ABSTRACT:
Background - Moral distress among the health workforce is increasingly featuring in public health discourse globally. But what is moral distress, what are the causes, and what are leaders’ responsibilities to minimise and manage it? This session will explore these questions with a focus on organisational-level causes and consequences of moral distress among frontline workers in public healthcare systems. Methods - Our interactive workshop will begin with panel-style inputs on definitions of moral distress, burnout and moral injury, followed by brief learning from: a) a scoping review of African literature; 2) a qualitative study of 121 new doctors and nurses working in Kenyan hospitals and 3) participatory consultative workshops held in South Africa, Ghana, Nepal and Kenya. The rest of the session will focus on gathering inputs from session participants on potential areas for intervention and the role of mid- and senior-level leaders. Results - Moral distress is applied variably in the literature, with reported interventions largely aspirational. Findings from the Kenyan work and consultations show that frontline health workers navigate prolonged conditions of resource scarcity and periodic shocks with inadequate institutional support. These conditions create moral grey zones where distinctions between right and wrong are blurred, and shocks such as COVID-19 intensify the moral distress embedded in everyday routines. Discussions on interventions will include structured (ethics) de-briefs, reorganisation of staff work routines, collaborative ethics education initiatives and training. Discussants will make final inputs. Conclusion - While organisational practices can act as drivers of distress and trauma, they can also be sites of intervention to minimize moral distress and promote well-being. Where carefully designed and implemented, they can have positive implications for service delivery, system resilience and public health. However, interventions can also exacerbate conditions which contribute to injury and the structural drivers of moral distress must also be addressed.