Abstract:
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 crosssectional
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
