Accommodate or Reject: The Role of Local Communities in the Retention of Health Workers in Rural Tanzania

Sirili, Nathanael; Simba, Daudi; Zulu, Joseph Mumba; Frumence, Gasto; Tetui, Moses

doi:10.34172/ijhpm.2021.77

Cited by 8 publications

(8 citation statements)

References 22 publications

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“…The balance between integration into a rural community and rejection may be delicate. 56 This may explain our participants' need to protect social integrity, and to include their clients in the creation of an alternative narrative of maternity care (figure 4).…”

Section: Bmj Global Healthmentioning

confidence: 99%

Understanding maternity care providers’ use of data in Southern Tanzania

et al. 2023

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IntroductionHealth information management system data is collected for national planning and evaluation but is rarely used for healthcare improvements at subnational or facility-level in low-and-middle-income countries. Research suggests that perceived data quality and lack of feedback are contributing factors. We aimed to understand maternity care providers’ perceptions of data and how they use it, with a view to co-design interventions to improve data quality and use.MethodsWe based our research on constructivist grounded theory. We conducted 14 in-depth interviews, two focus group discussions with maternity care providers and 48 hours of observations in maternity wards to understand maternity providers’ interaction with data in two rural hospitals in Southern Tanzania. Constant comparative data analysis was applied to develop initial and focused codes, subcategories and categories were continuously validated through peer and member checks.ResultsMaternity care providers found routine health information data of little use to reconcile demands from managers, the community and their challenging working environment within their daily work. They thus added informal narrative documentation sources. They created alternative narratives through data of a maternity care where mothers and babies were safeguarded. The resulting documentation system, however, led to duplication and increased systemic complexity.ConclusionsCurrent health information systems may not meet all data demands of maternity care providers, or other healthcare workers. Policy makers and health information system specialists need to acknowledge different ways of data use beyond health service planning, with an emphasis on healthcare providers’ data needs for clinical documentation.

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Section: Bmj Global Healthmentioning

confidence: 99%

Understanding maternity care providers’ use of data in Southern Tanzania

et al. 2023

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“…When primary health workers are respected and recognized by the community, they feel part of the community to the point that they are motivated and subsequently retained to continue working in rural areas. The respect and recognition by society can be seen through gestures of community appreciation [8,14], through the community naming their children after health workers, gifts such as chickens, goats being given to health workers after recovery. This motivates primary health workers as they feel part of the community especially when they are also appointed to leadership positions.…”

Section: Discussionmentioning

confidence: 99%

“…Most human resources for health either do not wish to, or work in rural settings during their careers owing to poor motivation. Various factors have been stated to motivate healthcare workers in rural areas including training opportunities, nancial and non-nancial incentives, and environmental support including fairness and transparency of human resource management systems [10][11][12][13][14][15]. Another study found that living conditions, social factors, working conditions, and individual factors in uence the motivation and retention of health professionals to work in rural areas [16].…”

Section: Introductionmentioning

confidence: 99%

Motivation and retention of primary healthcare workers in rural health facilities: An exploratory qualitative study of Chipata and Chadiza Districts, Zambia.

Manda

Silumbwe

Kombe

et al. 2022

Preprint

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BackgroundRural areas have the most pressing health needs in most low-and-middle-income countries and yet they face the largest shortage of human resources for health. This reality cripples the already fragile local healthcare systems as they struggle with how best to motivate and retain health workers in rural areas. This study sought explore the factors that shape motivation and retention of primary health workers in rural facilities of Chipata and Chadiza Districts, Zambia.MethodsThe study adopted a qualitative research study design using a phenomenological and exploratory approach. The data consisted of 28 in-depth interviews and observations with health workers at selected rural health facilities in Chipata and Chadiza Districts of the Eastern province of Zambia. Data were analyzed using thematic analysis approach with the use of NVivo software. ResultsThree thematic categories were identified by the participants as factors that influence the motivation and retention of primary health workers in rural facilities. Firstly, opportunities for career advancement through study leave and attendance of workshops accounted for motivation and retention. The second factor was related to the work environment which comes with stimulating tasks, promotion opportunities as well as co-worker recognition and relationships. Thirdly, the rural community dynamics of reduced cost of living, recognition, community and local support, and access to land for farming were found to contribute to the motivation and retention of rural health workers. ConclusionWhile motivational factors vary, opportunities for career advancement, stimulating and challenging tasks, opportunities for promotion, and co-worker recognition are core factors that can engender retention of rural health workers. Interventions are required to enhance rural health worker motivation and retention, including strengthening the supervision system, developing career progression pathways, and ensuring clear and transparent incentives. Strategies around retention need to be addressed as these would better enable rural primary health workers to cope with the challenging conditions they work in rural areas.

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“…In rural, remote areas such as our research setting, MCPs usually live within the small communities they serve, with reciprocal interdependencies. The balance between integration into a rural community and rejection may be delicate (53). This may explain our participants' need to protect social integrity, and to include their clients in the creation of an alternative narrative of maternity care (figure 4).…”

Section: Category 4: Protecting Informationmentioning

confidence: 99%

Understanding maternity care providers’ use of data: A qualitative study in Southern Tanzania

Unkels

Al‐beity

Julius³

et al. 2022

Preprint

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Introduction Health information management system data is collected for national planning and evaluation but rarely used for health care improvements at the sub-national or facility-level in low-and-middle-income countries. Research suggests that perceived data quality and lack of feedback are contributing factors. We aimed to understand maternity care providers′ perceptions of data and how they use them, with a view to co-design interventions to improve data quality and use. Methods We based our research on constructivist grounded theory. We conducted 14 in-depth interviews, two focus group discussions with maternity care providers and 48 hours of observations in maternity wards of two rural hospitals in Southern Tanzania. Constant comparative data analysis was applied to develop initial and focused codes, sub-categories and categories continuously validated through peer and member checks. Results Maternity care providers appropriated numeric data on service provision to reconcile their professional values and demands from managers and the community with effects of a challenging working environment. They felt controlled by their managers′ data requirements and alienated from service provision data. Providers added informal documentation ways for their own narrative data needs to reflect on and improve service quality. These also assisted them to recreate social relationships with managers, clients and the community. The resulting documentation system led to duplication and increased systemic complexity. Conclusions Data from health information systems does not represent an independent and neutral entity but is embedded into the social realities of different users. Appropriation and use of data reflect these realities and users′ working environment. Interventions to improve data quality and use may need to incorporate the multitude of clinical and administrative documentation and data needs to avoid duplication and inefficiencies.

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Accommodate or Reject: The Role of Local Communities in the Retention of Health Workers in Rural Tanzania

Cited by 8 publications

References 22 publications

Understanding maternity care providers’ use of data in Southern Tanzania

Understanding maternity care providers’ use of data in Southern Tanzania

Motivation and retention of primary healthcare workers in rural health facilities: An exploratory qualitative study of Chipata and Chadiza Districts, Zambia.

Understanding maternity care providers’ use of data: A qualitative study in Southern Tanzania

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