Review of Public Administration and Management

Employee Wellness Programmes and Productivity in the Workplace: The Case of the Gauteng Department of Education

Chrisen Mhangwani^* and Kholiswa Malindini Department of Education, Wits School of Governance, University of the Witwatersrand, Johannesburg, South Africa
^*Correspondence: Chrisen Mhangwani, Department of Education, Wits School of Governance, University of the Witwatersrand, Johannesburg, South Africa, Email:

Received: 10-Nov-2023, Manuscript No. RPAM-23-23876; Editor assigned: 13-Nov-2023, Pre QC No. RPAM-23-23876 (PQ); Reviewed: 27-Nov-2023, QC No. RPAM-23-23876; Revised: 04-Dec-2023, Manuscript No. RPAM-23-23876 (R); Published: 11-Dec-2023, DOI: 10.35248/2315-7844.23.11.428

Introduction

The literature on the impact of ill-health absenteeism phenomenon on the organisational productivity points out to the relevance of wellness interventions programmes to offset the emergence of lifestyle diseases by coming with health promotion programmes that are customised for organisational setting. Ill-health absenteeism behaviour presents organisational challenges as it interferes with organisational productivity to achieve the set strategic objectives. By definition, absenteeism is any failure to report for or remain at work as scheduled, regardless of the reason [1].

Accordingly, Litchfield, Cooper, Hanock, and Watt present that the observed phenomenon of ill-health absenteeism in the United Kingdom (UK) among the public and the private sector organisations has contributed much to the unproductiveness of these organisations [2]. These observations were related to how the phenomenon of ill-health absenteeism behaviour contributed to the rising annual cost to employers and this escalated to £29 billion for (UK) organisations for that period. Further, the study noted that ill-health absenteeism behaviour has implications on the costs of organisations and stress levels on other staff that are expected to double their efforts to compensate for the loss of productivity by covering for absent employees resulting in reduced productivity and customer service.

Il-health absenteeism behaviour also called the “bottom-line killer”, impacts on the availability of the workforce and the profitability of organization and contributes to the presenteeism behaviour where employees just present themselves to the work context but not producing what is expected of them to make organisations achieve their strategic mandates. To put this into context, from the global perspective, a survey conducted by Canada Life UK in 2013 pointed out that out of 1000 people surveyed, 93% of employees attended work despite being under health conditions that do not allow them to work. However, 20% of employees had perceptions that workplace pressure often subjects them to apply for sick leave and 13% highlighted the risk of redundancy at work. This emphasises the assumptions that the costs of ill-health absenteeism in organisations contribute to their unproductiveness thereby affect organisations profitability. In South Africa, the phenomenon of ill- health behaviour as observed by the Public Service Commission (PSC) commissioned study in 2010 highlighted that 63% of the national departments took ill-health absenteeism leave compared to 3% of the provincial departments in 2010; during the same period, it was established that the costs of ill-health leave applications to the employer due to ill-health amounted to six hundred and thirty-one million six hundred and thirty-three thousand and six hundred and sixty rands (R631 633 660) despite that programmes that seek to enhance health seeking behaviour were implemented.

Further, recent studies on global employee absenteeism highlight that a total of hundred and seventy-five million working days globally which translated to 3.3% of total working time were lost to ill-health absenteeism per annum and this amounted to over 14, 4 billion dollars in cost to the employers [3]. Moreover, Statistics South Africa (Stats SA) revealed that in South Africa by 2014 employee absenteeism amounted to 15% of the total working days and this translated to R16 billion a year lost to ill- health absenteeism [4]. Given the severity of employee absenteeism on productivity, literature highlights the significance of workplace health promotion programmes to ensure that employee’s health is promoted.

Thus, based on the adverse effects of ill-health absenteeism behaviour on productivity and workload in the workplace, literature reveals that one of the human resources’ effective strategies to curb ill-health absenteeism behaviour is workplace health promotion programmes. Having such programmes in the workplace is assumed to contribute to the reduction of emergence of illnesses and thus, ill-health absenteeism behaviour in the workplace. Consequently, the influence of health promotion programmes on employee wellbeing has recently gained attention in the public sector and in the private sector. Evidence points out that the implementation of health promotion programmes in working environments is relevant to organisational productivity to achieve service delivery objectives [5,6].

