Human resources for health care delivery in Tanzania: a multifaceted problem

Abstract

BackgroundRecent years have seen an unprecedented increase in funds for procurement of health commodities in developing countries. A major challenge now is the efficient delivery of commodities and services to improve population health. With this in mind, we documented staffing levels and productivity in peripheral health facilities in southern Tanzania.MethodA health facility survey was conducted to collect data on staff employed, their main tasks, availability on the day of the survey, reasons for absenteeism, and experience of supervisory visits from District Health Teams. In-depth interview with health workers was done to explore their perception of work load. A time and motion study of nurses in the Reproductive and Child Health (RCH) clinics documented their time use by task.ResultsWe found that only 14% (122/854) of the recommended number of nurses and 20% (90/441) of the clinical staff had been employed at the facilities. Furthermore, 44% of clinical staff was not available on the day of the survey. Various reasons were given for this. Amongst the clinical staff, 38% were absent because of attendance to seminar sessions, 8% because of long-training, 25% were on official travel and 20% were on leave. RCH clinic nurses were present for 7 hours a day, but only worked productively for 57% of time present at facility. Almost two-third of facilities had received less than 3 visits from district health teams during the 6 months preceding the survey.ConclusionThis study documented inadequate staffing of health facilities, a high degree of absenteeism, low productivity of the staff who were present and inadequate supervision in peripheral Tanzanian health facilities. The implications of these findings are discussed in the context of decentralized health care in Tanzania.

Primary oral health care and smiles for life curriculum adaptation for nurses training in low income countries: A case of Tanzanian context

“…In Tanzania, oral health screening services in primary health settings, particularly in reproductive and child health is inadequately addressed partly because the health care providers in these settings have little knowledge [14,15] and is partly due to the shortage of the oral health workforce. [16][17][18] In South Africa, like in Tanzania, there is minimal integration of oral health education at reproductive and child health sites. [19] According to this finding in South Africa; reproductive and child health sites remain important sites for integration of dental and oral health care with general health services.…”

“…A study conducted in a recent year revealed that only 14% of the recommended number of nurses and 20% of the clinical staff had been employed at the health facilities. [18] Human resources for health constraints are more severe in oral health arenas. According to the ministry of health, community development, gender, elderly and children (MoHCDGEC) report of 2012/2013, Tanzania had dentist-to-population ratio of 1:120,000 which is very low compared to that recommended by the World Health Organization of 1:7,500.…”

The Impact of Supportive Supervision on the Implementation of HRM processes; A Mixed-Methods study in Tanzania

“…Absenteeism is a major problem; key staff members may spend most of their time attending trainings or report ill frequently [17] resulting in low health worker performance and outputs. Inadequate staffing levels may be compounded by a high level of absenteeism which reduces access to services [18]. It has been noted that a fair and accurate performance review may begin with tracking employee behaviours and patterns [19] for example introducing registers of arrival and departure time.…”

“…This represents a form of wastage, especially if shortages of those skills exist in the country [17]. Health workers' job descriptions are often unavailable [18] and workloads do not match staffing levels [17]. A substantial portion of staff time may be spent on administrative duties [17] as opposed to treatment and caring activities [22].…”

“…CHMTs face various challenges in providing supportive supervision to peripheral health facilities including workload, staff shortage, financial constraints, and lack of vehicles or even unavailability of fuels. Improved supervision is likely to require timely disbursement of funds, sufficient staff, prior notification of visits, appropriate training for supervision and improved supervision of CHMTs by regional and national level staff [18].…”