Table 7.

Interventions to prevent violence against HCWs in hospitals

Reasons	Interventions	Potential to reduce the events
For HCWs in hospitals
Reaction to patient condition: Death. Serious condition. Treatment-related complication.	Training of HCWs in: Emergency care. Emergency communication. De-escalation skills.	15% verbal violence. 30% of physical violence.
Quality of care: Delay in care. Poor care.	Training of HCWs in: Improving responsiveness towards patients. Policies on: Minimum response and waiting time. Information on waiting time. HCW performance assessment on behaviour, promptness of response, consultation time and quality of care. Complaint counters for clients.	20% of physical violence. 25% verbal violence.
Lack of resources: Drugs, equipment, beds. Human resources.	Policies on: Patient to HCW ratio. Availability of medicines, supplies and equipment based on service delivery standards for level of care and distribution of disease burden.	10% physical violence. 25% verbal violence.
Patient behaviour: Overcrowding. Impatience to wait. Demand of care of personal choice. Expectation of protocol. Referral.	Educational measures: Awareness campaigns on the importance of one attendant policy, waiting for their turn and following the instructions of HCWs related to treatment, admission and care. Awareness and information about referral. Regulatory measures: Adherence to access restriction policies of hospitals. Making assault a non-bailable offence.	20% physical violence. 30% verbal violence.
Job-related reasons: Dissatisfaction with job performance. Disagreeing on job conditions. Being late or absent.	Zero tolerance policy at organisational level. Grievance policies for junior-level staff.	2.5% physical violence. 4% verbal violence.
For HCWs in ambulance services
Reaction to patient condition: Death. Serious condition. Treatment-related complication.	Training of HCWs in: Emergency care. Emergency communication. De-escalation skills.	10% verbal violence. 30% of physical violence.
Quality of care: Delay in arrival and shifting the patient. Poor care.	Training of paramedics on: Emergency care and shifting of the patient. Policies on: Minimum response time. Information on waiting time. Upscaling services based on burden.	45% of physical violence. 50% verbal violence.
Lack of resources: Equipment in ambulances for provision of standard prehospital emergency care.	Financial investment to equip ambulance services and set prehospital emergency care standards.	10% physical violence. 10% verbal violence.
Patient behaviour: Demand of care of personal choice. Demand of speeding up ambulance. Expectation of protocol.	Educational measures: Awareness campaigns on the importance of following the instructions of HCWs. Regulatory measures: Making assault a non-bailable offence.	10% physical violence. 25% verbal violence.
Job-related reasons: Dissatisfaction with job performance. Disagreeing on job conditions. Being late or absent.	Zero tolerance policy at organisational level. Grievance policies for junior-level staff.	5% physical violence. 5% verbal violence.
For LHWs and vaccinators
Quality of care: Delay in care. Poor care.	Training of LHWs and vaccinators: MNCH care and vaccination. Policies on: Minimum response time. Information on waiting time.	35% of physical violence. 15% verbal violence.
Patient behaviour: Misconception about vaccines. Misconception about family planning. Complaint of repeated visits. Referral.	Educational measures: Revise the strategy to accommodate the concerns of people and build national consensus on existing controversies related to vaccination and family planning. Regulatory measures: Making assault a non-bailable offence.	60% physical violence. 80% verbal violence.
Job-related reasons: Dissatisfaction with job performance. Disagreeing on job conditions/salary. Being late or absent.	Zero tolerance policy at organisational level. Grievance policies for junior-level staff.	2% physical violence. 5% verbal violence.

HCWs, healthcare workers; LHWs, lady health workers; MNCH, Maternal Neonatal and Child Health.