‘Overall, health workers felt abandoned and lost within an unsupportive system they serve…’ This is the key finding of a new paper from Tanzania.
‘Other challenges reported were lack of a clear strategic plan for staff career advancement and continuous professional development to improve health workers’ knowledge and skills necessary for providing quality maternal health care.’
CITATION: “Once the government employs you, it forgets you”: Health workers’ and managers’ perspectives on factors influencing working conditions for provision of maternal health care services in a rural district of Tanzania
Dickson Ally Mkoka, Gladys Reuben Mahiti, Angwara Kiwara, Mughwira Mwangu, Isabel Goicolea and Anna-Karin Hurtig.
Human Resources for Health 2015, 13:77 doi:10.1186/s12960-015-0076-5
Corresponding author: firstname.lastname@example.org
Background: In many developing countries, health workforce crisis is one of the predominant challenges affecting the health care systems’ function of providing quality services, including maternal care. The challenge is related to how these countries establish conducive working conditions that attract and retain health workers into the health care sector and enable them to perform effectively and efficiently to improve health services particularly in rural settings. This study explored the perspectives of health workers and managers on factors influencing working conditions for providing maternal health care services in rural Tanzania. The researchers took a broad approach to understand the status of the current working conditions through a governance lens and brought into context the role of government and its decentralized organs in handling health workers in order to improve their performance and retention.
Methods: In-depth interviews were conducted with 22 informants (15 health workers, 5 members of Council Health Management Team and 2 informants from the District Executive Director’s office). An interview guide was used with questions pertaining to informants’ perspective on provision of maternal health care service, working environment, living conditions, handling of staff’s financial claims, avenue for sharing concerns, opportunities for training and career progression. Probing questions on how these issues affect the health workers’ role of providing maternal health care were employed. Document reviews and observations of health facilities were conducted to supplement the data. The interviews were analysed using a qualitative content analysis approach.
Results: Overall, health workers felt abandoned and lost within an unsupportive system they serve. Difficult working and living environments that affect health workers’ role of providing maternal health care services were dominant concerns raised from interviews with both health workers and managers. Existence of a bureaucratic and irresponsible administrative system was reported to result in the delay in responding to the health workers’ claims timely and that there is no transparency and fairness in dealing with health workers’ financial claims. Informants also reported on the non-existence of a formal motivation scheme and a free avenue for voicing and sharing health workers’ concerns. Other challenges reported were lack of a clear strategic plan for staff career advancement and continuous professional development to improve health workers’ knowledge and skills necessary for providing quality maternal health care.
Conclusion: Health workers working in rural areas are facing a number of challenges that affect their working conditions and hence their overall performance. The government and its decentralized organs should be accountable to create conducive working and living environments, respond to health workers’ financial claims fairly and equitably, plan for their career advancement and create a free avenue for voicing and sharing concerns with the management. To achieve this, efforts should be directed towards improving the governance of the human resource management system that will take into account the stewardship role of the government in handling human resource carefully and responsibly.
SELECTED EXTRACTS (selected by Neil PW)
“There is nowhere to speak out our problems. Nowhere! How can you do that? We are afraid and decide to be silent and continue working with our problems. May be we can say this to people like you but otherwise we are avoiding victimization. But for us who are working in the remote areas, they need to find a way to listen to us a bit.” (Nurse, Dispensary H).
Inadequacy of facility infrastructure and unavailability of resources reported in this study played a key role in affecting health workers’ performance. Lack of running water and a reliable source of light in health facilities increased chances of cross infection putting health workers and women using these facilities at risk. This, along with an excessive workload as a result of shortage, unavailability of material resources and lack of supervision further handicapped health workers’ capacity leading to provision of suboptimal maternal care that leave women unsatisfied with the type of care they receive. Mistrust towards health workers and the health system in general become an outcome, and with continued blames received from the community, health worker morale decreased further.
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