Health personnel retention strategies in a peri-urban community: an exploratory study on Epworth, Zimbabwe

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Abstract

Background

The need to retain health personnel is a policy challenge undermining health system reform of the 21st century. The need to resolve this global health workforce crisis resulted in the First Global Forum on Human Resources for Health in 2008 from which the Kampala Declaration and Agenda for Global Action was formulated. However, whilst there have been several studies exploring the retention of health personnel towards this end, available literature does not provide a detailed narrative on strategies used in peri-urban communities.

The aim of this study was to explore retention strategies implemented in a Zimbabwean peri-urban community between 2009 and 2014 and implications for peri-urban communities towards the health system reform agenda.

Methods

The study was carried out in Epworth, a peri-urban community in Harare, Zimbabwe. The research design was a cross-sectional survey, in which qualitative methods were used in sampling, data collection, reporting and analysis. Qualitative tools were used to collect data through in-depth interviews with purposively selected health personnel managers at 10 local clinics and sample interviews with purposively selected healthcare workers who included registered general nurses, state-certified nurses, midwives, environmental health technicians, nurse aids and community health volunteers at each clinic. Two focus group discussions were carried out with community health volunteers. Qualitative data was subjected to thematic analysis, with coding being performed manually.

Results

A programme-specific strategic partnership between the government and donor community contributed towards the mobilisation of more health personnel, health facilities, worker development and remuneration. To complement this, the Ministry of Health intervened through the review and payment of salaries, support towards post-basic training and development, and protection. The local board, mission and donors contributed through the payment of top-up allowances and provision of non-monetary incentives.

Conclusions

The review of salaries, engagement of international strategic partners, payment of top-up allowances, support towards post-basic training and development, mobilisation of more health personnel, non-monetary incentives and healthcare worker protection were critical towards the retention of health personnel in the Epworth peri-urban community between 2009 and 2014.

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Most cited references 17

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Retention of health workers in Malawi: perspectives of health workers and district management

Ogenna Manafa, Eilish McAuliffe, Fresier Chidyaonga-Maseko … (2009)

Background Shortage of human resources is a major problem facing Malawi, where more than 50% of the population lives in rural areas. Most of the district health services are provided by clinical health officers specially trained to provide services that would normally be provided by fully qualified doctors or specialists. As this cadre and the cadre of enrolled nurses are the mainstay of the Malawian health service at the district level, it is important that they are supported and motivated to deliver a good standard of service to the population. This study explores how these cadres are managed and motivated and the impact this has on their performance. Methods A quantitative survey measured health workers' job satisfaction, perceptions of the work environment and sense of justice in the workplace, and was reported elsewhere. It emerged that health workers were particularly dissatisfied with what they perceived as unfair access to continuous education and career advancement opportunities, as well as inadequate supervision. These issues and their contribution to demotivation, from the perspective of both management and health workers, were further explored by means of qualitative techniques. Focus group discussions were held with health workers, and key-informant interviews were conducted with members of district health management teams and human resource officers in the Ministry of Health. The focus groups used convenience sampling that included all the different cadres of health workers available and willing to participate on the day the research team visited the health facility. The interviews targeted district health management teams in three districts and the human resources personnel in the Ministry of Health, also sampling those who were available and agreed to participate. Results The results showed that health workers consider continuous education and career progression strategies to be inadequate. Standard human resource management practices such as performance appraisal and the provision of job descriptions were not present in many cases. Health workers felt that they were inadequately supervised, with no feedback on performance. In contrast to health workers, managers did not perceive these human resources management deficiencies in the system as having an impact on motivation. Conclusion A strong human resource management function operating at the district level is likely to improve worker motivation and performance.

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The Ghana community-based health planning and services initiative for scaling up service delivery innovation.

Frank Nyonator, James Phillips, Jenny Stewart Williams … (2004)

Research projects demonstrating ways to improve health services often fail to have an impact on what national health programmes actually do. An approach to evidence-based policy development has been launched in Ghana which bridges the gap between research and programme implementation. After nearly two decades of national debate and investigation into appropriate strategies for service delivery at the periphery, the Community-based Health Planning and Services (CHPS) Initiative has employed strategies tested in the successful Navrongo experiment to guide national health reforms that mobilize volunteerism, resources and cultural institutions for supporting community-based primary health care. Over a 2-year period, 104 out of the 110 districts in Ghana started CHPS. This paper reviews the development of the CHPS initiative, describes the processes of implementation and relates the initiative to the principles of scaling up organizational change which it embraces. Evidence from the national monitoring and evaluation programme provides insights into CHPS' success and identifies constraints on future progress.

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Social Research Methods

A. BRYMAN, A Bryman, Alan Bryman … (2004)

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Author and article information

Contributors

Bernard Hope Taderera: htaderera@gmail.com

Journal

Journal ID (nlm-ta): Hum Resour Health

Journal ID (iso-abbrev): Hum Resour Health

Title: Human Resources for Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1478-4491

Publication date (Electronic): 27 April 2016

Publication date PMC-release: 27 April 2016

Publication date Collection: 2016

Volume: 14

Electronic Location Identifier: 17

Affiliations

[ ]School of Health Systems and Public Health, University of Pretoria, HW Snyman Building (North), 31 Bophelo Road, Gezina, Pretoria, South Africa

[ ]Department of Political and Administrative Studies, University of Zimbabwe, P.O Box MP 167, Mount Pleasant, Harare, Zimbabwe

[ ]National Department of Health of the Republic of South Africa, Civitas Building, 222 Cnr Struben St. & Andries St., Pretoria, 0001 South Africa

Article

Publisher ID: 113

DOI: 10.1186/s12960-016-0113-z

PMC ID: 4847243

PubMed ID: 27117921

SO-VID: 2cff9739-6d24-4c4a-92b6-f9c86435b450

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 30 August 2015

Date accepted : 20 April 2016

Funding

Funded by: African Population and Health Research Centre

Award ID: ADF 002

Award Recipient : Bernard Hope Taderera

Funded by: FundRef http://dx.doi.org/10.13039/501100001343, University of Pretoria ;

Award ID: 10443925

Award Recipient : Bernard Hope Taderera

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ScienceOpen disciplines: Health & Social care

Keywords: retention,strategies,health personnel,reform,peri-urban community,epworth,zimbabwe

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ScienceOpen disciplines: Health & Social care

Keywords: retention, strategies, health personnel, reform, peri-urban community, epworth, zimbabwe

Health personnel retention strategies in a peri-urban community: an exploratory study on Epworth, Zimbabwe

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Abstract

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UCL: UN SDG 10 Reduced Inequalities

Most cited references 17

Retention of health workers in Malawi: perspectives of health workers and district management

The Ghana community-based health planning and services initiative for scaling up service delivery innovation.

Social Research Methods

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