On-site safety practices and knowledge in deathcare work: a phenomenological account of the lived-experiences of deathcare workers in Ghana

Abstract

Background

While deathcare services in developed countries are provided by well-trained, adequately resourced professionals, the industry in Sub-Saharan Africa (SSA) is characterized by minimal training, apprenticeship, and severe resource constraints. Consequently, workers in SSA often lack knowledge of industry policies, fail to adhere to proper personal protective equipment (PPE) protocols, and maintain poor personal and hand hygiene. Therefore, this study explored the knowledge, on-site safety practices, and experiences of deathcare workers in selected facilities within the Central and Western North regions of Ghana.

Methods

Using a 10-item interview guide and observation checklists, we collected data from 35 participants selected using purposive sampling method. We employed a realistic phenomenological design and observational analysis to interpret the findings.

Results

Deathcare workers have limited knowledge of industry regulations designed to protect their health and safety. On-site practices are inconsistent with the Ministry of Health (MoH), Ghana, Occupational Health and Safety (OHS) and Infection Prevention and Control (IPC) guidelines. Specifically, workers fail to use PPE correctly, and their hand and personal hygiene practices do not conform to MoH standard operating procedures. These workers engaged in inappropriate handling of dead bodies risking exposure to infection.

Conclusions

These deathcare workers have very limited knowledge required to provide safe deathcare services and were unable to advocate for their rights under existing policy guidelines. The MoH must develop a policy to standardize the recruitment of deathcare workers, while training current workers for protection.

Supplementary Information

The online version contains supplementary material available at https://doi.org/10.1186/s12913-026-15073-1.

Background

Deathcare workers, including mortuary attendants and funeral directors, are integral members of the healthcare profession. They must possess the requisite qualifications, knowledge, skills, and personal attributes to ensure efficient and safe delivery of deathcare services [1–4]. To guarantee optimal workplace safety, these personal factors must be complemented by onboarding and ongoing training, the provision of personal protective equipment (PPE), adequate hygiene facilities, and supportive monitoring and supervision [5–7]. In developed nations, including New Zealand, Germany, Australia, the United Kingdom, and the United States, the deathcare industry is characterized by licensed, well-resourced professionals who deliver services consistent with the International Labour Organisation’s (ILO) decent work agenda [8–12]. In contrast, the deathcare industry in Sub-Saharan Africa (SSA) is marked by workers who are minimally trained or trained under apprenticeship, severely under-resourced, and poorly supervised on the job [13, 14]. Studies conducted among deathcare workers in SSA [15–20] indicate poor knowledge of industry policies, failure to adhere to proper PPE usage, inadequate hand and personal hygiene, and inappropriate manipulation of dead bodies during embalmment.

The deathcare industry in Ghana mirrors that of most SSA countries [16–19]. For instance, the industry in Ghana like most SSA countries is largely dominated by minimally educated personnel who have no formal education [16, 21–23], who often work under conditions that expose them to significant safety hazards [16–19]. Although research on African deathcare workers remains limited, existing evidence [16, 21–23] suggests that facility working conditions and safety practices are equally sub-optimal. For example, formaldehyde, a chemical hazard banned due to its high cancer risk, remains widely used preservative in Ghana’s deathcare industry [16, 18, 19]. Furthermore, workers face biological threats by handling human remains with bare hands and walking barefoot in such deathcare facilities [16]. Deathcare workers also encounter significant psychological hazards that threaten their health and well-being. For instance, a lack of effective coping strategies, limited social support, and emotional distress are strongly linked to burnout among these workers [24–26]. Psychological factors, including workload, ethical dilemmas, exposure to suffering, end-of-life situations, limited autonomy, and inadequate social support, influence burnout among deathcare workers [24–26]. Accordingly [25], to cope with recurrent exposure to bereavement, trauma, and grief, deathcare workers employ sustained emotional regulation, self-protective measures, and deliberate self-concealment, often under stigmatized or institutionally unsupported conditions.

