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<p class=MsoNormal><b style='mso-bidi-font-weight:normal'><font size=2
color=maroon face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:maroon;font-weight:bold;mso-bidi-font-weight:normal'>EQUINET Discussion Paper
61: </span></font></b><b style='mso-bidi-font-weight:normal'><font size=2
color=navy face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:navy;font-weight:bold;mso-bidi-font-weight:normal'><o:p></o:p></span></font></b></p>
<p class=MsoNormal><b style='mso-bidi-font-weight:normal'><font size=2
color=maroon face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:maroon;font-weight:bold;mso-bidi-font-weight:normal'>Non-financial
incentives and retention of health workers in <st1:country-region w:st="on"><st1:place
w:st="on">Tanzania</st1:place></st1:country-region>: Combined evidence from a
literature review and a focused cross-sectional study, </span></font></b><b
style='mso-bidi-font-weight:normal'><font size=2 color=navy face=Arial><span
style='font-size:10.0pt;font-family:Arial;color:navy;font-weight:bold;
mso-bidi-font-weight:normal'><o:p></o:p></span></font></b></p>
<p class=MsoNormal><b style='mso-bidi-font-weight:normal'><font size=2
color=maroon face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:maroon;font-weight:bold;mso-bidi-font-weight:normal'>Michael A <span
class=SpellE>Munga</span> and Deogratius R Mbilinyi<o:p></o:p></span></font></b></p>
<p><b><font size=2 color="#660000" face=Arial><span style='font-size:10.0pt;
font-family:Arial;color:#660000;font-weight:bold'>Cite as:</span></font></b><font
size=2 face=Arial><span style='font-size:10.0pt;font-family:Arial'> Munga MA, <st1:Street
w:st="on"><st1:address w:st="on">Mbilinyi DR</st1:address></st1:Street> (2008)
'Non-financial incentives and retention of health workers in <st1:place w:st="on"><st1:country-region
w:st="on">Tanzania</st1:country-region></st1:place>: Combined evidence from
literature review and a focused cross-sectional study,' EQUINET Discussion
Paper Series 61. EQUINET in co-operation with NIMRI, ECSA-HC: <st1:place w:st="on"><st1:City
w:st="on">Harare</st1:City></st1:place>.<o:p></o:p></span></font></p>
<p><b><font size=2 color="#660000" face=Arial><span style='font-size:10.0pt;
font-family:Arial;color:#660000;font-weight:bold'>Available online at:</span></font></b><font
size=2 face=Arial><span style='font-size:10.0pt;font-family:Arial'> </span></font><u><font
size=2 color="#000099" face=Arial><span style='font-size:10.0pt;font-family:
Arial;color:#000099'><a
href="http://www.equinetafrica.org/bibl/docs/DIS61HRmunga.pdf">http://www.equinetafrica.org/bibl/docs/DIS61HRmunga.pdf</a></span></font></u><font
size=2 face=Arial><span style='font-size:10.0pt;font-family:Arial'><o:p></o:p></span></font></p>
<p><font size=2 color="#663366" face=Arial><span style='font-size:10.0pt;
font-family:Arial'>The Tanzanian public health sector is losing workers to
internal and external migration.<span style='mso-spacerun:yes'>
</span>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 <st1:place w:st="on"><st1:country-region
w:st="on">Tanzania</st1:country-region></st1:place>, 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<span
style='mso-spacerun:yes'> </span>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.<span
style='mso-spacerun:yes'> </span>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<span style='mso-spacerun:yes'> </span>enable their implementation in
practice</span></font>.<o:p></o:p></p>
<p style='margin:0cm;margin-bottom:.0001pt'><font size=2 color=maroon
face=Arial><span style='font-size:10.0pt;font-family:Arial;color:maroon;
mso-bidi-font-weight:bold'>July 2008<o:p></o:p></span></font></p>
<p style='margin:0cm;margin-bottom:.0001pt'><font size=2 color=maroon
face=Arial><span style='font-size:10.0pt;font-family:Arial;color:maroon;
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<p style='margin:0cm;margin-bottom:.0001pt'><font size=2 color=black
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mso-bidi-font-weight:bold'>This email alerts to a new publication from the
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