Why do health workers in rural Tanzania prefer public sector employment?

Severe shortages of qualified health workers and geographical imbalances in the workforce in many low-income countries require the national health sector management to closely monitor and address issues related to the distribution of health workers across various types of health facilities. This article discusses health workers' preferences for workplace and their perceptions and experiences of the differences in working conditions in the public health sector versus the church-run health facilities in Tanzania. The broader aim is to generate knowledge that can add to debates on health sector management in low-income contexts. The study has a qualitative study design to elicit in-depth information on health workers' preferences for workplace. The data comprise ten focus group discussions (FGDs) and 29 in-depth interviews (IDIs) with auxiliary staff, nursing staff, clinicians and administrators in the public health sector and in a large church-run hospital in a rural district in Tanzania. The study has an ethnographic backdrop based on earlier long-term fieldwork in Tanzania. The study found a clear preference for public sector employment. This 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. 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. The preference for public sector employment among health workers shown in this study seems to be associated primarily with the favourable pension scheme. The overall shortage of health workers and the distribution between health facilities is a challenge in a resource constrained health system where church-run health facilities are vital in the provision of health care in rural areas and where patients tend to prefer these services. In order to ensure equity in distribution of qualified health workers in Tanzania, a national regulation and legislation of the pension schemes is required

Social security systems in Tanzania: Phase II: Co-operatives and Social Protection

In the 1950s and 1960s Tanzania had the third largest co-operative movement in the world. These co-operatives provided economic and social protection to members so that poor peasants could sell their crops even in years of bad world market prices. The services provided by co-operatives, like education and trusteeship for peasants who took out loans, collapsed when the government abolished co-operatives in 1976. They were re-introduced in 1982 but, due to their abolition, they had lost capital, personnel and members. The current co-operatives are much weaker than the pre-1976 ones and cannot provide the same kind of protection they once did. Co-operatives have still a great potential for social and economic protection but much change in the government policy on co-operatives is needed. African Journal of Social Work Vol.17(2) 2002: 29-4

Social security systems in Tanzania : Phase III: Mutual Aid

The paper investigates the role of mutual aid in the provision of social protection. Methodological triangulation involving survey interviews, focus group discussions, in-depth interviews, documentary reviews and participant observations were used to collect data. Findings show that mutual aid groups of different types have existed in different epochs during periods of peace, prosperity and even during calamities. Some mutual aid groups are organized on gender lines. These differences are also observed at the level of age groups, educational attainment, marital status and religious affiliation. Mutual aid groups in rural areas cover almost all kinds of contingencies while those in urban areas cover specified risks. Although mutual aid groups provide short-term protection against social and economic risks, their capacity for protecting members against long-term risks is impaired. The paper concludes by making suggestions for improving mutual aid groups so that they may provide adequate protection against all risks as well as for removing the inequities inherent in the system. African Journal of Social Work Vol.17(2) 2002: 4505

Social security systems in Tanzania: Phase I Overview of social security in Tanzania

The paper starts by examining the concept of social security in Tanzania, showing that there are three key issues in social security which have not been adequately addressed by existing social security schemes and need immediate attention. The paper then examines the nature and forms of social security in Tanzania in a historical perspective. It shows that non-conventional social security instruments have failed to promote equitable economic growth and have been heavily biased in favour of the well-off at the expense of the poor. The effectiveness of traditional and informal social security systems has been impaired by changes that have taken place since the colonial period. Formal social security schemes are riddled with problems. The development of formal social security has been gradual and the introduction of structural adjustment programmes has led to the decline of formal security schemes. In terms of coverage, formal social security schemes cover only 6% of the population and focus on only a few risks. African Journal of Social Work Vol.17(2) 2002: 11-2