Challenges faced by Social Workers in secondary setting such as hospital/ medical setting in Zimbabwe by Nothokozo

In Zimbabwe, Medical social work was introduced as a response to public health issues of disease prevention and control (Chitereka, 2012) Medical social workers are also employed in government hospitals and local authority hospitals such as Harare and Bindura Central Hospitals, coordination with the Department of Social Development\Welfare Services through the Case Management System. Social Workers in Zimbabwe working at secondary settings like hospitals have roles such as rehabilitation, counselling, conduction home visits among others. Medical social work is a sub discipline of social work that is aligned to public health, involves assessment, diagnosis and provision of social work interventions to improve the psychosocial functioning of patients and their families (Harris, 2006). Medical social work helps patients overcome the burden of treatment for both acute and chronic ailments. In light of all these, medico social workers face a plethora of challenges in the health sector, therefore this paper serves to analyze the challenges faced by social workers in secondary settings like hospitals considering lack of team work by working with interdisciplinary teams, resource constraints, high workload and case overload, challenging clients, long working hours to mention but a few. The paper is also going to proffer recommendations on how best can these challenges faced by social workers in secondary settings like hospitals be address for example through employment of more social workers in hospitals, the government of Zimbabwe to finance the health sector with 15% effectively as per the Abuja Declaration.

Medical Social Work as, a process which serves to assist the case worker in diagnosis and treatment of patient through study of the patient in his social situation and by understanding the patient and his environment(Cobat , 2010). Medical Social Work is the application of social work knowledge, skills, attitudes and values to the field of health and medicine (Thackeray, Farley and Skidmore, 1994). A Social worker is a person that is professionally trained and registered by the regulatory board of Council of Social Workers statutory Instrument 179 of 2005. 

Social Workers in secondary setting in like hospitals in Zimbabwe face a challenge of lack of team work by working with interdisciplinary teams. Social workers in Zimbabwe working in hospitals like for example Harare, Bindura hospital work with interdisciplinary teams for example doctors, nurses, case managers, and other health care professionals and lack of team work challenge they face in their field (Munyokoveri, 2019). Moreover, the major challenges associated with working in interdisciplinary teams include differing perspectives and the down looking upon the practice of social work in health settings. In terms of decision making, the organization overlooks the contribution of social workers on the ground that social workers are not medical practitioners. Differing Perspectives for example doctors and nurses are more concerned with curing the patient hence make use of the Curative Model but Social workers seeks to employ Multi Modal approach with BASIC ID (Lazarus, 1978) to effectively understand the circumstances surrounding the clients elements rather than just focusing on the Curative or Preventive aspect thus difference in techniques between social workers and the interdisciplinary team like doctors, nurses to mention but a few. Furthermore, insensitive policies are organizational challenges encountered in their field (Embriaco et.al, 2007) and (Yamatani, 2009) by social worker resulting in difference of opinion for example discharge plan, doctors and nurses may want to discharge clients like a victim of Gender Based Violence (GBV) but social workers may delay the discharge process in order to visit conduct Home Assessment of the client, offer counselling and psychosocial support as alluded by (Engel, 1966) that Medical Social Workers seeks to understand also the clients environment, family which may delay the treatment process and discharge plan. More so,   the interdisciplinary team members do not know what the Medical Social Workers role thus sometimes the roles and functions of social workers is often not appreciated and the practice often undermined. Therefore, lack of team work by working with interdisciplinary teams is also a challenge social workers face in Secondary settings like Hospitals

 Resources constraints is also a challenge faced by social workers in secondary setting like hospitals in Zimbabwe. In this respect,  resources such as financial, staffing and vehicle are some of the resource problems faced by social workers in hospitals especially government hospitals like Harare, Bindura and Bulawayo hospitals .Medical social work is a sub discipline of social work that is aligned to public health, involves assessment, diagnosis and provision of social work interventions to improve the psychosocial functioning of patients and their families (Harris, 2006) thus it requires more social work staff since there is a lot of work involved through the Case Management System in terms of assessment, planning, implementation, monitoring and evalution and also in the referral system to other helping agencies like the Department of Social Development / Social Welfare.  In this manner, (Westman and Bakker , 2008) argued lack of resources is a major component in the medical field that leads to high rates of burnout for example Medico Social Workers at Harare Hospital are poorly financed and poorly remunerated by the government of Zimbabwe. Due to the lack of resources like more social workers , financial and vehicle in the it is a challenge to help the vulnerable population, the medical social workers serve poor economic conditions, low wages and lack of opportunities, desire to gain international experience, and improved lifestyle (Tevera & Chikanda, 2009) thus lack of resources like vehicle as argued by (Mupedziswa ,2015) deters Medico Social workers from conducting home visits for clients who have been discharged for example a Child Welfare Case of a child who was sexually abused by another juvenile under Section 135 of the Criminal Procedure and Evidence Act (Chapter 9:07) and as encoded in the Children’s Act (Chapter 5:06), social workers have a role to conduct Home Assessment to probe the circumstances surrounding the offense as well as understand the Person In the Environment as alluded by (Bronfenbrenner, 1979).  Limited resources and limited funds also affect the working of medical social services. The process of getting services is exhaustive, Follow-up of patients is very weak. Family counseling is not being practiced properly in hospitals thus constraints of resources in the health sector limits the roles of Medical Social works hence it becomes a challenge. 