Though research interest in this industry is growing in Ghana, there are more to do. For instance, existing literature sowed that Dartey et al. investigated ergonomic [17], biological [18] hazards, and duties and job requirements of 19 mortuary attendants, while Botha et al. [16] explored health and safety hazards among 16 mortuary attendants. However, these studies did not include funeral directors, who also provide essential deathcare services. Currently, three key policies regulate and protect deathcare workers on the job: the Infection Prevention and Control (IPC) Guideline, the Occupational Health and Safety (OHS) Policy Guideline for healthcare workers, and Ghana’s Labour Law. To our knowledge, apart from Botha et al. [16], no study has explored the knowledge of deathcare workers regarding safety regulations in Ghana. There is a clear need for further research into the lived experiences of these professionals. Consequently, this study aims to explore the knowledge and on-site safety practices and experiences of deathcare workers in selected deathcare facilities in the Central and Western North Regions, Ghana.

Materials and methods

Research design

This study employed a qualitative realistic phenomenological (RP) design, supplemented with non-participant observation, to explore the knowledge, workplace safety practices, and experiences of deathcare workers in selected facilities in Ghana’s Central and Western North Regions. The study was guided by two research questions: (1) What are the experiences of deathcare workers regarding workplace policies and regulations? and (2) What are the on-site safety practices of deathcare workers?

The RP design was selected because it facilitates an in-depth exploration of lived experiences, accommodates small samples (35), integrates interview and observational data, and emphasizes reflexivity and researcher bracketing [27, 28]. For example, work and safety practices were observed from a distance without interfering with routine activities of the workers. Four researchers recorded observations in field notes, while reflexive journals were maintained throughout the study to document assumptions, beliefs, and potential biases. To ensure bracketing, the research team held regular discussions, critically reflected during data collection and interpretation in an attempt to minimize the influence of their personal perspectives on the study. Data triangulation was achieved by integrating interview and observation data and comparing findings across workers, managers, public and private facilities [27, 28].

Study area

The study was conducted across two regions of Ghana: Central and Western North. Three facilities were included: two in the Western North Region (facilities A and B) and one in the Central Region (facility C). Facility A is a government-owned and provides only mortuary services, while facilities B and C are privately owned that provide both mortuary and funeral services [29–31]. There is limited information regarding the health and safety practices of private mortuary and funeral facilities within the Central and Western North regions [16]. For instance, facility frequently receives a high volume of death cases, including those from neighbouring Ivory Coast [29]. Previous studies on mortuary facilities in Ghana’s Western Region identified the region’s proximity to Ivory Coast as a key factor for facility choice [16, 32]. These studies further indicate that mortuary workers in the region experience high workloads, burnout, and increased risk of infection.

Sampling

Maximum variation sampling was used to select public and private facilities across the two regions [27, 28]. Of the 38 identified deathcare workers [29–31], 32 (84%) participated through total population sampling, while six workers (16%) were excluded because they were unavailable during data collection. The final sample comprised 21 males (65.6%) and 11 females (34.4%). Participants included mortuary attendants and funeral directors, the most common categories of deathcare workers in Ghana [16, 32]. To enhance triangulation, one manager from each facility was also recruited. Data collection was conducted between February 10, 2024, and August 23, 2024.

Inclusion criteria

Must be a permanent or casual employee, available, and willing to participate.

Exclusion criteria

Reasons for exclusion included unavailability or leave during data collection, refusal to provide informed consent, emotional distress, poor health, volunteer status, and lack of psychological or mental readiness (e.g., intoxication).

Recruitment

Following approval from facility heads, supervisors introduced the research team to the workers, but had no further involvement in recruitment or data collection. Researchers approached participants directly during work breaks or periods of low activity. To minimize perceived coercion, supervisors were not informed of interview schedules or locations. Each participant received a lunch pack after completing the interview.

Instruments

Data were collected using semi-structured interview guides and an observation checklist, adapted from previous studies conducted in Ghana and elsewhere [16–19, 33–35]. The instruments were reviewed by occupational health and safety experts and experienced environmental health officers and subsequently pretested to ensure relevance and clarity.

