does not match with the improvement in human resource capacity in terms of numbers
and competencies. A study conducted by the World Health Organisation estimated that
Tanzania has 48,508 health workers, of whom 822 are physicians and 13,292 are nurses
(WHO 2006), but the country was found to have the lowest physician/population ratio
in the world. The same study shows that the country has 717 assistant medical officers
with practical clinical skills comparable to those of physicians. In addition, there were
5,642 clinical officers, who undertake a substantial share of the clinical practice. Medi-
cal assistants, with little or no formal training, constitute a large share (40%) of the
healthcare workforce (Munga & Maestad 2009).
Labour shortages in the health sector have contributed to the worsening of health in
Tanzania particularly in women and children. The Ministry of Health (URT 2005) as-
serts that maternal healthcare services and child malnutrition do not seem to have made
any improvements over the last two decades, partly due to among others, a lack of suffi-
ciently skilled and motivated staff, although patchy successes are noted elsewhere par-
ticularly in more wealthy and urbanised areas (URT 2003). As a result of these multiple
factors, it is estimated that eight out of ten children die at home and 6 of them without
any contact with formal healthcare, while ninety percent could be cured (URT 2005). It
is worse in rural areas where health workers are less attracted due to a difficult working
environment and lack of government capacity to attract and retain such workforce (Itika
2007).
At the end of the chapter, the learner should be able to:
- Appreciate the challenges facing human resources in health.
- Establish the relationship between theoretical and practical issues that influence staff
recruitment and retention. - Develop initiatives for improving human resource management for health in a
constrained environment.
Recruitment and retention of health staff as a global issue
A survey of 779 organisations in the United Kingdom (CIPD 2008) showed difficulties
in recruitment by 86% of the cases. There are a number of reasons including lack of
necessary skills (70%), higher level of employees’ expectations (44%) and lack of skills
(42%). Seventy five of the organisations surveyed had adopted a strategy of appointing
those with the potential to grow. There were also serious problems of staff retention by
80%, which was addressed through more pay by 53%, and learning and development by
46% while the improvement of selection process helped by 46% (CIPD 2008).
Healthcare personnel to population ratios in Africa have been high and have always
lagged behind the rest of the world. For example in the 1980s, one doctor catered for
10,800 persons in Sub-Saharan Africa (SSA), compared to 1,400 in all developing
countries and 300 in industrialised countries (USAID 2003). In the same period, one
nurse served 2,100 persons in Africa, compared to 1,700 persons in all developing coun-
tries and 170 in industrialised countries (World Bank 1994). The provider-to-population
ratios remained persistently high in the 1990s, with most countries having 1 doctor per
10,000 populations or more. In fact, ten countries have 1 doctor per 30,000 populations.
Other countries like Bolivia, Honduras, and India have 1 per 2,000 or 1 per 3,000 ratios.
Thirty one countries do not meet the WHO’s ‘Health for All’ standard of 1 doctor per
5,000 members of the population.