which can hardly be controlled by local authorities. Such external factors include a
regulatory framework that guides the recruitment vesting powers in the President’s of-
fice, public service management and the treasury, as well as the availability of qualified
and competent staff in the labour market which concerns the ministry of health and so-
cial welfare and the training institutions in the country (URT 2003). The internal factors
would include geographical location, access to social services and resources, which in-
fluences the ability to attract and retain staff through motivational packages.
Perhaps the systems theory (Dunlop 1958) is useful in analysing human resource
recruitment and retention as it considers the human resource management process as a
system that is constituted of process of inputs and outputs. That is where there are mul-
tiple actors who are influenced by sets of ideologies and institutional frameworks which
govern their relationships. However, as much as this theoretical perspective is useful, its
complexity in terms of data collection and analysis may ultimately lead to conclusions
and recommendations that may be of limited use in reality.
However, looking at the employment relationships between the local authorities and
other stakeholders, human resource recruitment and retention may be understood by
using the principal-agent theory. The principal-agent theory contends that although the
relationship between the central (principal) and local government (agent) is supposed to
be mutually supportive, in reality the two may have different interests that are in con-
flict (Pfeiffer & Salancik 1978; Ulrich & Barney 1984). Therefore, while the principal
would be exercising power and control over resources and decision making on recruit-
ment and selection for the agent, the agent would strive to free itself from the control
from the principal who is considered as part of the external constraining environment. In
this theory, while the central government would tend to exercise control of employment
in line with the national budget, local authorities would be forced to increase and retain
staff to meet the increasing service demand in hospitals amidst severe resource con-
straints.
Therefore, with regards to staffing matters, it would appear that first, local authorities
have to work much harder to increase their influence on staff recruitment and retention.
And second, while staff shortages would pressurise the ministry of health and social
welfare to increase training, there would not be enough people attracted into a career in
the healthcare service profession thanks to a limited budget and is hence less attractive.
This scenario leads to the concept of power and resource dependency.
Pfeiffer in Lawton & Aidan (1991: 67) considers power as the ability to influence
decisions and actions that is usually spread between different stakeholders in organisa-
tions who compete to have more power to control resources. Pfeiffer & Salancik (1977),
Ulrich & Barney (1984) and Aldrich (1999) have underscored the role of power in re-
source control in a principal-agent work relationship. According to their proposition,
although there are many sources of power, the legal framework that establishes organi-
sations, the hierarchical position in the organisational structure, and control over re-
sources are important in understanding power relations and dynamics in organisations.
In this analysis, power over human resources for health is what determines the major
differences between the principal and the agent in human resource dependency theory.
Resource dependency theory has its origin in the systems theory, which seeks to explain
why organisations have to depend on the external environment for growth and survival,
and the need to have some dependency on resources to achieve organisational goals.
Therefore, dependency is seen as an inevitable phenomenon because organisations can-