This proclamation supports Maslow’s theory of motivation, that satisfaction of basic
human needs is important in motivation (Armstrong 2003). Nurses depend on a monthly
salary, which cannot support the employee for the whole month. Certainly, a lump sum
of money will make an employee feel that they have won the lottery.
Participation in management meetings
Another innovation is to have quarterly meetings for all heads of healthcare facilities to
present their management information systems reports (MTUHA reports) unlike the
current practice where reports are sent by the healthcare facility or collected by the local
authority without feedback. The objective is to allow experience sharing and some kind
of ‘outing’ for the staff.
More than 84% of the employees felt that the move would motivate staff because
they would be able to share experience with others, learn, relax and improve relations
with management. The remaining employees had the opinion that the strategy would be
most useful to a few heads of healthcare facilities. Therefore, a more integrated and ho-
listic approach to motivation was desired.
Utility of principal-agent- dependency theories in Tanzania
The theoretical approach to the analysis has helped to understand the relationship be-
tween local authorities and central government in addressing the challenges of human
resource for health shortages in local authorities by unearthing the following.
First, human resources for healthcare shortages in terms of quantity and quality is a
reality and it is more disturbing than one would have thought when the numbers of staff
are compared to the academic and professional qualifications available.
Second, although the decentralisation by devolution has always intended to delegate
more powers over decision making, resource acquisition, utilisation and control, this has
not been the case. Power is still centralised at the level of the ‘principal’ and the impact
at the bottom ‘agent’ leaves a lot to be desired.
Third, the institutional framework that concentrates power over recruitment and pay
at the level of the principal leaves limited room for the agent to adopt strong recruitment
strategies because it creates a parent-child relationship.
Fourth, the same effect of the centralisation of power at the principal for recruitment
has created apathy with the agent and the human resources for healthcare at the expense
of the motivation of staff, and improved development and utilisation.
Sixth, there are emerging local level innovations (agent) to motivate staff to create
room for better staff recruitment and retention but using a framework generically de-
signed by the (principal). That is, centrally designed open performance appraisal and
information management systems by using money as a motivator seem to signal some
hopes that they (staff) will improve performance. If these innovations were put in place
as envisaged, they may somehow soothe some of the painful wounds of the already
overworked, unpaid and de-motivated staff. However, the effect would depend on the
ability of the local authority to generate its own finances and reduce dependency on the
central government, the effectiveness of the system and commitment to sustain it.
From this theory it has to be said that shortages of human resources for healthcare is
not a new phenomenon and various recruitment and retention strategies have been tried
and tested by many countries worldwide. Some strategies have worked quite well, while
others have produced limited results (Pillay 2009; Brandley & McAuliffe 2009). The