"Once the government employs you, it forgets you": Health workers' and managers' perspectives on factors influencing working conditions for provision of maternal health care services in a rural district of Tanzania
"Once the government employs you, it forgets you": Health workers' and managers' perspectives on factors influencing working conditions for provision of maternal health care services in a rural district of Tanzania
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DOI：
10.1186/s12960-015-0076-5
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发表时间：
2015-09-14
影响因子：
4.5
通讯作者：
Hurtig, Anna-Karin
中科院分区：
文献类型：
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作者：
Mkoka, Dickson Ally;Mahiti, Gladys Reuben;Hurtig, Anna-Karin
背景：在许多发展中国家，卫生人力危机是影响卫生保健系统提供包括产妇护理在内的优质服务的主要挑战之一。这一挑战涉及这些国家如何建立有利的工作条件，吸引和留住卫生工作者进入卫生保健部门，并使他们能够有效和高效地改善卫生服务，特别是在农村环境中。这项研究探讨了卫生工作者和管理者对影响坦桑尼亚农村地区提供孕产妇保健服务的工作条件的因素的看法。研究人员采取广泛的方法，通过治理的视角了解当前工作条件的现状，并将政府及其分散机构在处理卫生工作者方面的作用纳入背景，以提高卫生工作者的绩效和留存率。方法：对22名举报人(15名卫生工作者、5名理事会卫生管理团队成员和2名区执行主任办公室的举报人)进行深入访谈。访谈指南中使用了与以下问题有关的问题：提供产妇保健服务、工作环境、生活条件、处理工作人员的财务索赔、分享关切的途径、培训机会和职业发展。对这些问题如何影响卫生工作者提供孕产妇保健的作用进行了探讨。对卫生设施进行了文件审查和观察，以补充数据。访谈采用定性的内容分析方法。结果：总体来说，卫生工作者感到被遗弃和迷失在他们所服务的缺乏支持的系统中。困难的工作和生活环境影响了卫生工作者提供产妇保健服务的作用，这是与卫生工作者和管理人员面谈时提出的主要关切。据报告，存在官僚主义和不负责任的行政制度，导致迟迟不能及时答复卫生工作者的索赔，在处理卫生工作者的财务索赔方面没有透明度和公正性。提供信息的人还报告说，不存在正式的激励计划和表达和分享卫生工作者关切的自由途径。报告的其他挑战包括缺乏明确的工作人员职业发展和持续职业发展的战略规划，以提高卫生工作者提供高质量孕产妇保健所需的知识和技能。结论：农村卫生工作者面临着一些影响其工作条件和整体业绩的挑战。政府及其权力下放机构应负起责任，创造有利的工作和生活环境，公平公正地回应卫生工作者的财务要求，规划他们的职业发展，并创造一个与管理层表达和分享关切的自由渠道。为实现这一目标，应努力改进人力资源管理系统的治理，这将考虑到政府在谨慎和负责任地处理人力资源方面的管理作用。
Background: In many developing countries, health workforce crisis is one of the predominant challenges affecting the health care systems' function of providing quality services, including maternal care. The challenge is related to how these countries establish conducive working conditions that attract and retain health workers into the health care sector and enable them to perform effectively and efficiently to improve health services particularly in rural settings. This study explored the perspectives of health workers and managers on factors influencing working conditions for providing maternal health care services in rural Tanzania. The researchers took a broad approach to understand the status of the current working conditions through a governance lens and brought into context the role of government and its decentralized organs in handling health workers in order to improve their performance and retention.Methods: In-depth interviews were conducted with 22 informants (15 health workers, 5 members of Council Health Management Team and 2 informants from the District Executive Director's office). An interview guide was used with questions pertaining to informants' perspective on provision of maternal health care service, working environment, living conditions, handling of staff's financial claims, avenue for sharing concerns, opportunities for training and career progression. Probing questions on how these issues affect the health workers' role of providing maternal health care were employed. Document reviews and observations of health facilities were conducted to supplement the data. The interviews were analysed using a qualitative content analysis approach.Results: Overall, health workers felt abandoned and lost within an unsupportive system they serve. Difficult working and living environments that affect health workers' role of providing maternal health care services were dominant concerns raised from interviews with both health workers and managers. Existence of a bureaucratic and irresponsible administrative system was reported to result in the delay in responding to the health workers' claims timely and that there is no transparency and fairness in dealing with health workers' financial claims. Informants also reported on the non-existence of a formal motivation scheme and a free avenue for voicing and sharing health workers' concerns. Other challenges reported were lack of a clear strategic plan for staff career advancement and continuous professional development to improve health workers' knowledge and skills necessary for providing quality maternal health care.Conclusion: Health workers working in rural areas are facing a number of challenges that affect their working conditions and hence their overall performance. The government and its decentralized organs should be accountable to create conducive working and living environments, respond to health workers' financial claims fairly and equitably, plan for their career advancement and create a free avenue for voicing and sharing concerns with the management. To achieve this, efforts should be directed towards improving the governance of the human resource management system that will take into account the stewardship role of the government in handling human resource carefully and responsibly.