A 10-item interview guide was used, it was divided into two parts: Part 1 collected background information on deathcare workers (age, sex, education level, and years of experience), and Part 2 addressed awareness of regulatory policies, on-site safety practices, and workers’ experiences. Sample items included, “What does the Infection Prevention and Control Policy Guideline require of you?” “How does the Occupational Health and Safety Policy Guideline protect you as a deathcare worker?”, and “What do labour laws stipulate regarding your responsibilities and those of your manager?” Furthermore, the observation checklist assessed on-site safety practices and the working environment, including “personal hygiene, the handling of remains, the availability and use of PPE, water supply, and availability of air conditioners.”

A separate nine-item, two-part interview guide explored manager demographics and responsibilities towards workers’ safety. Each interview lasted 30 to 45 min and occurred during work breaks, to prevent workflow disruption. Observations of work practices took place during embalming, body preparation for public viewing, and release of bodies to relatives (see Appendix A). To ensure confidentiality and protect workers from perceived coercion, supervisors were not informed of interview times or venues, and audio recordings were accessible only to the research team. Although interviews were conducted on-site, the specific locations ensured privacy of the workers.

Ethical approval and consent to participate

Ethical approval was obtained from the Institutional Review Board of the 37 Military Hospital, Accra (37MH-IRB/PhD/IPN/817/23). Written and verbal informed consent were obtained from all participants prior to data collection. The study also adhered to the Declaration of Helsinki (7th edition) [36] and the Consolidated Criteria for Reporting Qualitative Research (COREQ). A clinical psychologist was available throughout data collection to provide support to participants and researchers.

Pre-testing

The instruments were pretested with seven deathcare workers (four mortuary attendants and three funeral directors) at a private facility (Facility Z) in one of the Municipalities within Western Region of Ghana. Additionally, we conducted an inter-rater reliability test for assessment from three Environmental Health Officers. The ratings improved from 57% to 89% [27, 28]. The officers rated the items (1–10, where 10 was the highest) for their suitability and whether the items captured the domains or contents we were attempting to measure.

Analysis

Data collection and analysis were conducted concurrently using a four-stage realistic phenomenological approach [27, 28]. To ensure ethical compliance, facility managers and the families of the deceased provided consent for observations, and a clinical psychologist was present to provide support. No video or photography was permitted; only note-taking was allowed. At each facility, data were collected from workers before supervisors, and both datasets were analysed together. In the first stage, audio recordings were transcribed verbatim and compared with field notes. Observational notes were cross-referenced with all data sources, including public and private facilities. Interview and observational data were cleaned and analysed separately. Audio recordings and field notes were iteratively compared to refine interview transcripts, while observational data underwent further examination [27, 28]. Additionally, all names inadvertently mentioned during interview were anonymized to ensure confidentiality (Table 1). This stage was conducted by three authors. In stage two, the interview and observational data were integrated into a single transcript. This transcript was cross-referenced with audio recordings and field notes to ensure accuracy and identify themes consistent with the study’s objectives.

Table 1.

Demographic characteristics of participants

Variable		Frequency
Gender	Male Female	23 12
Age	20–30 31–40 41–50 51–60	2 18 12 3
Level of formal education	Primary School Middle School/JHS SHS Diploma Degree	5 6 21 2 1
Years of experience	2-5yrs 6-10yrs 11yrs and above	10 20 5
Ownership	Public Private	7 28