As a result of the significant impact of chronic diseases on employee health and well-being and the ultimate ill-health absenteeism behaviour noted that employers have recently come up with strategies of adopting health promotion programmes and disease prevention strategies in the workplace to enhance the productivity of employees thereby the organisations [7]. As it has been recognised, inherent in the phenomenon of ill-health is the emergence of absenteeism behaviour [8]. Ill-health absenteeism behaviour has indirect implications on other employees’ productivity as they are expected to double their effort to compensate for the loss of productivity of the organisation. The escalation of the trend of ill- health absenteeism behaviour has put to a test on the effectiveness of the health promotion programmes in averting the phenomenon of ill-health absenteeism behaviour which in South Africa is often called the Employee Health and Wellness Programme (EHWP). According to the Department of Public Service and Administration (DPSA) strategic framework for employee health and wellness 2019 as amended health promotion programmes adopted by the programme seeks to implement proactive health intervention strategies that aim to prevent diseases from happening among the public service employees.

This health promotion programme is constituted by what the DPSA strategic framework identifies as pillars. These pillars include the HIV, TB and STIs Management Pillar which aims to deal with HIV related preventative programmes and management of HIV continuum of care, the Health and Productivity Management Pillar which deals with strategies to prevent the emergence of lifestyles diseases such as diabetes mellitus, hypertension, obesity, mental health issues and other related diseases. This followed by the Safety Health Environment Risk and Quality Management Pillar which seeks to employ strategies that ensures that the workplace is safe and the Wellness Management pillar that involves the prevention of the emergence of mental health issues and the promotion of a total employees’ wellbeing (DPSA Strategic Framework for EHW, 2019).

In response to this global phenomenon of ill-health absenteeism, the Gauteng Department of Education (GDE) as constitutionally mandated to deliver basic education services to the citizens of the Gauteng Province, recognised the imperativeness of its human capital health in delivering the basic education services as the nerve centre to achieving its strategic goals. To undo the phenomenon of ill-health behaviour among its employees and to promote the uptake of health-seeking behaviour, introduced the health promotion programme considering the DPSA framework for Employee Health and Wellness 2008 which was later amended in 2019. This was done considering the impact of the phenomenon of ill-health absenteeism behaviour among the GDE employees’ productivity as it has been identified as a contributory factor to the low productivity of the Department to achieve its stated objectives considering its vision and mission statements. In this study, EHW are referred as health promotion programmes.

The proactiveness of the health promotion programmes was recognised by the GDE considering its service provisions to disease prevention by providing health promotion education and screenings of diseases that may infringe on the normal functioning of employees and that of the organisations. However, despite the implementation of health promotion programmes to offset the ill-health absenteeism behaviour, there were notable observations over the years that there has been an increase in the number of applications for extended sick leaves (PILIR) by GDE employees from 2012 to 2019. To illustrate this trend, the following graph depicts how this behavioural trend has exponentially increased from 2012 to 2019 (Figure 1).

Figure 1: Percentages of ill-health leave application at the GDE from 2012 to 2019. Note: - Ill-health absenteeism applications for period (2012-2014), - Ill-health absenteeism leaves applications for period (2015-2017), - Ill-health absenteeism leave applications for period (2018-2019).

Accordingly, this challenge has put an extra strain on other employees’ productivity as they are expected to double their effort to compensate for the loss in productivity of the organisation. This has been a concern over time from the management point of view. Therefore, this study aimed at understanding why the phenomenon of ill-health absenteeism behaviour is persistent in GDE considering the implementation of the health promotion programme over the years since its inception. This is done against the background that previous studies in this regard focused mainly on HIV and TB management as well as the Wellness Pillar in isolation from the health promotion programme. Therefore this study places its emphasis on assessing the effectiveness of the health promotion programme in an integrated manner in addressing the ill-health absenteeism behaviour by exploring the perceptions of GDE employees towards the programme. This was particularly important given the existence of COVID-19 and its effects on the workplace and the employees as individual contributors to the organisation’s productivity. Thus, the overarching question that this paper sought to answer was: To what extent do health promotion programmes contribute to the reduction of employee ill-health absenteeism behaviour while also stimulating productivity in the workplace?

The rest of the paper is structured as follows: Section two unpacks the concept of workplace absenteeism; section 3 presents a theoretical review of the link between health promotion programmes and absenteeism and the effect on productivity; Section four presents empirical evidence; Section five outlines the adopted methodology; Section 6 presents and analyses the collected data; Section seven presents a conclusion and policy recommendations.

