilenti, DrPH, MPH, MSW at University of North Carolina at Chapel Hill for taking the time out of their busy schedules to read and provide feedback on this paper on such short notice. iii ABSTRACT Erica Virginia Brierley: Sexual Harassment Whistleblowing in the Uganda Health Workforce (Under the direction of Karine Dubé) This paper serves as a detailed review of sexual harassment and whistleblowing behaviors to summarize the challenges of addressing sexual harassment in the Uganda health workforce. The whistleblowing pathway is a complex process with four main decision-making steps: wrongful act, cost-benefit analysis of taking action, choice of reporting system, and reaction to outcomes. Intangible and structural reasons to or not to whistleblow are composed of individual, organizational, stimulus, and cultural factors. These are considered at each step of the decision- making process. The negative effects of intimidation and possible retaliation are heightened by the sensitive, and even taboo, nature of sexual harassment in Ugandan society. The conceptual understanding and interpretation of what constitutes sexual harassment, as well as how it is addressed in policies plays a major role in whistleblowing efforts. Clearer definitions, standardized sanction recommendations can help support and improve sexual harassment conditions and whistleblowing behaviors in Uganda’s healthcare workforce. iv v TABLE OF CONTENTS LIST OF FIGURES………………………………………………..……………………. vii LIST OF ABBREVIATIONS………………………………………………………….. viii CHAPTER 1: INTRODUCTION………………………………………………………… 1 Section 1.1: A Universal Public Health Problem………………………………… 1 Section 1.2: Speaking Out………………………………………………………… 2 Section 1.3: Uganda & Its Actors……………………………………………….... 3 Why Uganda Focused…………………………………………………….. 3 Section 1.4: Moving Forward…………………………………………………….. 4 CHAPTER 2: SEXUAL HARASSMENT BACKGROUND……………………………. 6 Section 2.1: Sextortion……………………………………………………………. 8 CHAPTER 3: WHISTLEBLOWING BACKGROUND………………………………... 15 Section 3.1: Wrongful Act…..…………….…………………………………….. 15 Section 3.2: No Action Taken……..………...………………………...………… 17 Intangible Reasons………………............................................................. 17 Structural Reasons………………………………………......................... 20 Section 3.3: Take Action…………………..…………………………………….. 24 Informal Whistleblowing………………………………………………... 25 Organization’s Reaction…………………………………………………. 28 CHAPTER 4: POLICIES & PRACTICE……………………………………………….. 32 Section 4.1: Formal Whistleblowing……………………………………………. 31 Section 4.2: Options & Trust in the Reporting System ....……….……………... 37 Sexual Harassment Policy Definitions…………………………………. 40 vi Whistleblowing Protection Policy Definitions…….……………………. 44 Section 4.3: Sanctions……………………………..…………………………….. 47 CHAPTER 5: RECOMMENDATIONS………………………………………………... 53 Section 5.1: Policy Implications……………………………………………........ 53 Section 5.2: Table Summary of Policy Recommendations…………………....... 58 APPENDIX: Wheels & Models ……………………………………….………………... 62 Figure 1 - Duluth Model: Power & Control Wheel…………....………………………... 62 Figure 2 - Family Violence Prevention Fund: Power & Control Wheel….....………….. 63 Figure 3 - Whistleblowing Models……………………………………………………… 64 Figure 4 - The Social Information Processing Model (SIP).............................................. 65 Model of Whistleblowing Responses………………………...…………………………. 66 Figure 5 - Miceli et al. Whistleblowing Model…………………………………. 66 Figure 6 - IntraHealth International Whistleblowing Pathway………………….. 67 REFERENCES…………………………………………………………………...……... 68 vii LIST OF FIGURES FOUND IN APPENDIX: WHEELS & MODELS Figure 1 - Duluth Model: Power & Control Wheel…………....………… Figure 2 - Family Violence Prevention Fund: Power & Control Wheel….....