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BMC Health Services Research
Published in: BMC Health Services Research 1/2018

Open Access 01-12-2018 | Research article

Retention of medical doctors at the district level: a qualitative study of experiences from Tanzania

Authors: Nathanael Sirili, Gasto Frumence, Angwara Kiwara, Mughwira Mwangu, Amani Anaeli, Tumaini Nyamhanga, Isabel Goicolea, Anna-Karin Hurtig

Published in: BMC Health Services Research | Issue 1/2018

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Abstract

Background

Retention of Human Resources for Health (HRH), particularly doctors at district level is a big challenge facing the decentralized health systems in poorly resourced countries. Tanzania, with 75% of its population in rural areas, has only 26% of doctors serving in rural areas. We aimed to analyze the experiences regarding the retention of doctors at district level in Tanzania from doctors’ and district health managers’ perspectives.

Methods

A qualitative study was carried out in three districts from June to September 2013. We reviewed selected HRH documents and then conducted 15 key informant interviews with members of the District Health Management teams and medical doctors working at the district hospitals. In addition, we conducted three focus group discussions with Council Health Management Team members in the three districts. Incentive package plans, HRH establishment, and health sector development plans from the three districts were reviewed. Data analysis was performed using qualitative content analysis.

Results

None of the districts in this study has the number of doctors recommended. Retention of doctors in the districts faced the following challenges: unfavourable working conditions including poor working environment, lack of assurance of career progression, and a non-uniform financial incentive system across districts; unsupportive environment in the community, characterized by: difficulty in securing houses for rent, lack of opportunities to earn extra income, lack of appreciation from the community and poor social services.
Health managers across districts endeavour to retain their doctors through different retention strategies, including: career development plans, minimum financial incentive packages and avenues for private practices in the district hospitals. However, managers face constrained financial resources, with many competing priorities at district level.

