Human resources for health care delivery in Tanzania: a multifaceted problem

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.In the last decade developing countries have witnessed an unprecedented increase in funds for the procurement of commodities such as drugs, vaccines and other medical supplies through the Global Fund for HIV/AIDS, Tuberculosis and Malaria (GFATM), Global Alliance for Vaccine Initiatives (GAVI) and other Global Health Initiatives (GHIs). At the same time there is growing recognition of local health system constraints which impair the efficient delivery of health care and threaten to reduce the effectiveness of the GHIs [1-5]. Scale-up of basic health services depends on the