where the supply of human resources outstrips the demand for it, staff shortages in the
health profession have led to less bureaucratic decision making in recruitment. The gen-
eral theory which considers ‘principals’ as the ministry of health and social welfare, the
public service department under the President’s office and the treasury in the ministry of
finance requires modification as will be observed later.
Therefore, the performance of the healthcare workforce needs to be understood as the
aggregate outcome of worker choices. Solutions to workforce issues have to identify
and address the factors that determine choices and the behaviour of healthcare workers,
such as their needs, values and expectations. It is also important that healthcare workers
play an active role in the development of policies, which will affect the environment in
which they are expected to work.
Human resources for healthcare at Korogwe District Council
Staff manning levels
The chapter takes the data obtained from a cross sectional case study that was collected
from key informants and medical staff through in-depth interviews, observations and
questionnaires. The district has 54 healthcare service delivery centres which include 2
hospitals, 4 health centres and 48 dispensaries. The council has a total workforce of 172
people with a shortage of 112 staff compared to the establishment. Table 13.1 displays
staff position by specialisation. The table shows that there were critical staff shortages
with the exception of medical attendants where there was a surplus. In reality, shortages
have led to situations where, in some cases, medical attendants work as nurses or even
clinical officers. As a result, some flexibility in staff recruitment was adopted.
Table 13.1 General staffing levels in district dispensaries
S/N Staff cadre Establishment Available Variations
1 Clinical Officers 70 11 -59
2 Public Health Nurse B 70 10 -60
3 Medical Attendant 32 39 7
Total 172 60 -112Recruitment strategies
Relaxation of procedures
The public service department issued an open ended permit to the ministry of health and
social welfare to recruit staff on behalf of the local authorities. Arrangements are also
made by the treasury to accommodate salaries for whoever is recruited. In this situation,
local authorities have nothing to do except lobbying to ensure that the ministry meets
staff requisitions as soon as possible. However, the public service department remained
with the role to influence job attraction and retention through better scheme of service
and remuneration packages. However, this new recruitment strategy did not seem to
have any significant effect on those employed in Korogwe as was the case in other local
authorities. This is because the healthcare facilities are relatively old and therefore most
employees were employed more than 17 years ago, before the relaxed employment sys-
tem.