Health Worker Engagement and Facility Performance in Delivering HIV Care in Tanzania
With an increasing number of people living with HIV linked to long-term treatment, a productive health workforce is essential to provide quality care. Engaged health workers are more productive and provide higher quality care. This study examined latent characteristics of engagement, factors that influence engagement, and the association with health facility performance in providing HIV care in Tanzania.
Using data collected from 1329 health workers and 183 health facilities across six regions in Tanzania, we used factor analysis and structural equation modelling to examine latent characteristics of engagement and influencing factors and generalized linear modeling to assess the association between engagement and facility performance.
We identified four characteristics of engagement (job satisfaction, being accountable, being a team player, and delivering equitable care) and three factors influencing engagement (supportive supervision, human resources and infrastructure, and competencies).
All four characteristics of engagement were associated with improved HIV care and outcomes; showing that interventions to improve job satisfaction, a characteristic of engagement, can positively impact facility performance. Facility performance cannot be improved through engaged workers alone and should be coupled with approaches to address gaps beyond human resources.