Strengthening human resources for health. A study of health worker availability and performance in Tanzania

Shortage of health personnel and poor health worker performance are among the most pressing problems of health systems in low-income countries. This proposal represents a strategic initiative to provide evidence that will be valuable in addressing these f undamental problems. The initiative is a collaboration between several research institutions in Norway, Europe and Africa and represents a wide spectre of competence within anthropology, economics, history, and health sciences / international public healt h. The project will identify key determinants of health worker availability and performance at district level in Tanzania. The project integrates quantitative analysis with in-depth qualitative studies of determinants of health worker availability, perfo rmance and motivation (at district, facility, health worker and community levels). Special attention is devoted to management practices at district and facility level, as well as physical working conditions and financial and non-financial incentives. The study of formal structures and procedures is complemented by studies of the social-cultural and historic context. The project builds research capacity both in Norway and in Tanzania, including training of five candidates to Ph.D. level, and will lay t he foundations of future evaluation of interventions related to the health personnel issue.