"Workhood"-a useful concept for the analysis of health workers' resources? an evaluation from Tanzania

Karin Gross,Brigit Obrist,Constanze Pfeiffer

doi:10.1186/1472-6963-12-55

Abstract

BackgroundInternational debates on improving health system performance and quality of care are strongly coined by systems thinking. There is a surprising lack of attention to the human (worker) elements. Although the central role of health workers within the health system has increasingly been acknowledged, there are hardly studies that analyze performance and quality of care from an individual perspective. Drawing on livelihood studies in health and sociological theory of capitals, this study develops and evaluates the new concept of workhood. As an analytical device the concept aims at understanding health workers' capacities to access resources (human, financial, physical, social, cultural and symbolic capital) and transfer them to the community from an individual perspective.MethodsCase studies were conducted in four Reproductive-and-Child-Health (RCH) clinics in the Kilombero Valley, south-eastern Tanzania, using different qualitative methods such as participant observation, informal discussions and in-depth interviews to explore the relevance of the different types of workhood resources for effective health service delivery. Health workers' ability to access these resources were investigated and factors facilitating or constraining access identified.ResultsThe study showed that lack of physical, human, cultural and financial capital constrained health workers' capacity to act. In particular, weak health infrastructure and health system failures led to the lack of sufficient drug and supply stocks and chronic staff shortages at the health facilities. However, health workers' capacity to mobilize social, cultural and symbolic capital played a significant role in their ability to overcome work related problems. Professional and non-professional social relationships were activated in order to access drug stocks and other supplies, transport and knowledge.ConclusionsBy evaluating the workhood concept this study highlights the importance of understanding health worker performance by looking at their resources and capacities. Rather than blaming health workers for health system failures, applying a strength-based approach offers new insights into health workers' capacities and identifies entry points for target actions.

Highlights

Health workers and capitals-the concept of workhood Drawing on the five core categories of capital used in the sustainable livelihood approach of the DfID [22] as well as on Bourdieu’s conceptualizations of capitals, we suggest six categories of workhood assets in order to describe health workers’ resources: human capital, financial capital, physical capital, social capital, and-instead of natural capital-cultural and symbolic capital
The first theme describes health workers’ experiences of working in a resource-poor setting. It illuminates what categories of workhood assets they were lacking in their daily work and provides health workers’ explanations of why they failed to access them
Using the workhood concept as an analytical device we illustrated on the one hand what working in resource constraint settings means to health workers

Summary

Introduction

The central role of health workers within the health system has increasingly been acknowledged, there are hardly studies that analyze performance and quality of care from an individual perspective. As an analytical device the concept aims at understanding health workers’ capacities to access resources (human, financial, physical, social, cultural and symbolic capital) and transfer them to the community from an individual perspective. Due to a tendency of perceiving bad performance as a problem of human resource management, there has been little attention to what access to resources means to health workers as social actors [14]. Some recent studies from Scotland and Australia on health professionals working in remote communities provided evidence that health workers’ access to resources is pertinent for their capacity to contribute to the social sustainability and health outcomes in their rural communities [16,17,18]. As “boundary crossers” they are in an ideal position to operate in and across different fields, including health [18]

Methods

Results

Discussion

Conclusion