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- Title
Explaining retention of healthcare workers in Tanzania: moving on, coming to 'look, see and go', or stay?
- Authors
Shemdoe, Aloisia; Mbaruku, Godfrey; Dillip, Angel; Bradley, Susan; William, JeJe; Wason, Deborah; Hildon, Zoe Jane-Lara
- Abstract
<bold>Background: </bold>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?<bold>Methods: </bold>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.<bold>Results: </bold>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.<bold>Conclusions: </bold>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.
- Subjects
TANZANIA; MEDICAL personnel; MEDICAL care; EMPLOYEE retention; MATERNAL health services; INDUSTRIAL safety; MEDICAL care standards; ATTITUDE (Psychology); HEALTH facilities; JOB satisfaction; MOTIVATION (Psychology); PERSONNEL management; RURAL health services; RURAL population; SAFETY; RESIDENTIAL patterns; CROSS-sectional method
- Publication
Human Resources for Health, 2016, Vol 14, p1
- ISSN
1478-4491
- Publication type
journal article
- DOI
10.1186/s12960-016-0098-7