Tanzania, like many other countries in Africa, is facing a severe shortage of qualified health professionals. Only 35% of positions in government health facilities have been filled, leaving Tanzania in the wake of burgeoning human resources for health crisis. According to the Annual Health Statistical Abstract from 2008, the national average of the population per medical officer was 64,000, 31,000 per assistant medical officer, and 7,000 per clinical officer. The shortage of health professionals has been exacerbated by the HIV/AIDS pandemic and other communicable diseases such as malaria and TB.
In an effort to improve the quality of care of HIV services delivered in Tanzania, the USAID Health Care Improvement Project (HCI) and the Ministry of Health and Social Welfare (MOHSW) began implementing a partner improvement collaborative in the Mtwara region in nine care and treatment centers in June of 2009. The aim of the collaborative is to apply QI methods to ART and PMTCT services in order to ensure a high quality of care is being delivered to clients. The collaborative is now looking to integrate HR interventions into its work in order to improve efficiency of service delivery, and strengthen health worker performance and engagement. Health worker productivity and engagement are integral to improving efficiency as they determine what tasks health workers perform and how engaged and motivated they are to perform at a high level.
In collaboration with the Government of Tanzania, HCI designed a baseline assessment of HIV/AIDS service providers to gather information on productivity and engagement. The information gathered from this baseline assessment will be used to develop a set of HR improvement packages based on best practices that will be integrated into the ongoing ART collaborative. The baseline was conducted in six sites in the region of Mtwara from June 30th- July 6th, 2010.
The assessment identified several areas where human resource management systems can be improved to strengthen provider efficiency and productivity and improve the quality of HIV/AIDS service delivery. All health workers should be provided with written job descriptions that clearly align their tasks and goals. Without written job descriptions, it is impossible to implement strong performance management. Recognition and reward systems can be improved to ensure that health workers get the acknowledgement and praise they deserve when they perform well. The process for performance evaluations needs to be communicated clearly with lower level facilities. Facility managers and providers should also learn how to set performance objectives. Promotion and career advancement opportunities are somewhat rare, which may affect worker motivation. The majority of employees are moderately engaged, regardless of the type of facility or the position they hold, but specific areas of engagement, such as recognition and materials, could be improved. Productivity appears to vary throughout the day with providers being very productive in the morning when patients arrive and productivity levels decreasing dramatically in the afternoon when client loads are low. Client flow does not appear to be a problem, but is something that should continue to be monitored since client loads can vary dramatically by day.