Retention strategies
Although it is a good strategy to improve the recruitment process, the ability to retain
the available staff is equally important.
Availability of district level strategy
District level strategy to retain staff lies within the powers of the district health officer,
and the district executive director. Seventy three of staff surveyed shared the opinion
that the district did not have any strategy to retain staff while twenty seven percent
thought that there was a strategy. Those who said that there is a strategy were nurses
who got the opportunities for training, as one of them said:
... I cannot complain because the district has sent me to school. If it were not for the district
my career opportunity would have been very limited. I feel obliged to remain and provide
services here as part of my gratitude. (Comments from Assistant Nurse)Availability of centralised retention strategy
It is also expected that staff would be motivated to remain if there is a government
(principal) scheme to provide incentives. Such incentives would include an allowance
for overtime, duty call allowance and days off duty. The proposition that staff are moti-
vated and hence encouraged to remain in the job through the use of incentive packages
was rejected by 96% of those surveyed. The data from interviews shows that the oppo-
site was the case as one nurse complained thus:
There is no enough staff. ... we work around the clock because there is no night shift. I was
not even allowed to go for my annual leave and yet nobody pays you anything outside in-
adequate salary. I am very tired but what can I do? (Comments from Assistant Nurse)Community based support systems for staff retention
In the absence of centralised incentive schemes (by the principal) and decentralised sys-
tem schemes (by the agent) for staff motivation and retention, there are reasonable calls
for community level innovations where local resources might be used. However, con-
trary to the expectations of the health sector reform objectives and more specifically the
community health funds, such incentives did not exist. One of the objectives of commu-
nity health fund is to improve the working environment for healthcare staff in areas
where the central government cannot efficiently deliver. Procurement of simple facili-
ties like furniture, painting offices, torch and batteries, pay for watchmen, provision of
tea or coffee during working hours can make a significant difference in employees’ mo-
tivation and boost staff retention. Staff in the health centre and dispensaries complained
that although they collected a significant amount of money and submitted the same to
the district, the release of funds from the district to the health facilities was a nightmare
despite several requests and follow-ups. The explanations from the district were nothing
less than bureaucracy and some kind of ‘excuse’.
Implications of a lack of an effective staff retention strategy
Contrary to the resource dependency theory where one would argue that organisations
have to develop strategies to use and retain scarce resources, the results show that both
the utilisation and retention of human resources for healthcare do not follow the same