*JHS – Junior High School; SHS – Senior High School

At stage three, three authors identified and developed initial codes using a coding book; coding continued until saturation was attained [27, 28]. Five authors conducted collaborative coding through the following steps: they read the transcripts multiple times, documenting initial reflections, recurring ideas, and unexpected patterns in analytical memos. Guided by the study’s objectives, they developed initial codes directly from the raw data. To ensure consistency, accuracy, and clarity, these codes were labelled, defined, and subjected to inclusion and exclusion criteria. The strategy was tested on a small data subset, leading to the creation, merger, and refinement of codes. Subsequently, the codes were categorized into themes and subthemes. The five coders compared their results, reconciling differences through consensus. Finally, the codebook reached stability when no further codes, themes, or insights emerged. Thematic data analysis was conducted using NVivo 14 [37]. At stage four, three authors established the phenomenon’s primary structures by providing an exhaustive summary. Furthermore, these authors supervised the entire data processing and analysis to ensure the authenticity and credibility of the findings. See Fig. 1 for a summary of the key methodological procedures applied.

Fig. 1.

Flow diagram of procedures (pre-testing, data collection, and data analysis)

Qualitative rigour

Trustworthiness was ensured through credibility, dependability, confirmability, transferability, and reflexivity [35–44]. Credibility was strengthened through prolonged engagement, direct observation, member checking, and triangulation of multiple data sources. Dependability was enhanced by providing a detailed description of the study procedures. Transferability was supported through comprehensive descriptions of the study context and participant characteristics [35–44].

Reflexivity was maintained through researcher bracketing, keeping reflective journals, and regular discussions regarding potential biases [35–44]. The lead author had prior experience in deathcare, while several authors had previously conducted research on deathcare workers or were affiliated with facilities providing deathcare services. Moreover, the last author is an experienced researcher who has supervised M.Phil. and Ph.D. theses on the subject. Continuous reflection helped ensure that interpretations remained grounded in participants’ accounts. Confirmability was further supported through collaborative coding, audit trails, and consensus-building among the research team [35–44].

Results

Two themes and three sub-themes emerged from the data analysis: (i) theme one – limited knowledge about deathcare industry regulations, (ii) theme two – unsafe on-site practices, which produced three sub-themes; poor adherence to PPE usage, inappropriate hand and personal hygiene practices, and inappropriate manipulation of dead bodies. Table 2 provides summary of themes and sub-themes for ease of reference.

Table 2.

Schematic table

Main Theme	Sub-theme	Interpretation	Supporting quote
Limited knowledge about deathcare industry regulations	No sub-theme	Highlights gaps in the ability of the workers to demand for and insist on their rights….	“…the IPC policy guideline talks about good handwashing.” (DCW6)
Unsafe on-site practices	Poor adherence to PPE usage	Weak protection against PPE preventable hazards….	“We had to plead with the relatives to buy the disposal gloves and nose masks for us….” (DCW14)
	Inappropriate hand and personal hygiene practices	Increased risk of infection due to inadequate hygiene facilities and training….	“Unless we handled a bad case, we do not bath before going home.” (DCW30)
	Inappropriate manipulation of dead bodies	High risk of infection and burnout due to inadequate training and personnel….	“We regularly experience splashes from the dead bodies during the embalmment.” (DCW29)

Theme one – Limited knowledge about deathcare industry regulations

We found that deathcare workers in selected facilities in the Central and Western North regions of Ghana have limited knowledge of the policies, specifically IPC, OHS, and Ghana’s Labour Law, that promote and protect them at work. While workers were aware of IPC and Ghana’s Labour Law, they were unaware of the OHS policy guidelines. One worker, DCW5, remarked:

Concerning the IPC policy guideline, we (workers) are expected to thoroughly wash our hands with water and soap after handling the dead bodies…. As regards the Labour Law, it talks about the things we must and must not do while on duty and also talks about the things our bosses (managers) must provide us with. See Table 1.

The worker could not identify specific provisions within the IPC or Ghana’s Labour Law. This ambiguity hinders employees’ ability to assert their rights and comply with policy requirements. Another worker, DCW6, explained:

…yes, I know that the IPC policy guideline talks about good handwashing and wearing PPE while on duty. I know about the Labour Law because it is always discussed at our union meetings…the things we (workers) are not to do while on duty, according to the Labour Law, include drinking (drinking alcohol), refusing to come to work, insulting our bosses (managers) and the relatives of the dead bodies, charging of illegal fees, and others. Similarly, our bosses (managers) must also provide us with the things (resources) to work with…yes, it is their (managers) duty which they fail to do. See Table 1.

