Human Resources

The author of this study assessed the situation of nurses and home-based care givers in Tanzania and found a number of challenges. Most non-household care services for PLWHAs were found to be carried out by a few civil society organisations, which are heavily reliant on external funding and the labour of volunteers, mostly women. This dependency on external funding and volunteer labour is argued to threaten the sustainability of the HBC programme. Volunteers include retired nurses, PLWHAs and poor women, who subsidise the cost of care out of their pockets by helping PLWHAs, such as with transport to clinics. Within the health workforce, the nursing cadre (the majority of whom are women) carry a disproportionate burden of care without adequate compensation, with gaps in provision of proper protective gear and allowances for HBC nurses not adequately covering transport costs and other hidden expenses. The authors note that this gap could be addressed, but many district councils do not have capacity to utilise the AIDS money allocated to them. They conclude that the HBC programme appears to have created unexpected financial burdens for households, and for paid HBC employees and volunteers.

With increased global attention on health worker retention, this analysis of the current situation finds a diversity of country contexts and situations that affect health worker retention and proposes that policy-makers develop a tailored bundle of interventions to attract health workers to rural service and encourage them to stay that are most appropriate for their own context and situation.

Literature on the impact of health sector reform (HSR) on motivation of healthcare workers (HWs) and performance in health service provision in developing countries is still limited. This paper describes the impact of HSR on HW motivation and performance in providing quality health care in Tanzania. Methods: Four districts selected from three regions were covered, involving in-depth interviews with HWs in public health facilities (HFs), focus group discussions with district managers and researchers’ observations. The cost-sharing system in public HFs and national health ‘basket’ funding system introduced in 1990s were the key HSR elements identified by the study participants as impacting on HWs motivation and performance. User-fees for public healthcare services was acknowledged as having supplemented government funds allocated to public HFs, although such facilities still experienced ‘stock-outs’ of essential medicines and other supplies, HF understaffing, low/lack of essential remuneration, shortage of and unrepaired staff houses, meagre office space, lack of transport facilities for emergency cases, minimal recognition of HWs at local primary healthcare committees and the district health service budgeting system being controlled by district and central level authorities, leaving little room for lower level stakeholders to participate. For the national healthcare system to succeed, the authors argue that HSRs will need to involve and motivate HWs who are frontline implementers of the reform strategies.

In this study, researchers surveyed the alumni of Community-Based Education and Service (COBE) programmes at Makerere University, Uganda, to obtain their perceptions of the management and administration of COBE and whether COBE had helped develop their confidence as health workers, competence in primary health care and willingness and ability to work in rural communities. A total of 150 alumni were contacted, of which 24 (13 females and 11 males) were selected for focus group discussions. The alumni almost unanimously agree that the initial three years of COBES were very successful in terms of administration and coordination. COBES was credited for contributing to development of confidence as health workers, team work, communication skills, competence in primary health care and willingness to work in rural areas. The alumni also identified various challenges associated with administration and coordination of COBES at Makerere. The authors conclude that health planners should take advantage of the long-term positive impact of COBES and provide the programmes with more support.