Perceived unfairness in working conditions: The case of public health services in Tanzania

Abstract

BackgroundThe focus on the determinants of the quality of health services in low-income countries is increasing. Health workers' motivation has emerged as a topic of substantial interest in this context. The main objective of this article is to explore health workers' experience of working conditions, linked to motivation to work. Working conditions have been pointed out as a key factor in ensuring a motivated and well performing staff. The empirical focus is on rural public health services in Tanzania. The study aims to situate the results in a broader historical context in order to enhance our understanding of the health worker discourse on working conditions.MethodsThe study has a qualitative study design to elicit detailed information on health workers' experience of their working conditions. The data comprise focus group discussions (FGDs) and in-depth interviews (IDIs) with administrators, clinicians and nursing staff in the public health services in a rural district in Tanzania. The study has an ethnographic backdrop based on earlier long-term fieldwork in the same part of Tanzania.ResultsThe article provides insights into health workers' understanding and assessment of their working conditions. An experience of unsatisfactory working conditions as well as a perceived lack of fundamental fairness dominated the FGDs and IDIs. Informants reported unfairness with reference to factors such as salary, promotion, recognition of work experience, allocation of allowances and access to training as well as to human resource management. The study also revealed that many health workers lack information or knowledge about factors that influence their working conditions.ConclusionsThe article calls for attention to the importance of locating the discourse of unfairness related to working conditions in a broader historical/political context. Tanzanian history has been characterised by an ambiguous and shifting landscape of state regulation, economic reforms, decentralisation and emerging democratic sentiments. Such a historic contextualisation enhances our understanding of the strong sentiments of unfairness revealed in this study and assists us in considering potential ways forward.

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Public and private maternal health service capacity and patient flows in southern Tanzania: using a geographic information system to link hospital and national census data

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Frontline health worker motivation in the provision of maternal and neonatal health care in Ghana

“…Other studies have documented frontline workers' perceptions of unfair remuneration with agitations for better remuneration in Ghana . Songstad et al (2011) also noted the influence of policy and political developments on worker remuneration and perceptions of injustice in Tanzania.…”

“…Worker motivation can be defined as the degree of willingness of the worker to maintain efforts towards achieving organizational goals (Franco et al 2002;Kanfer 1999). Extrinsic motivation factors including contingent rewards such as salary, policy reforms and organisational factors, and intrinsic motivation factors that embody the individual's desire to perform the task for its own sake, which is selfgenerated and non-financial such as interpersonal factors, have been cited as influencing worker motivation in Africa including Ghana (Agyepong et al 2004;Andersen 2004;Ansong-Tornui et al 2007;Bosu et al 2007;Chen et al 2004;Mutale et al 2013;Prytherch et al 2012;Rowe et al 2005;Songstad et al 2011;Willis-Shattuck et al 2008;Witter et al 2007). Thus worker motivation is an important indicator of the quality and responsiveness of an organization towards its frontline health workers.…”

“…Organisational justice theory is one of the critical theories in studying worker motivation (Latham and Pinder 2005;Songstad et al 2011;Zapata-Phelan et al 2009). …”