Ifakara Health Institute, Health System and policy thematic, Kiko Ave 463, Mikocheni, P,o, Box 78373, Dar es Salaam, Tanzania.
Hum Resour Health. 2012 Feb 22;10:3. doi: 10.1186/1478-4491-10-3.
Recent years have seen an unprecedented increase in funds for procurement of health commodities in developing countries. A major challenge now is the efficient delivery of commodities and services to improve population health. With this in mind, we documented staffing levels and productivity in peripheral health facilities in southern Tanzania.
A health facility survey was conducted to collect data on staff employed, their main tasks, availability on the day of the survey, reasons for absenteeism, and experience of supervisory visits from District Health Teams. In-depth interview with health workers was done to explore their perception of work load. A time and motion study of nurses in the Reproductive and Child Health (RCH) clinics documented their time use by task.
We found that only 14% (122/854) of the recommended number of nurses and 20% (90/441) of the clinical staff had been employed at the facilities. Furthermore, 44% of clinical staff was not available on the day of the survey. Various reasons were given for this. Amongst the clinical staff, 38% were absent because of attendance to seminar sessions, 8% because of long-training, 25% were on official travel and 20% were on leave. RCH clinic nurses were present for 7 hours a day, but only worked productively for 57% of time present at facility. Almost two-third of facilities had received less than 3 visits from district health teams during the 6 months preceding the survey.
This study documented inadequate staffing of health facilities, a high degree of absenteeism, low productivity of the staff who were present and inadequate supervision in peripheral Tanzanian health facilities. The implications of these findings are discussed in the context of decentralized health care in Tanzania.
近年来，发展中国家采购卫生商品的资金空前增加。现在面临的一个主要挑战是如何有效地提供商品和服务，以改善人口健康。考虑到这一点，我们记录了坦桑尼亚南部周边卫生设施的人员配置水平和生产力。
进行了一项卫生设施调查，以收集有关雇用人员、主要任务、调查当天的可用性、缺勤原因以及区卫生队监督访问的经验的数据。对卫生工作者进行了深入访谈，以探讨他们对工作量的看法。对生殖和儿童健康（RCH）诊所的护士进行了时间和动作研究，记录了他们按任务分配的时间使用情况。
我们发现，只有 14%（122/854）的推荐护士人数和 20%（90/441）的临床工作人员在这些设施中就业。此外，44%的临床工作人员在调查当天无法工作。对此给出了各种原因。在临床工作人员中，38%因参加研讨会而缺勤，8%因长期培训而缺勤，25%因公务旅行而缺勤，20%因休假而缺勤。RCH 诊所护士每天工作 7 小时，但在设施工作时只有 57%的时间有效工作。在调查前的 6 个月内，近三分之二的设施接受区卫生队的访问次数少于 3 次。
本研究记录了坦桑尼亚周边卫生设施人员配备不足、缺勤率高、现有人力资源生产力低以及监督不足的情况。在坦桑尼亚分散式医疗保健的背景下，讨论了这些发现的影响。
