Department of Development Studies, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
PLoS One. 2021 Apr 8;16(4):e0246262. doi: 10.1371/journal.pone.0246262. eCollection 2021.
Although Tanzania is operating a decentralized health system, most of the health workers' retention strategies are designed at the central level and implemented at the local level. This study sought to explore the bottom-up health workers' retention strategies by analyzing experiences from two rural districts, Rombo and Kilwa in Tanzania by conducting a cross-sectional exploratory qualitative study in the said districts. Nineteen key informants were purposefully selected based on their involvement in the health workers' retention scheme at the district and then interviewed. These key informants included district health managers, local government leaders, and in-charges of health facilities. Also, three focused group discussions were conducted with 19 members from three Health Facility Governing Committees (HFGCs). Qualitative content analysis was deployed to analyze the data. We uncovered health-facility and district level retention strategies which included, the promotion of good community reception, promotion of good working relationships with local government leaders, limiting migration within district facilities and to districts within the region, and active head-hunting at training institutions. Retention of health workers at the primary health care level is beyond remuneration. Although some of these strategies have financial implications, most of them are less costly compared to the top-bottom strategies. While large scale studies are needed to test the generalizability of the strategies unveiled in our study, more studies are required to uncover additional bottom-up retention strategies.
尽管坦桑尼亚实行的是分散式卫生系统，但大多数卫生工作者的保留策略都是在中央一级设计并在地方一级实施的。本研究通过对坦桑尼亚伦博和基尔瓦两个农村地区的经验进行横断面探索性定性研究，旨在探讨自下而上的卫生工作者保留策略。根据他们在地区和地区卫生工作者保留计划中的参与情况，有针对性地选择了 19 名关键信息提供者，然后对他们进行了访谈。这些关键信息提供者包括地区卫生经理、地方政府领导人和卫生设施负责人。此外，还与来自三个卫生设施管理委员会（HFGC）的 19 名成员进行了三次焦点小组讨论。采用定性内容分析方法对数据进行分析。我们发现了卫生设施和地区一级的保留策略，包括促进良好的社区接待、与地方政府领导建立良好的工作关系、限制在地区设施内和在地区内的迁移，以及在培训机构积极物色人才。初级卫生保健水平的卫生工作者保留不仅仅是薪酬问题。虽然其中一些策略有财务影响，但与自上而下的策略相比，它们中的大多数成本较低。虽然需要进行大规模研究来测试我们研究中揭示的策略的普遍性，但还需要进行更多的研究来揭示其他自下而上的保留策略。