Literature Review

The concept of Ill-health absenteeism

Kisakye, Tweheyo, Ssengooba, Pariyo, Rutebemberwa and Kiwanuka describe ill-health absenteeism as “the loss of scheduled time due to sickness leading to work absence and this has remained a long-standing challenge worldwide” [9]. Ill-health absenteeism behaviour also includes employees taking more sick leave than is necessary and the South African public service is known as extended sick leave for over thirty days and beyond. These authors note that the phenomenon of ill-health absenteeism behaviour has long been standing as a bone of contention in countries such as Norway, the United Kingdom, and the United States of America and this has been attributed to subjective health complaints [10,11]. Moreover, Hayat Khan et al., illuminate that employee absenteeism is influenced by two variables that is the ability to attend, and motivation to attend [12]. In this regard, these authors identify that an employee who is willing to attend could be affected by negative pressures including their affective response to the job situation which alludes to internal motivation that one has on the job and varying levels of external pressure from unavoidable factors such as illness, accidents, family responsibility and behavioural pressures such as stress due to job role, scope, leadership style among other administrative concerns.

The theoretical review–ill-health absenteeism, productivity and wellness programmes

Literature presents inconclusive findings regarding workplace ill- health absenteeism, the factors behind absenteeism and its effects on productivity. Further, various human resources departments adopt different mechanisms to reduce absenteeism to stimulate productivity and the effectiveness thereof. Thus, this section presents ill-health absenteeism theories. Evidence from literature points out that ill-health absenteeism behaviour increases medical costs, reduces productivity, elevates the rate of work accidents and causes financial losses [11,13-16].

This has been a concern in some countries where it represents the main occupational health risk [17]. Similarly, the GDE has been experiencing this phenomenon since 2012 and it has been a continuous trend since then with elevated ill-health absenteeism applications from 2018 to 2022. Therefore, this study aimed at assessing the perceptions of GDE employees towards the effectiveness of the GDE health promotion programmes.

Thus, to understand workplace ill-health absenteeism, this paper adopted the psychological theory of Health Belief Model (HBM) to understand the variables that are inherent ill-health absenteeism behaviour and how the variables within society directly affect employee’s behaviour and decision-making regarding work at the workplace.

HBM is widely used to understand health behaviours and the intention to follow prescribed stimuli to enhance healthy behaviours. According to this theory, employee behaviour in the workplace is directly affected by norms, rules, conventions, habits and values that is embedded in society. This implies that the observed rising ill-health absenteeism behaviour in the workplace could be a result of the rules put in place or could just be a habit which adversely affects productivity. Since the purpose of this paper is to examine the effectiveness of health promotion programmes in reducing absenteeism in the workplace, the HBM to understand how the individual’s perceptions of the threat posed by a health problem (susceptibility, severity), the benefits of avoiding the threat, and factors influencing the decision to act (barriers, cues to action, and self-efficacy).

Thus, this model is adopted to understand the perceived threats posed by the GDE environment to its employees as well as the perceived benefits of the health promotion programme put in place. The focus of the model is on individual perceptions about the environment and its determinants to enhance the uptake of the services offered by the health promotion programmes. Individual perceptions are factors that affect the perceptions of illness and with the importance of health to the individual, perceived susceptibility, and perceived severity. The combination of these factors effect a response that often manifests in the likelihood of the changed behaviour occurring [12,18,19].

Empirical evidence

Literature reveals that organisations’ employees are forced to double their effort to meet the challenges of the product markets and service delivery outputs. In line with the HBM model, allude that changes in lifestyles in the workplace may lead to ill-health and interventions that are designed to turn the situation around have been seen as considerably low-key and inexpensive [2]. Compounding this challenge, are the negative effects on the health and well-being of the employees. Baptiste notes that because of fatigue and ill-health, this has impacted the Return on Investment (ROI) due to the high cost to business and the public purse due to employees’ absence due to ill-health absenteeism [20].

The phenomenon of ill-health absenteeism behaviour in the public sector organisations has contributed exponentially to the increased healthcare costs per employee than in the private sector. Further, the work environment has been identified as a contributory factor to ill-health given the role of the employer in promoting excess sedentary employment or psychological pressures that comes with it [21]. On the contrary, the workplace is also seen as an effective platform for more general health promotion, for instance, report that working environments can have a positive impact on the health of both the individual and the society in general [14,22]. These authors further argue that by being at work, an individual can gain a sense of purpose and self-worth which often leads to greater self-esteem and higher productivity. Furthermore, being at work provides opportunities for individuals to effectively contribute to society and participate in it in a meaningful way.