Although the workers demonstrated some knowledge of the policies, it remains insufficient to guarantee the adequate promotion and protection of their rights. Furthermore, none of the interviewed workers possessed copies of these policies.

When confronted with the findings, a deathcare manager, DCM2, explained:

We (managers) actually do our best to train them (workers) in IPC but they tend to do their own things. We focus on IPC because the work they (workers) do regularly exposes them to infections. Your (researchers) findings are unfortunate and I blame it on their low levels of education…that is it. See Table 1.

Management failed to provide evidence of training plans or reports regarding these policies for deathcare workers. Furthermore, recruitment standards for these roles remain undefined. While these findings were anticipated, they may be attributed to both personal factors, such as the workers’ limited education, lack of risk aversion, and unhealthy beliefs regarding their profession, and systemic organizational issues, including the absence of formal training and recruitment protocols. Meanwhile, deathcare industry policies mandate that managers provide workers with regular training to improve their proficiency in various tasks.

Theme two – Unsafe on-site practices

This theme yielded three sub-themes including (i) poor adherence to PPE usage, (ii) poor hand and personal hygiene practices, and (iii) unsafe manipulation of dead bodies.

Sub-theme One: Poor adherence to PPE usage: We found that the workers face high risks of PPE preventable hazards, including needle pricks, cuts, abrasions, inhalation of pollutants, infections, and chemical contamination, due to inconsistent PPE use. Workers often handle formaldehyde, other chemicals, and dead bodies without wearing full protective gear. A worker, DCW23, said:

I know that PPE protect us from many dangers during work but it is not easy wearing them. For example, I wear nose mask but not during the embalmment procedure because of the formalin. The nose mask becomes soaked with vapour from the formalin which makes it uncomfortable to keep on, especially when the weather is warm. See Table 1.

Furthermore, some staff wear open-toed footwear while escorting relatives through the morgue. Additionally, some of the workers wear long fingernails which pose a risk, as they may puncture disposable gloves and compromise worker safety. Furthermore, the supply of PPE was inadequate and irregular, forcing workers to perform tasks without appropriate protection. A deathcare worker, DCW14, remarked: “…just two days ago, our boss (manager) tasked us to decorate a case (dead body) in one of the communities around without the PPE we needed. We had to plead with the relatives to buy the disposal gloves and nose masks for us…and it was not the first time that this happened.” See Table 1.

We observed that workers generally lack knowledge of proper donning and doffing techniques, and those who are informed often fail to follow protocols during PPE usage. This finding is attributed to several personal and organizational factors, including inadequate knowledge, a lack of risk aversion, irregular PPE supply, insufficient supervision, and a lack of formal training on the importance and use of PPE.

Sub-theme two: Inappropriate hand and personal hygiene practices: We found that workers’ hand and personal hygiene practices do not conform to the IPC Policy Guideline. Rather than using antiseptic handwashing, most workers practice social handwashing after handling bodies or completing other tasks. Even on busy days, workers often leave for home without bathing. A worker, DCW30, remarked:

…we always washed our hands with soap and water after every task. I know the work we do is dangerous (infectious) so I take my handwashing seriously. As for bathing, unless we handled a bad case (that is either the dead body is decomposing, mutilated, etc.) we usually do not bath before going home. See Table 1.

In one instance, a worker, DCW17, was observed eating a boiled egg in the office/storeroom near the morgue without first washing hands. When confronted, the worker, DCW17, explained: I have not handled any case (dead body) since morning so my hands were clean. The way you (researcher) are staring at me shows that you are worried for me…but I have been doing this work for over 9years now but without falling ill…. See Table 1. This attitude poses a significant health and safety risk, reflecting a sub-culture of poor adherence to personal and hand hygiene. Furthermore, some workers wore personal clothing for official duties, while others shared Wellington boots. These practices appear common among deathcare workers in the facilities explored. The findings were expected due to personal factors, such as negative perceptions of infections and the workers’ limited educational backgrounds, and organisational factors, including irregular water supply, inadequate handwashing and bathroom facilities, lack of supportive supervision, and insufficient IPC training.

