Abstract
BackgroundSevere shortages of qualified health workers and geographical imbalances in the workforce in many low-income countries require the national health sector management to closely monitor and address issues related to the distribution of health workers across various types of health facilities. This article discusses health workers' preferences for workplace and their perceptions and experiences of the differences in working conditions in the public health sector versus the church-run health facilities in Tanzania. The broader aim is to generate knowledge that can add to debates on health sector management in low-income contexts.MethodsThe study has a qualitative study design to elicit in-depth information on health workers' preferences for workplace. The data comprise ten focus group discussions (FGDs) and 29 in-depth interviews (IDIs) with auxiliary staff, nursing staff, clinicians and administrators in the public health sector and in a large church-run hospital in a rural district in Tanzania. The study has an ethnographic backdrop based on earlier long-term fieldwork in Tanzania.ResultsThe study found a clear preference for public sector employment. This was associated with health worker rights and access to various benefits offered to health workers in government service, particularly the favourable pension schemes providing economic security in old age. Health workers acknowledged that church-run hospitals generally were better equipped and provided better quality patient care, but these concerns tended to be outweighed by the financial assets of public sector employment. In addition to the sector specific differences, family concerns emerged as important in decisions on workplace.ConclusionsThe preference for public sector employment among health workers shown in this study seems to be associated primarily with the favourable pension scheme. The overall shortage of health workers and the distribution between health facilities is a challenge in a resource constrained health system where church-run health facilities are vital in the provision of health care in rural areas and where patients tend to prefer these services. In order to ensure equity in distribution of qualified health workers in Tanzania, a national regulation and legislation of the pension schemes is required.
Highlights
Severe shortages of qualified health workers and geographical imbalances in the workforce in many low-income countries require the national health sector management to closely monitor and address issues related to the distribution of health workers across various types of health facilities
During the years of the hiring freeze, there was limited public sector employment and many newly graduated professionals were employed by church-run health facilities
In the current situation where the public sector offers new employment opportunities and competitive retirement benefits, we sought to understand the preferences of health workers for public sector versus church sector employment, especially in rural areas, where church-run facilities are an important health care provider
Summary
Severe shortages of qualified health workers and geographical imbalances in the workforce in many low-income countries require the national health sector management to closely monitor and address issues related to the distribution of health workers across various types of health facilities. The severe shortage of health workers is a well-known problem in many low-income countries. Considerable geographical imbalances in health worker distribution and intra-country ‘migration’ from rural to urban areas are pronounced problems [1]:xviii,[2]. People tend to prefer church-run health facilities because they perceive the quality of services to be better [8,9], and church-run hospitals often attract patients from a wider area than their defined catchment area. Health workers’ motivation to perform their work well is a factor attracting growing interest. Gilson et al argue that health worker motivation “reflects a range of personal, organisational, and societal factors, including relationships with others” [14]
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