Despite all the higher productivity gains and some individual benefits which the working environment is assumed to yield to individuals, over a number of years there has been a noticeable spiralling increase in the number of incapacity benefit claimants which increased from 0.7 million in the late 1970s to around 2.7 million in 2006 [23-25]. Out of these cases, the mental health conditions stood out to be the most contributory factor to rising incapacity claims from 25% in the mid-1990s to 40% recently with stress and other mental health conditions now being the main causes of employee absence [21,26,27].

Methodology

The research approach

As the study sought to gain an in-depth understanding of how the Gauteng Department of Education (GDE) employees engage in ill-health absenteeism behaviour despite the implementation the health promotion programme by assessing its effectiveness, qualitative approaches were identified as useful for the study as they gave the researcher a chance to assess the perceptions of GDE employees from their lived experience in the context of GDE, and to enable the researcher to gain deeper insight into the phenomenon of ill-health absenteeism behaviour [28,29].

Research strategy

The study sought to examine the perceptions of employees in the Gauteng Department of Education. Thus, the adopted strategy for this study is a case study.

Data collection instruments and sample

Data for the study were collected from multiple sites of the Gauteng Department of Education including all four Head Office buildings and Fifteen Districts where the phenomenon of ill- health absenteeism behaviour persisted. The study employed the qualitative survey study to collect data where forty (40) participants were purposively selected with the idea that they have experience, knowledge, or practices to capture a wide variety of perspectives on the effectiveness of the GDE health promotion programme in averting the ill-health behaviour trend in GDE [30]. The choice of the qualitative survey was informed by its strength to collect data from multiple sites at the same time and it was regarded economic efficient.

Ethics considerations

Mcmillan posited the view that” ethics are standards and principles that are used to guide conduct to determine what is acceptable or not acceptable and are often related to values and morals”. Human participants were involved in this study, and thus, it was subjected to ethics approval from the University of the Witwatersrand Human Research Ethics Committee. All permissions including participants’ consent forms were obtained. Participants were assured that data collected from qualitative survey interviews would be treated with special caution and utmost confidence.

Data analysis

Based on the data collected, an analysis was conducted. As a recap, the purpose of this paper was to examine the perceptions of the Gauteng Department of Education concerning effectiveness of the implemented health promotion programme which aimed at reducing absenteeism in the workplace. The analysis was guided by the following interview questions.

• What do you understand about the GDE health promotion?

• The programme was implemented to promote the well-being of employees in order to increase their productivity and avert health conditions that can lead to ill-health (PILIR) thus ultimately rendering employee’s unproductive leading to constant absenteeism in the workplace in GDE? In your view, to what extent has this programme fulfilled the purpose for which it was implemented?

• Describe your experience with participating in the GDE health promotion programme, and how would you rate the services offered in the programme?

• Based on your view and experience, are the programme coordinators well-trained to stimulate a healthy and a conducive environment for employees through the programme?

Based on these questions, the following six steps were followed during data analysis and interpretation of responses from survey questionnaires:

• Transcribing of raw data

• Organising and preparing data

• Reading through all the data

• Coding

• Interrelating themes

• Data synthesis

Data from the qualitative survey questionnaires were extracted using thematic analysis and each participant’s responses were assigned a code to enhance anonymity and confidentiality of the responses. Thereafter, a thematic analysis was adopted based on identified patterns of occurrence observed from participant’s responses.

Identified themes: Three themes which were derived from the qualitative survey responses to understand the effectiveness of the GDE health promotion programme in enhancing employees’ productivity and this included the experiences of utilising services offered by the employer sponsored health promotion programme, the effectiveness of the health promotion programme and the ethical challenges in accessing the health promotion programme service provisions.

1. Understanding and experiences of utilising services offered by the GDE health promotion programme.

2. The effectiveness of the GDE health promotion programme.

3. Ethical challenges and capacity issues in the health promotion programme service provisions

Theme 1: Understanding the health promotion programme and its role in advancing employees’ productivity: Concerning the understanding of the programme and its role in advancing employees’ productivity, respondents presented varying views. For instance, the 40 respondents that were interviewed highlighted that a health promotion programme is beneficial in enhancing their productivity when faced with adverse health situations at work resulting from internal and external stressors. Respondents were employees from the GDE head office and its fifteen Districts. Although these participants have varying perceptions of what the implementation of the health promotion programme is meant to address.

