Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Human Resources for Health
Published in: Human Resources for Health 1/2016

Open Access 01-12-2016 | Research

Explaining retention of healthcare workers in Tanzania: moving on, coming to ‘look, see and go’, or stay?

Authors: Aloisia Shemdoe, Godfrey Mbaruku, Angel Dillip, Susan Bradley, JeJe William, Deborah Wason, Zoe Jane-Lara Hildon

Published in: Human Resources for Health | Issue 1/2016

Login to get access

Abstract

Background

In the United Republic of Tanzania, as in many regions of Sub-Saharan Africa, staff shortages in the healthcare system are a persistent problem, particularly in rural areas. To explore staff shortages and ways of keeping workers in post, we ask, (a) Which cadres are most problematic to recruit and keep in post? (b) How and for what related reasons do health workers leave? (c) What critical incidents do those who stay face? (d) And why do they stay and cope?

Methods

This is a multi-method paper based on analysis of data collected as part of a cross-sectional health facility study supporting maternal and reproductive health services in the United Republic of Tanzania. Qualitative data were generated through semi-structured interviews with Council Health Management Teams, and Critical Incident Technique interviews with mid-level cadres. Complementary quantitative survey data were collected from district health officials, which are used to support the qualitative themes.

Results

Mid-level cadres were problematic to retain and caused significant disruptions to continuity of care when they left. Shortage of highly skilled workers is not only a rural issue but also a national one. Staff were categorised into a clear typology. Staff who left soon after arrival and are described by ‘Look, See and Go’; ‘Movers On’ were those who left due to family commitments or because they were pushed to go. The remaining staff were ‘Stayers’. Reasons for wanting to leave included perceptions of personal safety, feeling patient outcomes were compromised by poor care or as a result of perceived failed promises. Staying and coping with unsatisfactory conditions was often about being settled into a community, rather than into the post.