Sub-theme Three: Inappropriate manipulation of dead bodies: We found that the manner in which bodies are manipulated during embalming and preparation for public viewing presents the greatest health and safety risk to workers. During these processes, workers drag, pull, push, and roll the bodies, often resulting in the ejection of blood, fluids, and faecal matter from the orifices. A worker, DCW29, explained:

We regularly experience splashes from the cases (dead bodies) during the embalmment…it is something you cannot avoid in this job (deathcare work). Usually, it is the condition and size of the case (dead body) that determines how to handle it…if the case (dead body) is heavy, then we are forced to push and drag during embalmment…. See Table 1.

Another worker, DCW30, remarked: “…there were instances where we had to spend so much time cleaning-up the cases because of faecal matter, which should have been done by the nurses before the cases are handed over to us.” See Table 1. Similarly, we found the workers “force” the dead bodies to assume specific postures for public viewing. This process brings workers into direct contact with the bodies, exposing them to bodily fluids and faecal matter. A worker, DCW32, said: “…we manipulate the case (dead body) to assume the posture that reflects his/her vocation, sometimes resulting in the emission of fluids and faecal matter. The process is such that you may sometimes have to force the body…the more complex the posture, the more the charges or fees.” See Table 1. These findings were expected, given the workers’ limited educational backgrounds, the lack of elevators, inadequate training, insufficient supervision, and the imposition of high fees.

Discussion

We explored the knowledge and safety practices of deathcare workers in selected facilities across the Central and Western North regions of Ghana. We identified lapses in management responsibility, resulting in limited worker awareness of occupational safety policies that promote and protect them.

Although OHS and IPC guidelines mandate formal training to improve knowledge and policy adherence, our findings indicate that these requirements are not being met. This management oversight is concerning, as it undermines the workers’ ability to advocate for their rights and adhere to safety protocols. These findings align with previous studies [16, 21–23] reporting low policy awareness among mortuary attendants in Ghana, Kenya, and Nigeria. Furthermore, the study found no institutional structures, such as in-service training, to raise awareness or improve workers’ knowledge of their rights and responsibilities. Consistent with previous findings [16, 21], this study reveals that pre- and post-deployment training, prerequisites for robust safety compliance, are lacking in these deathcare facilities. Clearly, management fails to ensure that workers are aware of and updated on safety regulations. This situation compromises worker safety, as duties may be performed in ways that leave personnel exposed to hazards. Management, in collaboration with Mortuaries and Funeral Facilities Agency (MoFFA), should organize quarterly training sessions to improve worker knowledge.

To realize the true value of PPE, the MoH’s IPC and OHS policy guidelines mandate its proper use by workers [45, 46]. Although these guidelines require deathcare facility management to formalize PPE training, involve workers in procurement of PPE, provide supportive supervision, and establish feedback mechanisms regarding PPE suitability, our findings indicate otherwise. The study indicates that deathcare workers face PPE-preventable hazards, including needle and nail pricks, lacerations, inhalation of hazardous substances, and infection, due to inconsistent PPE compliance. Embalming chemicals and other materials are frequently handled without adhering to the standard operating procedures (SOPs) for PPE usage mandated by the IPC and OHS Policy Guidelines of the MoH [45, 46]. Standard operating procedures include the proper donning and doffing of PPE, the selection of appropriate PPE for specific tasks, and the prohibition of reusing single-use items. Furthermore, equipment such as Wellington boots, utility gloves, and coveralls must not be shared. Consistent with previous studies [21–23] regarding mortuary attendants in SSA, these procedures are frequently neglected. Additionally, this study revealed that workers commonly wear private or casual clothing while performing work-related procedures and continue to wear these same garments when returning home. Additionally, some of the workers have long fingernails that could perforate disposal gloves, which further expose them to infections. Additionally, some workers have long fingernails that may puncture disposable gloves, increasing their risk of infection. These findings indicate lapses in management responsibility for the workers under the IPC and OHS policy guidelines, potentially compromising worker health, safety, and well-being [16, 21]. Contributing factors may include poor attitudes, inadequate training, insufficient PPE, rising temperatures, and a lack of supportive monitoring and supervision at these deathcare facilities. These workers face significant hazards that threaten their short- and long-term health and well-being. Unfortunately, some adverse effects may only manifest after retirement. MoFFA must take punitive action against facility managers who have failed to meet their regulatory responsibilities.