For example, some responses have indicated a common view on the implementation of the health promotion programme in GDE as propounded by sixteen participants both from Head Office and Districts. This is evidenced by the following extract from a response by participant number 15 who is a Head Office official tasked with implementing the programme who stated that…“This programme is very useful, it helps one to maintain their healthy living by training staff on different topics (e.g. financial advice, stress/depression, sports training etc.) by health promotion unit, by doing this training and giving weekly or monthly brochure or pamphlets through email to staff”.

Consistently, participant number twelve (12) conceded that the implementation of the health promotion programme in GDE is beneficial to employees’ health and productivity. “My understanding is that health promotion programme is implemented not only to avert ill-health absenteeism but to raise awareness on Health and Wellness issues, provide basic health and wellness services and ensure that staff members are well equipped physically and psychologically for their better wellbeing”.

Moreover, another conceding response came from participant number nine (9) who shared the same sentiments stating that:

“Health promotion programme is a very important program for employees as we come from different backgrounds it helps employees to talk and find solutions to things they are dealing with in their personal lives”.

In support of this view, participant number fourteen (14) responded in a way that seeks to confirm what participant number nine has propounded. “It is a holistic approach to caring for the wellbeing of employees and their dependents. The employer providing services to support employees, putting needs at the forefront”.

Participant number three (3) also agreed that the implementation of the health promotion programme is effective and meets its objectives. Much of the evidence regarding the objective of the health promotion programme in advancing employees’ productivity was propounded by participant number five (5) who alluded that the programme is performing to its potential and many employees in adverse health conditions are assisted to regain their productivity potential. This is evidenced by the subsequent excerpt: “The programme is performing to its potential. A lot of employees are helped through it. It is a programme that is available to all employees to use and assist them with whatever challenges they are experiencing in their own life. I think the health promotion programme is doing an exquisite job within the department and therefore the support they are giving to us is helpful”.

Despite the positive views and experiences presented by the 16 participants, other participants had conflicting views regarding the programme. For instance, one participant stated that…. “This programme is pretty much useless. People still get absent and are not productive, yet the programme exists”. In the same vein, Participant (34) echoed the views as…“In most instances, how the health promotion programme is being conducted, it doesn’t meet its intended objective”

Further, participant number thirty-two (32) highlighted sentiments that expose the gaps in the implementation of the health promotion programme in GDE stating that….

“The programme is not effective and requires strengthening arms of human capital to meet its intended objectives”.

Another participant suggested that even though the program is implemented, and theoretically, however, it would be effective if it was advertised effective y to cover a wide range of activities and groups of employees. That is, to bring awareness about the programme. “Theoretically, it may be there. However, if it were compulsory and cover all the needs of all employees it would be better”.

Consistent with the above view, another participant indicated that the programme is ideal to enhance employees’ productivity. However, the policy exists but is lacking in implementation. This is evidenced by the following excerpt. “It is an ideal programme for employees to perform effectively; however, the programme is only on paper not effective in terms of implementation”.

Theme one sought to assess the level of understanding of the respondents concerning the programme and its role in the workplace. Although there were varying perceptions regarding the importance of this programme, more evidence from the participants’ responses pointed out to the relevance of this programme to enhancing the GDE employees’ health challenges. However, some participants’ responses highlighted considerable concerns regarding its implementation where some outlined that although the programme exists, no credible evidence can be deduced from it to achieve its effectiveness in addressing the phenomenon of ill- health absenteeism in GDE. Lastly, respondents raised concerns regarding employees’ awareness of the programme.

Theme 2: Employees’ experiences with utilising the services offered the health promotion programme: Concerning the utilisation of the programme services, participants yet again raised varying views. For instance, while some respondents highlighted that health promotion programme is crucial in addressing workplace issues and curbing absenteeism-some respondents were of the view the it does not help at all. That said, a participant (12) stated that my experience as a participant in the programme is that I have learned a lot as I was able to get advice regarding certain topics about my health and work-related issues and utilizing certain services provided by the programme”. This suggests that the programme has to some extent been effective in serving its purpose.

Furthermore, another participant (35) stated that….”There is a hotline given by our department to utilize if one wants to get assistance privately rather than using the officials within the unit, I have utilized this line several times whilst I was under a lot of stress, they listened to my problem and they promised to check the area where I reside and also referred me to psychologists.”