Conclusions

The Human Resources for Health system in the United Republic of Tanzania appears to lack transparency. A centralised monitoring system could help to avoid early departures, misallocation of training, and other incentives. The system should match workers’ profiles to the most suitable post for them and track their progress and rewards; training managers and holding them accountable. In addition, priority should be given to workplace safety, late night staff transport, modernised and secure compound housing, and involving the community in reforming health services culture and practices.
Literature
1.
Araujo E, Maeda A. How to recruit and retain health workers in rural and remote areas in developing countries. Washington: The World Bank (World Bank Health, Nutrition and Population Discussion Paper); 2013.
2.
World Health Organization. Increasing access to health workers in remote and rural areas through improved retention. Geneva: WHO; 2010. p. 1–9.
3.
Prytherch H, Kakoko DCV, Leshabari MT, Sauerborn R, Marx M. Maternal and newborn health care providers in rural Tanzania: in-depth interviews exploring influences on motivation, performance and job satisfaction. Rural Rem Health. 2012;12:2072.
4.
Dal Poz MR, Gupta N, Quain E, Soucat ALH. Handbook on monitoring and evaluation of human resources for health: with special applications for low- and middle-income countries. Geneva: WHO; 2009.
5.
Zurn P, Dolea C, Stilwell B. Nurse retention and recruitment: developing a motivated workforce. ICN Issue Paper No. 4. Geneva: International Council of Nurses, WHO; 2005.
6.
Rockers PC, Jaskiewicz W, Wurts L, Kruk ME, Mgomella GS, Ntalazi F. Preferences for working in rural clinics among trainee health professionals in Uganda: a discrete choice experiment. BMC Health Serv Res. 2012;12:212.CrossRefPubMedPubMedCentral
7.
8.
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;9:9.CrossRefPubMedPubMedCentral
9.
Ifakara Health Institute. Tanzania Service Availability and Readiness Assessment (SARA) 2012. Dar es Salaam: Ifakara Health Institute; 2013.
10.
Mubyazi GM, Bloch P, Byskov J, Magnussen P, Bygbjerg IC, Hansen KS. Supply-related drivers of staff motivation for providing intermittent preventive treatment of malaria during pregnancy in Tanzania: evidence from two rural districts. Malar J. 2012;11:48.CrossRefPubMedPubMedCentral
11.
Kuper A, Reeves S, Levinson W. An introduction to reading and appraising qualitative research. BMJ. 2008;337:288.CrossRef
12.
13.
Chell E. Critical incident technique. In: Cassell C, Symon G, editors. Essential guide to qualitative methods in organizational research. London: Sage; 2004. p. 45–60.CrossRef
14.
15.
Brown A, Cometto G, Cumbi A, de Pinho H, Kamwendo F, Lehmann U, et al. HRH Exchange of the Global Health Workforce Alliance: mid-level health providers: a promising resource. Rev Peru Med Exp Salud Publica. 2011;28(2):308–15.CrossRefPubMed
16.
Lehmann U. Mid-level health workers. The state of the evidence on programmes, activities, costs and impact on health outcomes. A literature review. Geneva: WHO, Department of Human Resources for Health; 2008.
17.
18.
Ministry of Health and Social Welfare, Tanzania. Human Resource For Health And Social Welfare Strategic Plan 2014 – 2019. Dar es Salaam: Ministry of Health and Social Welfare; 2014.
19.
Schaaf M, Freedman LP. Unmasking the open secret of posting and transfer practices in the health sector. Health Policy Plan. 2015;30(1):121–30.CrossRefPubMed
20.
Sheikh K, Freedman L, Ghaffar A, Marchal B, el-Jardali F, McCaffery J, et al. Posting and transfer: key to fostering trust in government health services. Hum Resour Health. 2015;13(1):1–4.CrossRef
21.
Bradley S, Kamwendo F, Chipeta E, Chimwaza W, de Pinho H, McAuliffe E. Too few staff, too many patients: a qualitative study of the impact on obstetric care providers and on quality of care in Malawi. BMC Pregnancy Childbirth. 2015;15:65.CrossRefPubMedPubMedCentral
22.
Mbaruku GM, Larson E, Kimweri A, Kruk ME. What elements of the work environment are most responsible for health worker dissatisfaction in rural primary care clinics in Tanzania? Hum Resour Health. 2014;12:38.CrossRefPubMedPubMedCentral
23.
Songstad NG, Moland KM, Massay DA, Blystad A. Why do health workers in rural Tanzania prefer public sector employment? BMC Health Serv Res. 2012;12:92.CrossRefPubMedPubMedCentral
24.
Zinnen V, Paul E, Mwisongo A, Nyato D, Robert A. Motivation of human resources for health: a case study at rural district level in Tanzania. Int J Health Plann Manage. 2012;27:327–47.CrossRefPubMed
25.
Katongole SP, Mugisha JF, Anguyo R, Bikaitwoha EM, Wampande LN. Perceptions of health workers and managers on the use of non-monetary human resource motivation tools in general hospitals of central Uganda. Int J Public Health Res. 2015;3(5):264–70.
26.
Mutale W, Ayles H, Bond V, Tembo Mwanamwenge Mwanamwenge MT, Balabanova D. Measuring health workers’ motivation in rural health facilities: baseline results from three study districts in Zambia. Hum Resour Health. 2013;11:8.CrossRefPubMedPubMedCentral
27.
Serneels P, Montalvo JG, Pettersson G, Lievens T, Butera JD, Kidanu A. Who wants to work in a rural health post? The role of intrinsic motivation, rural background and faith-based institutions in Ethiopia and Rwanda. Bull World Health Organ. 2010;88:342–9.CrossRefPubMedPubMedCentral
28.
Zurn P, Codjia L, Sall FL, Braichet J-M. How to recruit and retain health workers in underserved areas: the Senegalese experience. Bull World Health Organ. 2010;88:386–9.CrossRefPubMedPubMedCentral
29.
Honda A, Vio F. Incentives for non-physician health professionals to work in the rural and remote areas of Mozambique—a discrete choice experiment for eliciting job preferences. Hum Resour Health. 2015;13:23.CrossRefPubMedPubMedCentral
30.
Metadata
Title
Explaining retention of healthcare workers in Tanzania: moving on, coming to ‘look, see and go’, or stay?
Authors
Aloisia Shemdoe
Godfrey Mbaruku
Angel Dillip
Susan Bradley
JeJe William
Deborah Wason
Zoe Jane-Lara Hildon
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Human Resources for Health / Issue 1/2016
Electronic ISSN: 1478-4491
DOI
https://doi.org/10.1186/s12960-016-0098-7

Other articles of this Issue 1/2016

Human Resources for Health 1/2016 Go to the issue

Case study

E-learning for research capacity strengthening in sexual and reproductive health: the experience of the Geneva Foundation for Medical Education and Research and the Department of Reproductive Health and Research, World Health Organization

Research

Difficulties experienced by migrant physicians working in German hospitals: a qualitative interview study

Research

A systematic review of physician retirement planning

Research

Impact of MPH programs: contributing to health system strengthening in low- and middle-income countries?

Research

Factors influencing motivation and job satisfaction among supervisors of community health workers in marginalized communities in South Africa

Research

A study of organizational versus individual needs related to recruitment, deployment and promotion of doctors working in the government health system in Odisha state, India