Assessment of Health Worker Productivity in Tanzania

The shortage of health workers has been extensively documented and described as a national crisis. According to the 2013 mid-term review of the Third Health Sector Strategic Plan, Tanzania has a 39 percent deficit in the health workforce across all cadres. Contributing factors to the shortage include poor deployment, brain drain, and low absorption capacity of government for graduate health workers. The health workforce crisis in Tanzania involves more than a personnel shortage. Unequal distribution of the health workforce, poor motivation and performance, and low productivity are also contributing to the crisis. However, information regarding the productivity of health workers in Tanzania is relatively limited, making it difficult to develop effective advocacy strategies to address the crisis. The Benjamin W. Mkapa Foundation undertook a study to improve understanding of health worker productivity in Tanzania. The study aimed to assess health workers' productivity during working hours, examine health workers' productivity in relation to level of care, type of cadre, and geographical location, and examine the perceived effect of financial and non-financial incentives on productivity. The study covered 30 selected health facilities in six localities using a cross-sectional approach that employed both qualitative and quantitative methods. Quantitative data on health workers' time use was gathered using time motion studies, with about 135 health workers observed while performing their duties. Observed health workers spent 47 percent of their working time on productive activities. Productivity levels differed with respect to cadre, level of facility, and geographical location. Pharmaceutical assistants were the most productive cadre, with 72 percent of their time spent on productive activities. Productivity was found to be highest in hospital settings, with 55 percent of time spent on productive activities. However, when considering the time that health workers were actually present at health facilities, 66 percent of their time was spent on productive activities. These findings suggest that health workers are being underutilized, but the interpretation of productivity changes when considering the time that health workers are present at facilities. The study highlights the need for effective advocacy strategies to address the health workforce crisis in Tanzania, including improving the distribution of the health workforce, motivating and retaining health workers, and increasing productivity.