Retention of medical doctors at the district level: a qualitative study of experiences from Tanzania

Nathanael Sirili,Tumaini Nyamhanga,Mughwira Mwangu,Isabel Goicolea,Anna-Karin Hurtig,Angwara Kiwara,Amani Anaeli,Gasto Frumence

doi:10.1186/s12913-018-3059-0

Nathanael Sirili, Tumaini Nyamhanga + Show 6 more

Open Access

https://doi.org/10.1186/s12913-018-3059-0

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Abstract

BackgroundRetention of Human Resources for Health (HRH), particularly doctors at district level is a big challenge facing the decentralized health systems in poorly resourced countries. Tanzania, with 75% of its population in rural areas, has only 26% of doctors serving in rural areas. We aimed to analyze the experiences regarding the retention of doctors at district level in Tanzania from doctors’ and district health managers’ perspectives.MethodsA qualitative study was carried out in three districts from June to September 2013. We reviewed selected HRH documents and then conducted 15 key informant interviews with members of the District Health Management teams and medical doctors working at the district hospitals. In addition, we conducted three focus group discussions with Council Health Management Team members in the three districts. Incentive package plans, HRH establishment, and health sector development plans from the three districts were reviewed. Data analysis was performed using qualitative content analysis.ResultsNone of the districts in this study has the number of doctors recommended. Retention of doctors in the districts faced the following challenges: unfavourable working conditions including poor working environment, lack of assurance of career progression, and a non-uniform financial incentive system across districts; unsupportive environment in the community, characterized by: difficulty in securing houses for rent, lack of opportunities to earn extra income, lack of appreciation from the community and poor social services.Health managers across districts endeavour to retain their doctors through different retention strategies, including: career development plans, minimum financial incentive packages and avenues for private practices in the district hospitals. However, managers face constrained financial resources, with many competing priorities at district level.ConclusionsRetention of doctors at district level faces numerous challenges. Assurance of career growth, provision of uniform minimum financial incentives and ensuring availability of good social services and economic opportunities within the community are among important retention strategies.

Highlights

Retention of Human Resources for Health (HRH), doctors at district level is a big challenge facing the decentralized health systems in poorly resourced countries
To carry out the key informant interviews (KIIs), we used an interview guide that we developed based on the literature on the HRH crisis and the challenges faced in retaining HRH in Tanzania (See Additional file 1)
Unfavourable working conditions Unfavourable working conditions characterized by the absence of uniform mechanisms to ensure career growth, a non-uniform financial incentive system, and unfriendly work environments were found to make the retention of medical doctors (MDs) difficult across the districts

Summary

Introduction

Retention of Human Resources for Health (HRH), doctors at district level is a big challenge facing the decentralized health systems in poorly resourced countries. Sub-Saharan Africa, home to 11% of the global population and 24.3% of the global burden of diseases, accounts for only 3% of the total global HRH [2]. Despite the observed regional imbalance, retention of the HRH – and of physicians in rural areas – remains a big challenge facing policy- and decision-makers of today within countries worldwide [3,4,5]. One half of the global population lives in rural areas and is served by less than a quarter of the total physician HRH [6, 7]

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