Recognizing a global shortage of health workers (HWs), particularly in low- and middle-income countries (LMICs), persistent calls to increase retention and recruitment of this essential workforce have been made. Attrition of HWs is driven in part by unsafe working conditions. To help promote and improve the occupational health and safety (OHS) of HWs, the International Labour Organization (ILO) and World Health Organization (WHO), two specialized agencies of the United Nations, developed

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... ISE. This quality improvement tool helps health facilities identify workplace hazards and develop and apply low-cost solutions. This dissertation examines the overriding question: 'What are the enabling factors and barriers to the effective local implementation of internationally designed tools, to improve the OHS of HWs in high-risk areas?' To achieve this, it first explores the roles of the ILO and WHO in promoting the OHS of HWs through 17 semi-structured expert interviews supplemented by a literature and document review. Second, it examines the enabling factors and barriers to the implementation of HealthWISE in seven hospitals in Mozambique, South Africa, and Zimbabwe using a multiple-case study and applying the i-PARIHS framework. Finally, it develops theories about how HealthWISE works to improve the OHS of HWs through a realist evaluation. Roles identified as appropriate for international organizations included raising awareness and advocating (for OHS improvements) as well as developing and supporting the application of tools (like HealthWISE). Factors that enabled efficacious implementation of HealthWISE included dedicated local team members who adapted HealthWISE to workers' OHS knowledge and skill levels and to the cultures and needs of their workplaces. Initial program theories suggested that HealthWISE works by increasing HWs' feelings of value, empowerment, and ownership over their personal health and safety, and by emphasizing the need to work with available resources – based on content developed by two rec [...]