To showcase the practicability of the health promotion programme in assisting employees with work-related issues, a participant (31) espoused that the programme is essential in developing employees’ psycho-socially and had a great experience with the counsellors during her unfortunate health situation. This is supported by the following response…“From a professional point of view, I have seen individuals develop socially and psycho-socially from health promotion programme and as an Individual I also had a great experience with counsellors”.

Harmoniously, the participant (17) stated that participating in the programme offerings rejuvenates the health of employees and encourages a good state of mind to enhance productivity. This assertion is propounded below like this….“Health promotion programme is an important programme that every human being should participate in. It gives a total rejuvenation and establishes a good state of mental health”.

Consistent with the above assertion, another participant (39) alluded to health promotion programmes as a programme that is well placed to assist and encourage employees to take care of their health to enhance the organisation’s productivity. Evidence to support this statement is highlighted hereunder…..“As a wellness coordinator assisting and encouraging employees to take part in the programme, it is indeed a useful programme and assists employees a great deal”.

Furthermore, participant twenty-seven (27) agrees with the above view through her experience by reinforcing that the activities provided by the health promotion programmes in GDE encourage employees to get engaged in their daily duties with ease. The following statement advances this perception…“through this programme offering, I know things that are outside of my work”. Another participant postulated that although she had no experience with utilising the services offered by the health promotion programme in GDE, she once referred one of her employees who had behavioural problems and upon consultation, she noticed the employee’s attitude towards her work is improving. The following excerpt qualifies this assertion……“I have never used health promotion programme myself, but I have urged someone to get help and from it after which I saw her attitude towards work and other employees improving.”

Contrary to the above responses, some participants were of the view that sometimes the use of the programme services when one is undergoing work-related stressors can potentially lead to adverse health. For instance, another participant (38) highlighted that despite the fact that the health promotion programme is implemented, no practical results can be deduced from the programme intervention on issues that affect employees in their daily routine…..“It never did anything for me. We know it is there, but no implementation or practicality to it.”

Of particular concern, participant number twenty-six (26) highlighted that since the service offerings by the health promotion programme are offered in a two-tier system, the onsite which is implemented by the Departmental practitioners/coordinators and the offsite which is contracted by the Department, the onsite offerings lack professionalism as per her encounter. This is evidenced by the following extract from her response….“Lack of professionalism on in-house services”.

Moreover, participant number twenty-nine (29) argued that despite the health promotion programme being implemented, and employees do participate in this programme, problems among employees still exist. Below is the response from the district officers responded in this way……” Despite that the health promotion programme is implemented, employees continue to encounter issues that threaten their productivity. However, participation in this programme is ongoing”.

Theme two addressed the experiences in utilising the services offered by the health promotion programme. In this instance, participants’ responses further highlighted varying individual experiences in utilising these services whenever they felt challenged with workplace and other health-related challenges. Most participants’ responses were of the view that their experience in utilising these services was of value as they can relate their experiences with improved productivity in their working and general life. However, some responses alluded to the services offered by the programme as less effective to address their health challenges and this is compounded by the lack of professionalism in the onsite offerings, and some highlighted that the existence of the health promotion programme in GDE does not change the phenomenon of ill-health absenteeism behaviour.

Theme 3: The effectiveness of the health promotion programme: On this theme, sixteen (16) participants responded to this question with varying perceptions illuminated through their responses. Most of the participants shared common views on the value of the health promotion programme in assisting with health challenges that can interfere with their productive lives. However, some participant’s perceptions have shown divergent views, and this was highlighted emanating from their experience in utilising the services offered by the programme. To authenticate this, participant fifteen (15) elucidated her view on the value of the health promotion programme as….“Poor”.

Some participants’ perceptions have accentuated that the services offered by the health promotion programme are valued highly when faced with adverse health conditions that might have rendered them unproductive and ultimately lead to the application of ill-health absenteeism leave. Participant number twelve (12) pointed out that the programme is “highly valuable as it assists us, employees, to better ourselves to be more productive.”

Congruently, another participant highlighted that from his experience; the services offered by the health promotion programme were of great importance and fit for purpose. Below is his response… “Very highly”.

Similarly, participant number thirteen (13) conceded that the services offered by the EHWP provide good value and are offered voluntarily and confidentially. This is evidenced by the following quotation as espoused by the participant……“It provides a good value to the employees more especially that it is voluntary, confidential and employees can do this by themselves”.

Further, participant number fourteen (14) holds a view that she thinks the health promotion programme offerings are important, however, it is not marketed to reach a wider population of employees. This is her response…  “I think they are important is just that employees are not informed about it.”

