Six Key Considerations When Implementing Employee Wellness Programmes In Africa And Developing Countries
Employee wellness programmes vary by organisation, industry and location. One size does not fit all. There has been a lot of investment in people, workplaces and research in the developed countries resulting in more evidence and guidance relevant to their environment.
Access to workplace wellness programme or services is 47.4% in North America, 28.1% in Europe, 9.1% in MENA, 6.2% in Latin America, 5.3% in Asia Pacific and 1.4% in Sub-Saharan Africa. The access rates are higher with large employers such as multinationals and local big corporate organisations across all regions. High informal sector employment of up to 90% in Sub-Saharan Africa and low per capita expenditure on health are major barriers to employee access to health and wellness services.
Developing and implementing employee wellness programmes in developing countries require different perspectives that are creative and can be adapted to meet local needs.
GBC Health and Sentinel Consulting published ‘’Wellness For A Global Workforce Workplace wellness initiatives in low and middle-income countries’’ that recommends the key steps below:
1.Define your context
Whether you work for a multinational or a local business in any developing country, your health system is significantly different from those in developed countries. Your social determinants of health (the conditions in which people are born, grow, live, work and age) and the associated health challenges will be different as well. Your employee wellness goals will be determined by the local health and environment, organisational policy and environment, family and individual factors.
In a Buck Consultants 2014 report, the top three employer objectives and top three health issues driving wellness strategy across continents and United States were different.
Workplace safety was a major driver of wellness objective and strategy in Africa and Asia while, the developed markets have advanced beyond this. As at 2014, it was only in Africa that infectious disease and HIV/AIDs featured as one of the top three health issue and your strategy and goals would address this at that time. We could not adopt the strategy and goals of the US or Europe even if our head-office was based there at the time.
A wellness committee (if not in place already) representing different functions or departments will be needed to work on the review and implementation project to initiate the process.
Key questions to consider:
• What are the principal motivations behind your programme?
• Who are your stakeholders? What do they think are the key issues?
• Is there any supporting data? What else is being done?
Some of the motivations for implementing wellness programmes in developing countries in 2013 are:
• Increase workforce productivity
• Increase workforce engagement
• Reduce workforce absenteeism due to sickness
• Reduce direct healthcare costs or health insurance premiums
• Corporate social responsibility
• Improve workforce retention
• Reduce workforce absenteeism due to family sickness or caring obligations
• Reduce accident rates or improve safety
2.Define your targets
There will always be a shopping list of issues to address from different stakeholders – head-office, regional office (for multinationals), the board, management, employees, family of employees, trade unions and the local community. You do not have unlimited resources.
The employee wellness committee will need to identify and prioritise the issues that are critical to your programme motivations and objectives. Ensure all relevant stakeholders agree.
Key questions to consider:
- What broad areas should be addressed that satisfy local and organisation-wide requirements, and are seen as important by all stakeholders?
- What are the central problems?
- What causes the problems?
- Which are the most influential causes? Which are the least influential?
- Which causes can be addressed and cannot be addressed by the programme?
3.Design your activities
- It is important that you do not select activities until you have completed the first two steps above. Jumping to select activities without the initial analysis and steps will result in activities that are irrelevant and without any value to the participants and the organisation.
- Identify the interventions and activities that effectively address the most influential causes of the central problems. You could explore environmental supports, policy changes and individual programming. Ensure your selection aligns with and matches your resources and that they augment or complement each other.
Key questions to consider:
• What activities will ensure you achieve your objectives and aims, and will be well-received? Consult with all stakeholders—optimize your plans
• Who are the target participants?
• Will broadening the target group increase effectiveness?
• Where, when and how do the activities take place? Include budget, logistics, facilitators, physical resources. Convenience to participants and minimal/ no disruption to work schedules are often essential.(It is important to have the activities within working hours as much as possible to encourage participation and engagement).
• Can the activities be designed and run (“owned”) by the target groups rather than imposed?
• What motivations to participate are there? Peer recognition? Incentives? Disincentives?
