title: Human resources for health care delivery in Tanzania: a multifaceted problem.
abstract: BACKGROUND
  Recent years have seen an unprecedented increase in funds for procurement of health commodities in developing countries. A major challenge now is the efficient delivery of commodities and services to improve population health. With this in mind, we documented staffing levels and productivity in peripheral health facilities in southern Tanzania.
  
  
  METHODS
  A health facility survey was conducted to collect data on staff employed, their main tasks, availability on the day of the survey, reasons for absenteeism, and experience of supervisory visits from District Health Teams. In-depth interview with health workers was done to explore their perception of work load. A time and motion study of nurses in the Reproductive and Child Health (RCH) clinics documented their time use by task.
  
  
  RESULTS
  We found that only 14% (122/854) of the recommended number of nurses and 20% (90/441) of the clinical staff had been employed at the facilities. Furthermore, 44% of clinical staff was not available on the day of the survey. Various reasons were given for this. Amongst the clinical staff, 38% were absent because of attendance to seminar sessions, 8% because of long-training, 25% were on official travel and 20% were on leave. RCH clinic nurses were present for 7 hours a day, but only worked productively for 57% of time present at facility. Almost two-third of facilities had received less than 3 visits from district health teams during the 6 months preceding the survey.
  
  
  CONCLUSIONS
  This study documented inadequate staffing of health facilities, a high degree of absenteeism, low productivity of the staff who were present and inadequate supervision in peripheral Tanzanian health facilities. The implications of these findings are discussed in the context of decentralized health care in Tanzania.
authors.affiliation: Ifakara Health Institute, Health System and policy thematic, Kiko Ave 463, Mikocheni, P,o, Box 78373, Dar es Salaam, Tanzania. fmanzi@ihi.or.tz.
authors.forename: Fatuma
authors.initials: F
authors.lastname: Manzi
authors.forename: Joanna Armstrong
authors.initials: JA
authors.lastname: Schellenberg
authors.forename: Guy
authors.initials: G
authors.lastname: Hutton
authors.forename: Kaspar
authors.initials: K
authors.lastname: Wyss
authors.forename: Conrad
authors.initials: C
authors.lastname: Mbuya
authors.forename: Kizito
authors.initials: K
authors.lastname: Shirima
authors.forename: Hassan
authors.initials: H
authors.lastname: Mshinda
authors.forename: Marcel
authors.initials: M
authors.lastname: Tanner
authors.forename: David
authors.initials: D
authors.lastname: Schellenberg