Participant number fifteen (15) echoed the same sentiments, pointing out that the services offered by the programme have since improved due to COVID-19. However, she is not sure if this programme reaches all the GDE employees, especially in schools. To validate this statement, the following is an extract of her response….. “The services offered by our health promotion program have improved a lot since COVID-19 though not sure if their training is accessible to those outside offices (e.g., schools), and also it was lacking previously on issues that seek to promote health in the building that we occupy. All I know is that this programme is of value to use since I always get assisted whenever in need”.

Participant (01) response in this regard corroborated that the health promotion programme services have value on the lives and productivity of the employees and it also assists holistically on issues that affect them. Below is the assertion to validate this statement… ”I value the services very much because apart from the financial benefit they provide much-needed service to clients”.

Theme three examined the effectiveness of the health promotion programme in averting the phenomenon of ill-health absenteeism behaviour. In this theme, participants’ responses ignited the need for the elevation of these services across all the GDE institutions as its effectiveness has been recommended. Most of the participants’ responses elucidated that health promotion is effective in rejuvenating their productiveness in all aspects of their lives. However, some participants responses suggested that the services offered by this programme are poor as the needs of the employees are not considered in the programme planning.

Theme 4: Ethical challenges in health promotion programme service provisions: In this theme, issues about ethical practices when utilising the services provided by the employer-sponsored health promotion programme were highlighted by thirty-six (36) participants. The composition of responses comprised of the Head Office and District officials. Varying responses were illuminated on why GDE employees engage in ill-health absenteeism behaviour despite the implementation of the employer sponsored 4. GDE health promotion programme and the trust which GDE employees have in it. Based on the participants’ responses, it was deduced that the negative interference with the employees’ adverse health issues by management may serve as a disincentive for employees to participate in this programme. On the other hand, some participants have spelt out that the health promotion programme may be used to propel the take-up of ill-health absenteeism leave prematurely.

Over and above that, some participants have put forward that the health promotion programme coordinators cannot be trusted to handle their issues in a confidential manner that they would have anticipated from trained officials. Therefore, this becomes problematic for GDE employees to participate and share their health issues with them. In this regard, trust issues has contributed to some electing to consult with their identified medical practitioners or other healthcare facilities outside the employer-sponsored health promotion programme services. Much of the evidence regarding these issues is presented in the following excerpts from participants’ responses. Participant number twenty-nine (29) justifies this by saying…..”Confidentiality issue is the key for the supervisors. They cannot keep things to themselves and that annoys employees resorting to keeping quiet, consulting doctors genuinely so and others request sick notes just to be away from work environment”.

However, a divergent view was highlighted by participant sixteen’s (16) response who alluded that some employees may abuse the services offered by this programme to suit their predetermined agenda to just stay away from office conflicts. The following statement validates this claim……“I feel that employees abuse the PILIR (ill-health absenteeism) because some may find work boring and not challenging anymore as well as creating and avoiding office conflict. And by using the EHW programme it would force them to confront the workplace issues and strategize a solution.”

Ethical issues on the provision of these services were elucidated by participant number eighteen (18) who claimed that trust issues in the coordinators/practitioners in handling their issues may be a deterrent to utilising these services to undo ill-health absenteeism behaviour among GDE employees. Another issue on this, the participant postulated that the issue regarding ill-health absenteeism behaviour could be associated with the deficiencies in the marketing of the programme to reach all sectors of the employees across the province. To put this claim into context, the following is an extract from participant responses…..”I take that the problem is within the officials’ personality for not thinking on utilizing the services offered by the GDE or either trust issues on the person offering these services. If most of them were using them, I don’t think there will be a lot of absenteeism, especially in schools. I am not sure if they do have access to this training offered or given awareness by the health promotion programme. Again, it might be ignorance from the officials.”

The unethical behaviour of the managers towards employees who utilise the services offered by the health promotion programme and personality traits against the programme was highlighted by participant number twelve (12) who postulated that some employees may choose not to use the services offered by the employer- sponsored programme for fear of being prejudiced against by their managers and some feel that the health promotion programme is for the vulnerable and weak and the purported stigma around the utilisation of these services to enhance productivity. The following is the snippet taken from the participant’s response….”Often people experience ill-health absenteeism because some are reluctant to access the services because they regard the health promotion programme as for the weak, secondly some believe health promotion programme can be used against them by the employer, and others don’t want to share information, particularly with supervisors with the fear of being judged due to their challenges and there is still a sense of stigma around Wellness programme”.