…. Figure 3 - Whistleblowing Models……………………………………… Figure 4 - The Social Information Processing Model (SIP)............................. Figure 5 - Miceli et al. Whistleblowing Model…………………… Figure 6 - IntraHealth International Whistleblowing Pathway…………. viii LIST OF ABBREVIATIONS Afcode Agenda for Community Development EA 2006 Uganda Employment Act 2006 (Sexual Harassment) ER 2012 Uganda Employment (Sexual Harassment) Regulations 2012 FVPF Family Violence Protection Fund Guideline for Mainstreaming Gender Equality into Human Resources for Health GGE 2015 Management IAWJ International Association of Women Judges MDGF Millennium Development Goal Fund MDG 3 Millennium Development Goal: Gender Equity MOHRUMin Ministry of Health-Republic of Uganda NDVH (U.S.) National Domestic Violence Hotline OECD Organization for Economic Cooperation and Development PIGR Policy Implementation Guidelines on the Prevention and Response of Sexual 2017 Harassment in the Health Sector 2017 PS 2005 Code of Conduct and Ethics for Uganda Public Service 2005 RAINN (U.S.) Rape, Abuse & Incest National Network SHFPP Sexual Harassment Focal Point Person SIP Model Social Information Processing Model TAWJA International Association of Women Judges of Tanzania UNDP United Nations Development Programme WP 2010 Uganda Whistleblower Protection Act 2010 WPAC WO WORLD Policy Analysis Center ix CHAPTER 1. INTRODUCTION Section 1.1: A Universal Public Health Problem Sexual harassment in the workplace has always been globally pervasive. Health workers are particularly susceptible to sexual harassment. In recent reports of sexual harassment experienced by nurses, it ranges from 7% in Rwanda to 91% in Israel (Newman et al., 2017). These numbers are more than likely underestimated, as sexual harassment is underreported (Maass et al., 2013). Sexual harassment has a high impact on public health as it can result in trauma that has short-term and long-term health impacts of the victims, both mentally and physically. Trauma from harassment can result in increased stress, anxiety, depression, and in some cases, post-traumatic stress disorder or suicide. It can also result in unsafe abortions of unwanted pregnancies and sexually transmitted infections (Newman et al., 2017). In the workforce, sexual harassment has professional and economic consequences on the victim, such as punishment and retaliation by a supervisor. This can include negative reviews of the victim’s job performance, punitive transfers to other locations or departments, demotion, and delayed or missed salaries. This significantly erodes and costs a victim’s opportunities for career and financial growth, which can perpetuate the need for a victim to stay in the harassing and toxic work environment longer. It can also present challenges in the victim’s personal life, such as the quality of life in the home and family growth. Sexual harassment also can negatively affect work productivity, quality, office morale, and team relationships. This has consequences on the victim and team performance, but also the quality of service and other outputs that the organization produces. When those services and outputs are related to healthcare services, it has a ripple effect on the 1 greater public’s health; which makes sexual harassment in the health workforce a particularly important concern for the general public and policymakers who have a responsibility to the general public. Section 1.2: Speaking Out Over the past decade, largely due to the internet and social media, there has been a surge in women reporting and speaking up about sexual harassment in the workplace (XYonline, 2018). The American #MeToo and the French #BalanceTonPorc movements have fueled a new discussion and debate about how to not only prevent, but also encourage the reporting of sexual harassment before it grows. This early identification may help prevent sexual harassment from impacting nurses’ livelihoods, mental and physical safety, and the quality of health-care they provide. In any country, tackling sexual harassment and encouraging the reporting of impropriety, also known as whistleblowing, will encounter societal and cultural norms informing what behavior is wrongful or persecution-worthy; organizational tolerance impacting the enforcement of employment sexual harassment acts and regulations; stimulus factors such as frequency and severity of harassment; and individual perception of the accessibility, support, and risk of whistleblowing. Since sexual behavior and sexual violation of
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