Hand and personal hygiene are central to IPC, particularly for deathcare workers frequently exposed to infectious environments and toxic substances [21, 23]. This principle is firmly rooted in the IPC and OHS policy guidelines of the Ministry of Health (MoH) [45, 46], which the practices of the workers must reflect. Although regulations require facility management to implement mandatory training on universal precautions for corpse handling, conduct regular hygiene and PPE workshops, improve PPE availability, provide supportive supervision, and encourage incident reporting, our findings indicate otherwise. Worker hygiene practices remain inconsistent with these regulations. The policy guidelines mandate that workers wash their hands with soap under running water immediately before and after each task; wash, dry, and iron reusable PPE; refrain from sharing PPE; bathe immediately after handling remains; and protect their hair, beards, and fingernails from exposure [45, 46]. However, workers failed to adhere to these safety protocols. This aligns with previous studies [21, 22] reporting similar findings regarding mortuary attendants in Nigeria and Kenya. Furthermore, the use of casual or private clothing to perform procedures is prohibited by the regulations, as such garments may harbour pathogens and odours. As noted in previous studies [16, 21], workers can become vectors for infection, potentially transmitting work-acquired diseases to their families and the public. Additionally, deathcare workers have historically faced a negative occupational identity, as society often perceives their work as “dirty” and prone to infection [16, 21, 24–26]. This negative characterization has led to the rejection, stigmatization, and marginalization of these workers [24–26]. Such experiences were widely reported among deathcare workers during the recent SARS-CoV-2 pandemic [24]. The MoFFA must conduct unannounced site visits to facilities and take punitive action against managers who fail to fulfil their responsibilities under these regulations.

OHS and IPC policy guidelines [45, 46] enjoin deathcare managers to implement the mandatory, consistent use of PPE, ensure rigid adherence to IPC and universal precautions, provide training on safe handling, and establish supportive monitoring and supervision. These measures are essential to mitigate the risk of exposure to blood, faecal matter, and other potentially infectious agents released from a body’s orifices during vigorous manipulation, particularly when handling decomposing remains. Contrary to policy guidelines, the manner in which workers handle dead bodies, particularly during embalming and preparation for public viewing, exposes them to hazardous biological materials. This aligns with findings from a previous study [47] regarding mortuary attendants in Ghana. Furthermore, as noted by Monisi [48], these findings highlight deficiencies in management oversight and the public health risks associated with specific deathcare practices, especially during disease outbreaks. In this study, we found that workers manipulate corpses into specific postures to meet family demands, thereby commanding higher fees. This practice prioritizes economic gain over worker safety [48], resulting in severe health risks for staff and broader public health threats. To address these issues, the MoFFA, the agency overseeing Ghana’s deathcare facilities, and the MoH must implement unannounced inspections. This measure will compel deathcare supervisors to prioritize OHS issues at their facilities and enforce regulatory compliance. Supervisors who fail to meet these responsibilities must be sanctioned to serve as a deterrent.

