Centre for International Health, University of Bergen, Norway.
BMC Health Serv Res. 2012 Apr 5;12:92. doi: 10.1186/1472-6963-12-92.
Severe shortages of qualified health workers and geographical imbalances in the workforce in many low-income countries require the national health sector management to closely monitor and address issues related to the distribution of health workers across various types of health facilities. This article discusses health workers' preferences for workplace and their perceptions and experiences of the differences in working conditions in the public health sector versus the church-run health facilities in Tanzania. The broader aim is to generate knowledge that can add to debates on health sector management in low-income contexts.
The study has a qualitative study design to elicit in-depth information on health workers' preferences for workplace. The data comprise ten focus group discussions (FGDs) and 29 in-depth interviews (IDIs) with auxiliary staff, nursing staff, clinicians and administrators in the public health sector and in a large church-run hospital in a rural district in Tanzania. The study has an ethnographic backdrop based on earlier long-term fieldwork in Tanzania.
The study found a clear preference for public sector employment. This was associated with health worker rights and access to various benefits offered to health workers in government service, particularly the favourable pension schemes providing economic security in old age. Health workers acknowledged that church-run hospitals generally were better equipped and provided better quality patient care, but these concerns tended to be outweighed by the financial assets of public sector employment. In addition to the sector specific differences, family concerns emerged as important in decisions on workplace.
The preference for public sector employment among health workers shown in this study seems to be associated primarily with the favourable pension scheme. The overall shortage of health workers and the distribution between health facilities is a challenge in a resource constrained health system where church-run health facilities are vital in the provision of health care in rural areas and where patients tend to prefer these services. In order to ensure equity in distribution of qualified health workers in Tanzania, a national regulation and legislation of the pension schemes is required.
在许多低收入国家，合格卫生工作者严重短缺，劳动力在地理上分布不均，这要求国家卫生部门密切监测和解决各类卫生机构中卫生工作者分布问题。本文讨论了卫生工作者对工作场所的偏好，以及他们对公共卫生部门与坦桑尼亚教会运营的卫生机构之间工作条件差异的看法和经验。更广泛的目标是生成知识，为低收入背景下的卫生部门管理辩论增添内容。
本研究采用定性研究设计，以深入了解卫生工作者对工作场所的偏好。数据包括坦桑尼亚农村地区公共卫生部门和一家大型教会运营医院的辅助人员、护理人员、临床医生和管理人员的十次焦点小组讨论（FGD）和 29 次深入访谈（IDI）。该研究基于在坦桑尼亚的早期长期实地工作，具有民族志背景。
研究发现，人们对公共部门就业有明显的偏好。这与卫生工作者的权利和获得政府服务提供给卫生工作者的各种福利有关，特别是有利的养老金计划为老年提供经济保障。卫生工作者承认，教会运营的医院通常设备更好，提供的患者护理质量更高，但这些担忧往往被公共部门就业的财务资产所抵消。除了部门特定的差异外，家庭问题在工作场所决策中也显得很重要。
本研究中卫生工作者对公共部门就业的偏好似乎主要与有利的养老金计划有关。整体卫生工作者短缺以及卫生机构之间的分布是资源有限的卫生系统面临的挑战，在这种系统中，教会运营的卫生机构在农村地区提供医疗保健方面至关重要，而且患者往往更倾向于选择这些服务。为了确保在坦桑尼亚公平分配合格的卫生工作者，需要对养老金计划进行国家监管和立法。
