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

Abstract

BackgroundIn 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?MethodsThis 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.ResultsMid-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.ConclusionsThe 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.

Balancing the cost of leaving with the cost of living: drivers of long-term retention of health workers: an explorative study in three rural districts in Eastern Uganda

“…In this study, health workers faced work-related stress and stress related to delayed salaries. Similar to previous studies [44,47] health workers coped with the two main sources of stress in several ways. These coping strategies required the health workers to supplement their income or to be distracted.…”

“…Some health workers have been reported to stay in their posts because of the opportunity to be able to assist mankind [36], In our study, some health workers viewed their work as a vocation to the community, rather than just work which they are required to do [3,44]. More females than males tended to mention the ‘call to serve’ as a factor that motivated their long stay.…”

“…Most health workers cited the need to be near family, maintain community ties, and have opportunity to invest and amass assets as reasons for their long stay in rural areas. Previous research also shows that health workers’ ‘embeddedness’ at a location is influenced by community ties, having families in a location, and opportunities to invest [44–46]. In such circumstances, the health workers choose the community first, then they choose the job indirectly [44].…”

“…Previous research also shows that health workers’ ‘embeddedness’ at a location is influenced by community ties, having families in a location, and opportunities to invest [44–46]. In such circumstances, the health workers choose the community first, then they choose the job indirectly [44]. Officials who recruit health workers should consider health worker preferences and attachment to communities since this may enhance their retention.…”

“…Most health workers in rural areas stay in their jobs because of job security and pensions [44]. Indeed, all health workers unanimously indicated a preference for working within the public sector whether it was urban or rural mostly because of its permanent job positions.…”