Manager and Provider Perspectives of the Work Environment Experienced by Associate Clinicians, Nurses and Midwives Who Deliver Emergency Obstetric Care in Tanzania

Positive practice environments promote the health, safety and well-being of health workers by supporting professionalism, acknowledging performance and ensuring opportunities for professional growth. According to the International Collaborating Partners of the Positive Practice Environments Campaign, positive practice environments foster a motivated, productive and high-performing pool of workers who deliver high quality care. Research shows that achieving positive practice environments for health care professionals is problematic worldwide. In Tanzania, the capacity of human resources for health managers to implement deliberate and strategic action to plan for and effectively deploy health workers, as well as safeguard their practice environments, is severely diminished. The basic strategic human resources management (SHRM) components model was used to guide understanding of the relationship between people management practices and the practice environment. This dissertation examined the people management practices that have been implemented in Tanzania and their impact on the practice environment experienced by associate clinicians (ACs), nurses and midwives who deliver emergency obstetric care (EmOC). Interview and survey data obtained from frontline ACs, nurses and midwives and members of Council Health Management Teams (CHMTs) tasked with planning for and deploying health human resources offered provider and managerial perspectives of the practice environment within which EmOC is delivered in Tanzania. The eight people management practices specified in the basic SHRM components model were applied in varying extents across the 48 districts assessed. Partial implementation contributed to loss of motivation and undermined the performance of ACs, nurses and midwives who deliver the essential interventions constituting EmOC in Tanzania

Professional practice models for nurses in low-income countries: an integrative review

Background: Attention is turning to nurses, who form the greatest proportion of health personnel worldwide, to play a greater role in delivering health services amidst a severe human resources for health crisis and overwhelming disease burden in low-income countries. Nurse leaders in low-income countries must consider essential context for nurses to fulfill their professional obligation to deliver safe and reliable health services. Professional practice models (PPMs) have been proposed as a framework for strategically positioning nurses to impact health outcomes. PPMs comprise 5 elements: professional values, patient care delivery systems, professional relationships, management approach and remuneration. In this paper, we synthesize the existing literature on PPMs for nurses in low-income countries. Methods: An integrative review of CINAHL-EBSCO, PubMed and Scopus databases for English language journal articles published after 1990. Search terms included nurses, professionalism, professional practice models, low-income countries, developing countries and relevant Medical Subject Heading Terms (MeSH). Results: Sixty nine articles published between 1993 and 2014 were included in the review. Twenty seven articles examined patient care delivery models, 17 professional relationships, 12 professional values, 11 remuneration and 1 management approach. One article looked at comprehensive PPMs. Conclusions: Adopting comprehensive PPMs or their components can be a strategy to exploit the capacity of nurses and provide a framework for determining the full expression of the nursing role

District health manager and mid-level provider perceptions of practice environments in acute obstetric settings in Tanzania: a mixed-method study

Background: In sub-Saharan Africa, the capacity of human resources for health (HRH) managers to create positive practice environments that enable motivated, productive, and high-performing HRH is weak. We implemented a unique approach to examining HRH management practices by comparing perspectives offered by mid-level providers (MLPs) of emergency obstetric care (EmOC) in Tanzania to those presented by local health authorities, known as council health management teams (CHMTs). Methods: This study was guided by the basic strategic human resources management (SHRM) component model. A convergent mixed-method design was utilized to assess qualitative and quantitative data from the Health Systems Strengthening for Equity: The Power and Potential of Mid-Level Providers project. Survey data was obtained from 837 mid-level providers, 83 of whom participated in a critical incident interview whose aim was to elicit negative events in the practice environment that induced intention to leave their job. HRH management practices were assessed quantitatively in 48 districts with 37 members of CHMTs participating in semi-structured interviews. Results: The eight human resources management practices enumerated in the basic SHRM component model were implemented unevenly. On the one hand, members of CHMTs and mid-level providers agreed that there were severe shortages of health workers, deficient salaries, and an overwhelming workload. On the other hand, members of CHMTs and mid-level providers differed in their perspectives on rewards and allocation of opportunities for in-service training. Although written standards of performance and supervision requirements were available in most districts, they did not reflect actual duties. Members of CHMTs reported high levels of autonomy in key HRH management practices, but mid-level providers disputed the degree to which the real situation on the ground was factored into job-related decision-making by CHMTs. Conclusions: The incongruence in perspectives offered by members of CHMTs and mid-level providers points to deficient HRH management practices, which contribute to poor practice environments in acute obstetric settings in Tanzania. Our findings indicate that members of CHMTs require additional support to adequately fulfill their HRH management role. Further research conducted in low-income countries is necessary to determine the appropriate package of interventions required to strengthen the capacity of members of CHMTs