Conclusions

Retention of doctors at district level faces numerous challenges. Assurance of career growth, provision of uniform minimum financial incentives and ensuring availability of good social services and economic opportunities within the community are among important retention strategies.
Appendix
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Literature
1.
WHO. The world health report: 2006: working together for health. Geneva: World Health Organization; 2006.
2.
Anyangwe SC, Mtonga C. Inequities in the global health workforce: the greatest impediment to health in sub-Saharan Africa. Int J Environ Res Public Health. 2007;4(2):93–100.CrossRefPubMedPubMedCentral
3.
Pathman DE, Williams ES, Konrad TR. Rural physician satisfaction: its sources and relationship to retention. J Rural Health. 1996;12(5):366–77.CrossRefPubMed
4.
Glasser M, MacDowell M, Hunsaker M, Salafsky B, Nielsen K, Peters K, Meurer M. Factors and outcomes in primary care physician retention in rural areas. South African Family Practice. 2010;52(4):336–40.CrossRef
5.
Kotzee TJ, Couper ID. What interventions do south African qualified doctors think will retain them in rural hospitals of the Limpopo province of South Africa? Rural Remote Health. 2006;6(3):581.PubMed
6.
Dussault G, Franceschini MC. Not enough there, too many here: understanding geographical imbalances in the distribution of the health workforce. Hum Resour Health. 2006;4(1):12.CrossRefPubMedPubMedCentral
7.
8.
Mills EJ, Kanters S, Hagopian A, Bansback N, Nachega J, Alberton M, Au-Yeung CG, Mtambo A, Bourgeault IL, Luboga S, Hogg RS. The financial cost of doctors emigrating from sub-Saharan Africa: human capital analysis. BMJ. 2011;343:d7031.CrossRefPubMedPubMedCentral
9.
10.
Araujo E, Maeda A. How to recruit and retain health Workers in Rural and Remote Areas in developing countries a guidance note. 2013.
11.
Yumkella F. Retention of health care workers in low-resource settings: challenges and responses. IntraHealth International. 2006;1:1-4.
12.
Farooq U, Ghaffar A, Narru IA, Khan D, Irshad R. Doctors’ perception about staying in or leaving rural health facilities in district Abbottabad. J Ayub Med Coll Abbottabad. 2004;16(2):64–9.PubMed
13.
Sirili N, Kiwara A, Gasto F, Goicolea I, Hurtig A-K. Training and deployment of medical doctors in Tanzania post-1990s health sector reforms: assessing the achievements. Hum Resour Health. 2017;15(1):27.CrossRefPubMedPubMedCentral
14.
URT. Ministry of Health and Social Welfare. Mid-Term Review of the Health Sector Strategic Plan III 2009 – 2015, Main Report. Dar es Salaam: United Republic of Tanzania; 2013.
15.
WHO. World health statistics 2010. Geneva: World Health Organization; 2010. p. 177.
16.
URT. Ministry of Health and social welfare. Human resource for health strategic plan 2008–2013. Dar es Salaam: United Republic of Tanzania; 2008.
17.
URT. National Bureau of statistics. Population and housing census. Dar es Salaam: United Republic of Tanzania; 2012. p. 2013.
18.
URT. Ministry of Health and social welfare. Human resource for health country profile 2013/2014. Dar es Salaam: United Republic of Tanzania; 2014.
19.
Sirili N, Kiwara A, Nyongole O, Frumence G, Semakafu A, Hurtig AK. Addressing the human resource for health crisis in Tanzania: the lost in transition syndrome. Tanzan J Health Res. 2014;16(2):104–11.CrossRefPubMed
20.
Sirili N, Angwara K, Simba D. Challenges towards realization of health care sector goals of Tanzania development vision 2025, training and deployment of graduate human resource for health. East Afr J Public Health. 2013 Jun;9(2):476–86.
21.
URT. Ministry of Education and vocation training. Higher education students loans board, local undergraduate application form for grants. Dar es Salaam: United Republic of Tanzania; 2012.
22.
URT. Ministry of Health. National Health Policy [draft]. Dar es Salaam: United Republic of Tanzania; 2003.
23.
URT. Policy paper on local government reform. Dar es Salaam: United Republic of Tanzania; 1998.
24.
Munga MA, Songstad NG, Blystad A, Mæstad O. The decentralisation-centralisation dilemma: recruitment and distribution of health workers in remote districts of Tanzania. BMC Int Health Hum Rights. 2009;9(1):9.CrossRefPubMedPubMedCentral
25.
26.
Kwesigabo G, Mwangu MA, Kakoko DC, Warriner I, Mkony CA, Killewo J, Macfarlane SB, Kaaya EE, Freeman P. Tanzania's health system and workforce crisis. J Public Health Policy. 2012;33(1):S35–44.CrossRefPubMed
27.
Manzi F, Schellenberg JA, Hutton G, Wyss K, Mbuya C, Shirima K, Mshinda H, Tanner M, Schellenberg D. Human resources for health care delivery in Tanzania: a multifaceted problem. Hum Resour Health. 2012;10(1):3.CrossRefPubMedPubMedCentral
28.
Mkoka DA, Mahiti GR, Kiwara A, Mwangu M, Goicolea I, Hurtig AK. “Once the government employs you, it forgets you”: health workers’ and managers’ perspectives on factors influencing working conditions for provision of maternal health care services in a rural district of Tanzania. Hum Resour Health. 2015;13(1):77.CrossRefPubMedPubMedCentral
29.
Patton MQ, Cochran Michael. A guide to using qualitative research methodology. 2002.
30.
URT. Ministry of Health and social welfare. Human resource for health country profile 2012/2013. Dar es Salaam: United Republic of Tanzania; 2013.
31.
Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24(2):105–12.CrossRefPubMed
32.
Kohlbacher F. The use of qualitative content analysis in case study research. InForum qualitative Sozialforschung/Forum: Qualitative Social Research 2006;7(1):4-10.
33.
URT. Ministry of Health and social welfare. Final evaluation report for human resource for health strategic plan 2008–2013. Dar es Salaam: United Republic of Tanzania; 2014.
34.
Frehywot S, Mullan F, Payne PW, Ross H. Compulsory service programmes for recruiting health workers in remote and rural areas: do they work? Bull World Health Organ. 2010;88(5):364–70.CrossRefPubMedPubMedCentral
35.
Shemdoe A, Mbaruku G, Dillip A, Bradley S, William J, Wason D, Hildon ZJ. Explaining retention of healthcare workers in Tanzania: moving on, coming to ‘look, see and go’, or stay? Hum Resour Health. 2016;14(1):2.CrossRefPubMedPubMedCentral
36.
Kabene SM, Orchard C, Howard JM, Soriano MA, Leduc R. The importance of human resources management in health care: a global context. Hum Resour Health. 2006;4(1):20.CrossRefPubMedPubMedCentral
37.
Bärnighausen T, Bloom DE. Designing financial-incentive programmes for return of medical service in underserved areas: seven management functions. Hum Resour Health. 2009;7(1):52.CrossRefPubMedPubMedCentral
38.
World Health Organization. Increasing access to health workers in remote and rural areas through improved retention: global policy recommendations. Geneva: World Health Organization; 2010.
39.
Dolea C, Stormont L, Braichet JM. Evaluated strategies to increase attraction and retention of health workers in remote and rural areas. Bull World Health Organ. 2010;88(5):379–85.CrossRefPubMedPubMedCentral
40.
41.
Dambisya YM. A review of non-financial incentives for health worker retention in east and southern Africa. Health systems research group, Department of Pharmacy, school of health sciences, University of Limpopo, South Africa. 2007 (44):49–50.
42.
Abimbola S, Olanipekun T, Igbokwe U, Negin J, Jan S, Martiniuk A, Ihebuzor N, Aina M. How decentralisation influences the retention of primary health care workers in rural Nigeria. Glob Health Action. 2015;8(1):26616.CrossRefPubMed
43.
URT. Ministry of Health and social welfare. Human resource for health strategic plan 2014-2019. Dar es Salaam: United Republic of Tanzania; 2014.
44.
USAID. IntraHealth international and Mkapa HIV AIDS foundation. Tanzania human resource capacity project. Multisectoral criteria for defining underserved areas. A basis for developing an incentive package. Dar es Salaam: IntraHealth International; 2012.
45.
SPHSS-MUHAS. Analysis of the constraints in human resource availability (training, recruitment, deployment and retention) especially in hard to reach areas. Dar es Salaam: School of Public Health and Social Sciences-Muhimbili University of Health and Allied Sciences; 2009. p. 1–83.
46.
Chen L, Evans T, Anand S, Boufford JI, Brown H, Chowdhury M, Cueto M, Dare L, Dussault G, Elzinga G, Fee E. Human resources for health: overcoming the crisis. Lancet. 2004;364(9449):1984–90.CrossRefPubMed
47.
Shenton AK. Strategies for ensuring trustworthiness in qualitative research projects. Educ Inf. 2004;22(2):63–75.
Metadata
Title
Retention of medical doctors at the district level: a qualitative study of experiences from Tanzania
Authors
Nathanael Sirili
Gasto Frumence
Angwara Kiwara
Mughwira Mwangu
Amani Anaeli
Tumaini Nyamhanga
Isabel Goicolea
Anna-Karin Hurtig
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2018
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-018-3059-0

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