Table 7

Interventions to prevent violence against HCWs in hospitals

ReasonsInterventionsPotential 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.