• What are the barriers to participation and behaviour change? How can these be minimized?
• How are the motivations, aims and methods of the programme communicated to stakeholders?
• How is confidentiality guaranteed? (Confidentiality often increases participation). Confidentiality could also be a legal or regulatory requirement.
4.Define your goals
Define what you aim to achieve, when, and how you will prove it. Doing this well enables you to demonstrate your success. You cannot manage what you don’t measure.
Define your metrics and targets. How you demonstrate that your programme achievements are satisfying the original organisational motivations and the objectives. Attach a value and timescale to each target. Targets must be realistic. Intermediate milestones assist you to judge whether your longer-term targets will be met.
Include metrics describing resources, activities, results of activities, impact (e.g., what has been procured) (e.g., number of participants; number of smoking cessation packs distributed) (e.g., number of people who have stopped smoking; number who have lost weight or reduction in Body Mass Index (BMI), reduction in Blood Pressure (BP), reduction in Fasting Blood Glucose) (e.g., reduction in stress-attributable absenteeism, increase in employee productivity).
Capture how the data is gathered and analysed. Define control groups if possible (i.e., comparable non-participants). Who does this? When? How? Baseline and post intervention assessments of participants will assist attribution of trends to programme interventions.
Programme Evaluation Framework
- Structural - Leadership engagement, Policies, Environmental support
- Process - Programme fidelity, Dose delivered vs Dose received, Participation, engagement and satisfaction rates
- Outcome - Health ,Financial, Productivity
From: A Strategic Measurement and Evaluation Framework to Support Worker Health by R. Goetzel June 2013
The programme evaluation framework above gives a list of measures to evaluate our programmes at all stages. Structural evaluation determines how well a programme is structured to achieve its goals. Process evaluation determines if the execution is progressing according to plan and helps with making adjustments when required. Outcome evaluation looks at goals, reduction in health risks, quality of life and financial improvement.
5.Define your resources
Building a successful employee wellness programme requires resources including employee time and finances. You may initially have an employee wellness committee preparing your organisation and running the programme post launch. The decision to get a dedicated staff will depend on the size of your organisation, expected impact, available funding and type of desired wellness culture.
Define what you need in order to run the activities. Specify people, equipment, buildings/locations, training materials, publicity materials etc. Don’t forget your monitoring and evaluation activities. Internal resources or outsourcing? Define vendor options, community collaborations, NGO partnerships.
Budget required? Any opportunities for grants or awards? When is each resource required? Where does each resource come from? Is it quality assured? Include quality assurance of outsourced services.
What one-off and ongoing training does the team require? When? Who will coordinate this? Who will provide training? If provided externally, can a sustainability model be built in, e.g., through train-the trainer approaches?
6.Monitor your progress
Monitoring will provide you with information to modify your programme to meet your objectives on employee health and wellness related to their attitudes, behaviours and health indicators or as defined by your stakeholders.
Regular and continual consultation with stakeholders to ensure activities are being received as planned - focus groups, key informant interviews, surveys and/or anecdotal feedback.
Gather, analyse and collate performance and financial metrics and responses from stakeholders. Feed lessons learned back into programme design.
Demonstrate business case to senior leadership. Periodic objective evaluation. Periodically assess whether programme strategy is correct and the programme’s contribution to broader organisational success metrics e.g., employee health, productivity, absenteeism.
Some questions to consider:
Any unexpected or unintended consequences? If so, what? Why?
Any adverse or ineffective interventions? If so, what can be done to remediate?
1. WORKING WELL: A Global Survey of Health Promotion, Workplace Wellness and Productivity Strategies ‘’ Buck Consultants July 2014.
2. Global Wellness Institute, The Global Wellness Economy: Looking Beyond COVID December 2021
3. Wellness For A Global Workforce Workplace wellness initiatives in low and middle-income countries GBC Health Sentinel Consulting May 2013
4. A Strategic Measurement and Evaluation Framework to Support Worker Health Committee on DHS Occupational Health and Operational Medicine by R. Goetzel, June 2013