Improving motivation among primary health care workers in Tanzania: a health worker perspective

The aim of this study was to explore the experiences of health workers working in the primary health care facilities in Kilimanjaro Region, Tanzania, in terms of their motivation to work, satisfaction and frustration, and to identify areas for sustainable improvement to the services they provide.The primary issues arising pertain to complexities of multitasking in an environment of staff shortages, a desire for more structured and supportive supervision from managers, and improved transparency in career development opportunities. Further, suggestions were made for inter-facility exchanges, particularly on commonly referred cases.The discussion highlights the context of some of the problems identified in the results and suggests that some of the preferences presented by the health workers be discussed at policy level with a view to adding value to most services with minimum additional resources.In 1992 the Tanzanian Ministry of Health (MoH) reviewed the national primary health care (PHC) strategy and decentralized primary health care delivery from national level to district level. It was envisaged that making local governments responsible for staffing and maintaining health centre and dispensary-based facilities would improve the provision of services [1]. The strategy also incorporated continuing education to health workers as a means of improving their knowledge and skills and as an important motivation factor.The MoH has developed career development structures for each category of health worker, including criteria for upgrading. Other incentives for health workers may include housing and appreciation of good performance as well as improvement of communication between different levels of the health system [2]. Guidelines for effective and efficient health care delivery require District Health Management Team (DHMT) members to directly supervise each PHC facility at least once a quarter [3].Despite relatively widely distributed urban and rural health care services i