not survive without the external environment from which organisational inputs are
sourced and the outputs are released into. However, resource dependency theory puts
emphasis on the external dependency, resource allocations and budgets as the main ar-
eas where organisations are caught, which is an unhealthy situation because the ultimate
effect of resource dependency is the reduction of organisational discretion, interference
with the achievement of organisational goals, and ultimately threatening the existence of
the organisation (Dwyer et al. 1987; Scott 1998; Grewal & Dharwadkar 2002; Pfeiffer
& Salancik 1978). Therefore, strategic organisations should aim at reducing dependency
by embarking on a number of innovations to reduce dependency and hence increase
power and use the external influence to its advantage. With this perspective, an organi-
sation can manage an increasing dependency on the principal by adapting to or avoiding
external demands, by executing strategies that may include creating a negotiated envi-
ronment (Pfeiffer & Salancik 1978). The chapter will focus more on the extent to which
local authorities depend on the central government (as the principal) in its decisions and
actions to recruit and retain human resources in dispensaries and health centres and the
extent to which they (local authorities) are able to ‘negotiate’ and thereby create an en-
vironment more favourable for recruitment and the retention of human resources for
health as one of the key critical resource in health service delivery in local authorities.
Figure 13.1 displays the theoretical framework
Figure 13.1 Principal-agent-resource-dependency framework
Figure 13.1 suggests that in a normal situation, local authorities would request a permit
to recruit a specific number of staff from the President’s office, public service manage-
ment and after multiple consultations with the ministry of health and social welfare and
the treasury, a recruitment permit may or may not be granted (URT 2003). The major
decision making criteria would be budgetary constraints and the extent of shortages in
that particular local authority compared to other areas where distributive equity may be
considered. Even where a recruitment permit is issued, there may not be qualified staff
to recruit, and even if available, people may not be attracted to the job. If, for some rea-
son, recruitment is achieved, retention may be problematic if there is no strong ‘negoti-
ated environment’ to reduce turnover.
The negotiated environment has to reduce both resource dependency and decision
making through the agent. Thus, the bargaining for human resource recruitment and
Innovations in
‘negotiated
environment’Agent
(Local authority)Impreoved human resource
recruitment and retentionpotential human resourcePrincipal
(Ministries)
bargaining for human resource
recruitment and retention