Scholars show why doctors flee TZ

Intern doctors  express dissatisfaction based on their experiences working in Muhimbili National Hospital during a protest in May last year. PHOTOS | FILE 

In Summary

• According to studies in the Tanzania medical care system, various problems plaguing  the public health sector  are  a major force in driving doctors to relocate to other countries, a majority of doctors feel that their employers do not care about their welfare.

Dar es Salaam.  A report released this weekend  indicates that 184 of Tanzania’s graduate doctors emigrated abroad by mid this year in  ‘search for greener pastures’.

According to other studies in the Tanzania health care system, the various problems plaguing  the public health sector in the country are  a major driving force for  these doctors decision to relocate to other countries . Here are some scholarly studies and findings.

Motivation of health care workers in Tanzania: A case study of Muhimbili National Hospital, a 2008 study found lack of concern by employers for staff welfare to be a negative indicator for both motivation in the workplace and overall work performance.

 Majority of the workers in the study (88 per cent) felt that their employers did not care about their welfare. This figure represents: 82.4 per cent of their doctors, 90.7 per cent of nurses, 85.7 per cent of other clinical support workers, and 87.9 per cent of supporting staff.

Finding also generally reflected how  hospital workers perceived the interest or concern in personnel issues by the hospital management.

“A fairly negative view was reported by workers with respect to the attitude of the employer in allowing days off for a worker with a sick spouses or child,” the report read.

In addition, assistance from the hospital management to sick workers was rated as unsatisfactory to some extent by nearly 88 per cent of the workers and such negative feelings were most prominent among the doctors (91.2 per cent), followed closely by the nursing staff (90 per cent) and other clinical support staff (76.5 per cent).

Another study, Tanzania’s health system and workforce crisis, a 2012 paper by Dr Gideon Kwesigabo, Dr Mughwira Mwangu and Dr Deodatus Kakoko, all lecturers at the Muhimbili University of Health and Allied Sciences (Muhas), pointed out ‘Serious System Challenges Facing Health Workers ‘ as chronic shortages of equipment and supplies (including vaccines, antibiotics, and other essentials) compounding poor quality of services at primary health-care facilities. They added  that irregular supply of essential drugs at all levels of the health delivery system have led to unnecessary referrals resulting in  problems with hygiene  particularly in dispensaries and health centres where water supplies are often non-existent, erratic, and unsafe.

Lack of supervision and low motivation were also mentioned and attributed to lack of capacity to satisfactorily complete diagnostic examinations at dispensaries and district hospitals. Further, the report notes that primary care workers often go months without supervision, and reports about quality  of care vary, from helpful to unsystematic and unfriendly.

Another factor raised was inadequate communication between health service providers at the various levels, meaning that providers’ skills and facilities are not maximized and that it is difficult to organise referrals and feedback through the various levels of the referral chain.

“Even at referral hospitals, including the apex of care at Muhimbili National Hospital, worker satisfaction is compromised. In 2003/2004, a large proportion of staff surveyed there reported dissatisfaction: almost half of doctors and nurses, 67 per cent for auxiliary clinical staff, and 39 per cent of support staff.”

The paper reads:“They cite many concerns common in lower-level facilities: low salaries, frequent unavailability of necessary equipment and facilities, inadequate performance evaluation and feedback, poor communication channels in and among units and between workers and management, lack of participation in decision-making processes, and a general lack of concern for workers welfare by the hospital management.”

A 2010 research focusing on rural-urban imbalance of human resources for health entitled ‘Wrong schools or wrong students? The potential role of medical education in regional imbalances of the health workforce in the United Republic of Tanzania’ by Beatus  Leon1 and Julie Kolstad. The study  found that: lack of a primary interest in medicine among medical school entrants, biases in recruitment, the absence of rural related clinical curricula in medical schools, and a preference for specialisation not available in rural areas, are among the main obstacles for building a motivated health workforce which can help correct the inequitable distribution of doctors in the United Republic of Tanzania.

“After five years in medical school, only  eight per cent of the students reported being more motivated for a medical career than they were upon entry. Two-thirds reported feeling less motivated and only 25% retained the initial level of motivation they had at the time of joining the medical school,”

The report concludes that the implications of producing demotivated doctors in a country with scant health professionals  are potentially enormous, as it is likely that both the probability of doctors leaving the health sector is higher