PHA-Exch> EQUINET Discussion Paper 61: Non-financial incentives and retention of health workers in Tanzania

[Rene Loewenson]

EQUINET Discussion Paper 61: 
Non-financial incentives and retention of health workers in Tanzania:
Combined evidence from a literature review and a focused cross-sectional
study, 
Michael A Munga and Deogratius R Mbilinyi
Cite as: Munga MA, Mbilinyi DR (2008) 'Non-financial incentives and
retention of health workers in Tanzania: Combined evidence from literature
review and a focused cross-sectional study,' EQUINET Discussion Paper Series
61. EQUINET in co-operation with NIMRI, ECSA-HC: Harare.
Available online at: http://www.equinetafrica.org/bibl/docs/DIS61HRmunga.pdf
The Tanzanian public health sector is losing workers to internal and
external migration.  This paper examines the implementation of policies to
govern non-financial incentives to retain health workers. It outlines a
range of non-financial incentives set in policy in Tanzania, including
training; leave; promotion; housing; and a safe and supportive working
environment. It also examines the systems for managing personnel and the
implementation of incentives as a factor in retention, including the
participatory personnel appraisal system; worker participation in discussing
their job requirements and welfare; supervision; recognition and respect.
Drawing on a review of policy, published and grey literature and on a field
study of seven districts, including five underserved districts, the paper
finds that while a number of incentives exist in policy, their
sustainability is eroded by the absence of special earmarked funding for
their implementation. Decentralised districts also lack adequate powers and
authority to manage health workers, weakening their ability to implement
non-financial incentives. There was general consensus from health workers
and managers that interventions such as training and education, promotion
and the provision of safe working and living environments, can be strong
motivators if implemented in an effective and sustainable manner.  In
contrast, health workers interviewed pointed to the demotivating effect of
poor implementation of available non-financial incentives. The management
and resource barriers to implementing non financial retention incentives are
further explored in the paper and recommendations made to strengthen the
implementation of incentives. The authors conclude that analysis of issues
driving retention needs to take into account both individual and structural
factors that shape individual health workers' preference structures and the
complex nature of the health care labour market. A trivialised pull and push
factors framework in analysing complex problems like retention, will not
guide sustainable solutions, which need to be based on an understanding of
factors that not only guide the design of incentive regimes, but also the
resources, management systems and other factors that  enable their
implementation in practice.
July 2008
 
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