High Workload and case overload is also a challenge faced by Social workers in secondary setting like hospitals in Zimbabwe. Heavy caseloads are common in the field of social work, this is especially for social workers in the field of child welfare. Social workers are often given caseloads that exceed the recommended maximum which puts substantial pressure on the worker to process their cases as quickly as possible (Yamatani, Engel, & Spjedlnes, 2009). Secondary settings like hospitals like  Wilkins and Beatrice hospitals do not have many Medico Social workers hence that one or two social workers have to attend to all clients and assess all cases thus (Harris, 2006) concurred with (Embriaco et al., 2007) that overall workload has been associated with high burnout rates.  High workload experienced by health care providers can impact not only their health and quality of working life, but also can negatively impact their patient’s safety (Carayon & Alvarado, 2007) thus due to poor staffing leading to high work over load Medico Social workers may not effectively implement their roles and function at the hospital for example offering rehabilitation to clients suffering from a mental disorder like depression. Challenges social workers encounter included for example increasing paperwork, unmanageable caseloads, and difficult clients (Whitaker et al., 2006). Social workers report that major work-related stressors included insufficient time to do their job since more clients need to be attended (Whitaker & Arrington, 2008). The quick processing of cases can negatively impact clients as social workers are unable to provide adequate time and services needed for each case. Thus high Workload and case overload is also a challenge faced by Social workers in secondary setting like hospitals in Zimbabwe.

Social workers in secondary settings in Zimbabwe like Hospital face the challenge of Challenging Clients. Social workers dealing with challenging clients is one of the major challenges they experience that lead to increases in stress, for example social workers providing mental health services (Whitaker & Arrington, 2008). Research has proven  found that social workers who work with clients that have severe and persistent mental illnesses reported feeling incompetent, which led to higher levels of burnout symptoms (Acker and Lawrence ,2009). Medical social worker values the ethical concepts of self-determination of the patients as encoded in the (National Association of Social Workers, 2017) code of ethics and  strives to ensure the right of the patient to make his/her own choice about treatment, planning, care and discharge thus due to challenging clients ethical dilemmas can also arise when dealing with difficult clients (Becker, 2003). Furthermore, (Ulrich et al., 2007) found that nearly two-thirds of social workers working in hospitals reports that they felt powerless, overwhelmed, and frustrated when there were presented with ethical issues that they could not do anything about for example the Mental Health Act (Chapter 15:12) of 1956 gives clients suffering from any mental disorder like substance abuse to refuse treatment and rehabilitation services hence this can negatively impact clients as it can lead to inadequate and unethical services to clients.

However, the writer in this segment recommends that government of Zimbabwe and Private Health sector should employ more Social workers in order to combat the challenges of high workloads and caseloads providing more time for case assessment, planning and implementation through the Case Management System.. The Government of Zimbabwe should provide more finance for the health sector in order to employ more Medico Social Workers in hospitals and reduce resource constraints thus should adhere to the Abuja Declaration that prompts funding the National Health Sector with 15% from the National Budget. 

However, the Government of Zimbabwe should restructure some health related policies like the Mental Health Act (Chapter 15:12) in order to encompass the new technological changes, address the over growing population and the universal provision of health services for all clients. Thus it enable Medico Social workers and other practitioners like psychiatrist to be able to deal with challenging clients refusing treatment. 

However, the government of Zimbabwe and private hospitals should increase Medico Social workers remuneration or salary to deal with the problem of brain drain and poor social work staffing in hospitals like Harare and Bulawayo hospital. Many professional social workers are leaving the country in search for green pastures in the United Kingdom due to the fact that social workers are poorly salaried.

This paper has successfully managed to analyze challenges faced by Social workers in hospitals. It considered, lack of team work by working with interdisciplinary teams, resource constraints, high workload and case overload, challenging clients, long working hours to mention but a few. The paper is also going to proffer recommendations on how best can these challenges faced by social workers in secondary settings like hospitals be address for example through employment of more social workers in hospitals, the government of Zimbabwe to finance the health sector with 15% effectively as per the Abuja Declaration

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