"Workhood"-a useful concept for the analysis of health workers' resources? an evaluation from Tanzania

Case studies were conducted in four Reproductive-and-Child-Health (RCH) clinics in the Kilombero Valley, south-eastern Tanzania, using different qualitative methods such as participant observation, informal discussions and in-depth interviews to explore the relevance of the different types of workhood resources for effective health service delivery. Health workers' ability to access these resources were investigated and factors facilitating or constraining access identified.The study showed that lack of physical, human, cultural and financial capital constrained health workers' capacity to act. In particular, weak health infrastructure and health system failures led to the lack of sufficient drug and supply stocks and chronic staff shortages at the health facilities. However, health workers' capacity to mobilize social, cultural and symbolic capital played a significant role in their ability to overcome work related problems. Professional and non-professional social relationships were activated in order to access drug stocks and other supplies, transport and knowledge.By evaluating the workhood concept this study highlights the importance of understanding health worker performance by looking at their resources and capacities. Rather than blaming health workers for health system failures, applying a strength-based approach offers new insights into health workers' capacities and identifies entry points for target actions.Quality of care strongly influences utilization of health care services and access to effective treatment. However, many studies from different countries of Sub-Saharan Africa have reported poor quality in terms of diagnostics and case management [1-5]. Other studies highlight the impact of health workers' bad attitudes towards their clients on quality of care [6-9]. Furthermore, health workers' discrimination and lack of respect towards the very poor and vulnerable is a theme that emerges in a number of studies [9-11]. Informal economic activities of