Health professionals and trade union collaborative partnerships : prospects for a mutually secure workplace within comprehensive health centres

Abstract

Healthcare delivery in South Africa's rural and semi-rural comprehensive health centres (CHCs) remains challenged by persistent resource constraints, high staff turnover, and fragile interprofessional and labour relations. Although trade unions have historically advocated for workers' rights, their limited visibility and functionality in these settings may weaken collaboration, safety culture and mutual trust among health professionals. This study explored the experiences of health professionals and trade union representatives regarding collaboration and secure workplace relations within rural and semi-rural CHCs. It further developed and validated the Interprofessional Union and Collaborative Partnership (IPUCP) model and implementation guidelines. The model integrates Maslow's Hierarchy of Needs, Watson's Theory of Human Caring, the Interprofessional Education Collaborative (IPEC) framework and the Labour-Management Partnership (LMP) model. A sequential explanatory mixed-methods design was employed to ensure both breadth and depth of understanding. In Phase 1 (quantitative), six rural and semi-rural CHCs were purposively selected, two each from Gauteng, Mpumalanga and Northwest provinces. Within these selected CHCs, a total-population approach was followed by inviting all eligible and available health professionals to complete the questionnaire. Sixty-nine questionnaires were distributed and 42 usable questionnaires were returned, yielding a response rate of 61%. A self-administered five-point Likert-scale questionnaire measured leadership, communication, workplace safety, collaboration and union functionality. Quantitative data were analysed using the Statistical Package for the Social Sciences (SPSS), version 26.0, and reliability was confirmed through a Cronbach's alpha of 0.70. In Phase 2 (qualitative), participants from Phase 1 who consented to further engagement were purposively selected as participants for three focus group discussions and ten in-depth interviews. Audio data were transcribed verbatim and analysed thematically using Braun and Clarke's (2021) six-phase framework. Integration of both datasets was achieved through narrative weaving, joint displays and meta-inference matrices to illustrate convergence, divergence and expansion, enabling a comprehensive interpretation of findings. The integrated results revealed systemic constraints, including resource and infrastructure shortages, weak communication structures, limited union participation and inadequate leadership support. Findings further emphasised inclusive capacity building, caring leadership, role clarity, mutual respect and the need for visible and functional union representation to promote collaborative and psychologically safe environments. Workplace security in rural and semi-rural CHCs was found to be aligned to three interdependent pillars: physical and infection-control safety, relational and psychological safety, and procedural-justice safety. The validated IPUCP model and accompanying implementation guidelines offer a contextual framework to strengthen interprofessional collaboration, enhance trust and reinforce labour-management partnerships in rural and semi-rural CHCs. The study concludes that sustainable collaboration requires supportive leadership, shared accountability, visible organised labour and the integration of caring and humanistic values into everyday workplace practices.