Recommendations for policy and future research directions

Guided by the study’s findings, we recommend that the Ministry of Health and deathcare managers develop a policy to standardize the recruitment of deathcare workers. This would ensure the hiring of personnel with the requisite qualifications, knowledge, and competencies, ultimately improving industry safety compliance. Additionally, managers should collaborate with the Mortuaries and Funeral Facilities Agency to organize continuous professional training for staff. Managers should intensify supportive supervision to improve adherence to standard operating procedures. Furthermore, they must urgently repair faulty sinks and ensure a consistent water supply to promote better hand and personal hygiene among staff. Future research could employ quantitative methods to assess the knowledge of deathcare workers across all facilities in Ghana, as well as examine work-related health conditions among retired personnel. Investigating on-site safety practices, health, and well-being among deathcare workers in Ghana’s public and private facilities warrants further consideration.

Strengths and limitations

This study explored two key cadres of deathcare workers, mortuary attendants and funeral directors, across selected facilities in Ghana’s Central and Western North regions. The research design enabled a broad range of perspectives from both public and private facilities to better understand the complexity of their experiences. By utilizing multiple data sources, including managers, workers, and both private and public facilities across the Western North and Central regions, and employing diverse data collection techniques such as interviews and observations, we achieved data triangulation and a deeper understanding of the phenomenon. Furthermore, to ensure the instrument’s trustworthiness and improve the study’s reproducibility, we pretested the tools and applied established qualitative research principles throughout the data collection and analysis.

While deathcare managers and workers may find these findings useful for improving on-site safety and personal health, there are limitations. The transferability of the results is constrained by the small sample size of 35 participants, the inclusion of only three facilities, and representation from only two of Ghana’s sixteen administrative regions. Despite the study’s methodological rigour, we recognize that incorporating a quantitative approach would have provided additional insights.

Conclusions

Deathcare workers in the selected facilities within Ghana’s Central and Western North regions possess limited knowledge of industry regulations and policies. This deficiency undermines workers’ ability to advocate for workplace health and safety protections and may compromise the safe delivery of services. Furthermore, current on-site safety practices are inconsistent with the MoH’s OHS and IPC policy guidelines. Although workers were not provided with the full complement of required PPE, they also failed to utilize the few that were available. Furthermore, workers’ hand and personal hygiene practices do not conform to the standard operation procedures outlined in the MoH’s OHS and IPC policy guidelines. While this is largely due to irregular water supply, faulty sinks, and a lack of bathrooms, it is severely exposing workers to infection that could compromise public health. Many of these workers were at risk of exposure to bodily fluids and faecal matter from the orifices of the deceased due to inappropriate handling, particularly during embalming and preparation for public viewing. Consequently, these workers may become sources of infection.

Supplementary Information

Below is the link to the electronic supplementary material.

Abbreviations

COREQ

Consolidated Criteria for Reporting Qualitative Research

IPC

Infection Prevention and Control

ILO

International Labour Organisation

MoH

Ministry of Health

MoFFA

Mortuaries and Funeral Facilities Agency

OHS

Occupational Health and Safety

PPE

Personal Protective Equipment

RP

Realistic phenomenology

SOP

Standard Operating Procedure

SSA

Sub-Saharan Africa

Author contributions

Authors EWA and NNB Conceptualised and Designed the Protocols. Authors EWA, AAAB, CES, VKD, SM, and NNB Conducted Data Collection and Acquisition. Authors EWA, CES, AAAB, and NNB carried out extensive data processing and management. Authors EWA, SM, VKD, and NNB developed the initial manuscript. Authors CES and VKD wrote the initial draft. Author EWA and AAAB did extensive review and editing. All authors considerably edited the manuscript, proofread for intellectual content and consented to its publication.

Funding

No author received funding for a part or the whole of the study.

Data availability

All relevant data involved in this study are fully reported in the analysis. Other data not reported are confidential and not to be disclosed to third parties.

Declarations

Ethical approval

Ethical approval was obtained from the Institutional Review Board of the 37 Military Hospital, Accra (37MH-IRB/PhD/IPN/817/23).

Consent to publish from the patients

Not applicable.

Consent for publication

All authors consented to publish this paper.

Competing interests

The authors declare no competing interests.