Consistently, participant number fourteen (14) corroborates those ethical breaches hinder employees to use the services offered by the employer-sponsored programme to enhance their productivity thus undoing the behavioural trend of ill-health absenteeism behaviour. The following participant’s response substantiates this statement like this……“The stigma that is attached to counselling, it is presumed that the person is mentally ill rather than seeking help and support”. Often employees are scared to utilise the services offered by employer-sponsored programmes. These sentiments were shared by participant nine (9) who said that employees are scared to share their problems at work, and some are not aware that these services do exist. This emanates from how the programme is marketed. To share light on this statement, the following is the participant citation regarding this……“People are scared to share their problems at work and also not being aware that there are such programs in place”.

Concerning capacity issues, participant seventeen (17) purported that the problems with health promotion programme service provisions emanate from capacity constraints stemming from poorly trained Coordinators/Practitioners in each pillar in the onsite delivery model. The participant further highlighted that the Department should employ more competent personnel to deal with work-related stress to enable the employees to consult them knowing that their issues will be treated confidentially by these well-trained ethically competent personnel. To authenticate this assertion, below are the citations from the participant response…..“I think the resource/capacity is lacking for them to assist all the officials, it will be best to increase the staff capacity of the health promotion programme and employ experienced or trained officials for each relevant issue. For example, if it’s sports training, employ a qualified person, appoint staff to deal with stress (especially work- related) where one will go and get help with confidence knowing that my issues are treated with confidentiality”.

In the same vein, participant nineteen (19) shared similar sentiments regarding the ethical and professional training of GDE health promotion Coordinators/Practitioners to instil confidence in their service offerings. To support this view, below is the participant perception drawn from the survey response….

Theme four addressed the ethical challenges in implementing the health promotion programme in GDE. In this theme, participants’ responses were widely concerned with the unethical behaviour and low professionalization of the programme implementers on the onsite offerings. These challenges have been highlighted as deterrents to GDE employees’ participation in the programme offerings.

Results and Discussion

The purpose of this study was to examine the extent to which the health promotion programme curbs employee absenteeism in the Gauteng Department of Education. Through the developed themes, it transpired that most employees clearly understand the rationale behind the introduction of the programme and the objectives to be accomplished through the programme in the workplace. However, some concerns and issues around the programme were also raised, for example, although the programme has clear objectives, it is not well implemented and not efficiently marketed. Consequently, some participants perceive it as existing only on paper. Concerning the effectiveness of the programme, most of the respondents acknowledged the usefulness of the programme in serving its purpose and assisting in resolving their workplace personal issues and ultimately stimulating productivity. However, some respondents perceived the programme as useless since it did not help them. Some concerns around the employees’ awareness of the programme were raised.

Furthermore, concerning the ethics and capacity of programme implementers, respondents raised concerns regarding the capacity and qualifications of programme implementers. Respondents believed that implementers are not sufficiently skilled to deal with certain matters, as a result, some employees are victimised and called names after utilising the programme services. Some participants echoed the lack of ethical practice in offering the services offered in this programme. These gaps in the implementation of the health promotion programme may have debilitating health outcomes on the GDE employees thus affecting their productivity. These results are consistent with the sociology and the social-ecological model which posit that health behavioural change requires that the context within which the programme offerings occur to be considered by implementers [31,32].

Conclusion and Recommendations

This paper sought to examine the effectiveness of the health promotion programme in averting ill-health absenteeism in the workplace. The findings in this study suggest that although the programme may be effective in serving its purpose, there are still underlying issues that programme implementers need to consider if the programme is to improve its effectiveness and enhance productivity. The study also accentuated the relationship between the competency of the health promotion programme implementers, their ethical practices and the trust and value of its offerings to the successful implementation of this programme. The recognition of the employees’ needs in the planning phase of this programme has been underscored as a predictor of effective participation in the programme offerings. In this regard, the variation of content offerings to different employees’ needs becomes imperative.

To this end, individual perceptions regarding the consumption of health promotion programme services should be considered when implementing the programme. The recognition of the individuality of every employee’s needs in the planning and implementation of health-enhancing programmes becomes justifiable to enhance its effectiveness and to increase participation by the employees.

Conflict of Interest

The authors confirm that there is no conflict of interest to declare.

Data Availability Statement

The data that supports the findings of this study is available on request.

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