Implementation of the incentive scheme for human health in the public health facilities in Newala district

Abstract

Background: Availability of human resource for health and its distribution to required areas is vital in delivering health care services, especially in rural areas. Deployment, attraction and retention of health workers in rural districts/areas have been a problem for a long period. Various incentives and benefits have been set by the government of Tanzania whereby employers are directed to provide those incentives to improve attraction and retention of health workers. However, its implementation and outcomes is not well explored. Objectives: The study aimed at assessing the implementation of the public health sector incentive scheme for attraction, deployment and retention of human resource for health in Newala district. Materials and methods: A cross sectional descriptive study was conducted in Newala district between March and May, 2010 using both quantitative and qualitative data collection methods. A total of 120 health workers were interviewed using semi-structured questionnaires, and an interview guide was used for key informants (4 district officials and three heads of facilities) in their respective workplaces. Results: Majority of health workers interviewed were not aware of their stipulated benefits and rights. Health workers who had heard about the govermnent documents stipulating health workers rights and benefits were 63.3%, while only 14.5% of those who had heard about the documents reported to had ever read such government documents. Both financial and non financial incentives were implemented but the overtime allowances were less implemented in rural health facilities as compared to urban health facilities. It was also found that majority of health workers had attended seminars (81. 7%), while less than fifty percent had been promoted (33.3%), and went for leave (24.2%). Nurses were more likely to have had attended seminars than other cadres. Furthermore, district/health facility official reported that some of the incentives were specific to a certain cadres while some were for all health workers (e.g. overtime allowances). Majority of health workers who reported to had received non financial incentives were satisfied with those incentives which also was reported to create job satisfaction, however, those who reported to had received financial incentives were not satisfied with leave allowances hence created job dissatisfaction. Incentives preferred by health workers were overtime allowances,

Vlll improved working conditions and tools, while their leaders preferred to provide hardship allowances and housing. This study also revealed the factors affecting effective implementation of incentive scheme were shortage of funds and district lack authoritative power to implement. Conclusion and Recommendations: Majority of health workers interviewed were not aware of their benefits and rights. Both fmancial and non fmancial incentives were implemented but overtime allowances were less implemented in rural facilities. Health workers who reported to receive non fmancial incentives were satisfied with those incentives which also were reported to create job satisfaction. District and facilities leaders should give education to all health workers concerning their benefits and rights. Implementation of non fmancial incentives (e.g. recognition) should be emphasized. Further research should be conducted to assess the relationship between different types of incentives and improved work performance in hard to reach districts.