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Health workers prefer public sector

In Tanzania, health workers in rural areas prefer to work in the public sector, even though the church-run hospitals mostly provide better patient care and are better equipped. A favourably pension scheme seems to be part of the reason.

Why do health workers in Tanzania prefer public sector employment?
Songstad NG, Moland KM, Massay DA, Blystad A:
BMC Health Services Research 2012, 12:92.

Uneven distribution of health workers
Shortages of qualified health workers and geographical imbalances in the workforce pose major challenges in many low-income countries. These issues require the national health sector management to closely monitor and address difficulties related to the distribution of health workers across health facilities. This article is based on a qualitative study in rural Tanzania and addresses health workers’ preferences for workplace. The study found a clear preference for public sector employment. 

Public sector most attractive
The health workers’ experiences and perceptions of the differences between the public health sector and church-run health facilities are an important part of the study. PhD candidate Nils Gunnar Songstad found that public sector was associated with health worker rights and access to various benefits offered to health workers in government service. Particularly the favourable pension schemes providing economic security in old age was attractive.

Health workers acknowledged that church-run hospitals generally were better equipped and provided better quality patient care, but these concerns tended to be outweighed by the financial assets of public sector employment. In addition to the sector specific differences, family concerns emerged as important in decisions on workplace.

Regulation of pension scheme required
The overall shortage of health workers and the distribution between health facilities is a challenge in a resource constrained health system. The church-run health facilities are especially important for provision of health care in rural areas, and in these areas patients actually tend to prefer them over public sector facilities.

In order to ensure equity in distribution of qualified health workers in Tanzania, a national regulation and legislation of the pension schemes is required.

Read the full article in BMC Health Services Research.