title: Explaining retention of healthcare workers in Tanzania: moving on, coming to 'look, see and go', or stay?
abstract: BACKGROUND
  In the United Republic of Tanzania, as in many regions of Sub-Saharan Africa, staff shortages in the healthcare system are a persistent problem, particularly in rural areas. To explore staff shortages and ways of keeping workers in post, we ask, (a) Which cadres are most problematic to recruit and keep in post? (b) How and for what related reasons do health workers leave? (c) What critical incidents do those who stay face? (d) And why do they stay and cope?
  
  
  METHODS
  This is a multi-method paper based on analysis of data collected as part of a cross-sectional health facility study supporting maternal and reproductive health services in the United Republic of Tanzania. Qualitative data were generated through semi-structured interviews with Council Health Management Teams, and Critical Incident Technique interviews with mid-level cadres. Complementary quantitative survey data were collected from district health officials, which are used to support the qualitative themes.
  
  
  RESULTS
  Mid-level cadres were problematic to retain and caused significant disruptions to continuity of care when they left. Shortage of highly skilled workers is not only a rural issue but also a national one. Staff were categorised into a clear typology. Staff who left soon after arrival and are described by 'Look, See and Go'; 'Movers On' were those who left due to family commitments or because they were pushed to go. The remaining staff were 'Stayers'. Reasons for wanting to leave included perceptions of personal safety, feeling patient outcomes were compromised by poor care or as a result of perceived failed promises. Staying and coping with unsatisfactory conditions was often about being settled into a community, rather than into the post.
  
  
  CONCLUSIONS
  The Human Resources for Health system in the United Republic of Tanzania appears to lack transparency. A centralised monitoring system could help to avoid early departures, misallocation of training, and other incentives. The system should match workers' profiles to the most suitable post for them and track their progress and rewards; training managers and holding them accountable. In addition, priority should be given to workplace safety, late night staff transport, modernised and secure compound housing, and involving the community in reforming health services culture and practices.
authors.affiliation: Ifakara Health Institute, Kiko Avenue, Plot 463, P.O. Box 78373, Mikocheni, Dar es Salaam, Tanzania. ashemdoe@ihi.or.tz.
authors.forename: Aloisia
authors.initials: A
authors.lastname: Shemdoe
authors.affiliation: Ifakara Health Institute, Kiko Avenue, Plot 463, P.O. Box 78373, Mikocheni, Dar es Salaam, Tanzania.
authors.forename: Godfrey
authors.initials: G
authors.lastname: Mbaruku
authors.affiliation: Ifakara Health Institute, Kiko Avenue, Plot 463, P.O. Box 78373, Mikocheni, Dar es Salaam, Tanzania.
authors.forename: Angel
authors.initials: A
authors.lastname: Dillip
authors.affiliation: School of Health Sciences, City University London, 1 Myddelton Street, London, EC1R 1UW, England.
authors.forename: Susan
authors.initials: S
authors.lastname: Bradley
authors.affiliation: Oxford Policy Management, GEPF House, Plot No 37, New Bagamoyo Road, P.O Box 71166, Dar es Salaam, Tanzania.
authors.forename: JeJe
authors.initials: J
authors.lastname: William
authors.affiliation: Department of Public Health, NHS Ayrshire & Arran, Dalmellington Rd, Ayr, KA6 6AB, Scotland.
authors.forename: Deborah
authors.initials: D
authors.lastname: Wason
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, MD1, Science Drive 2, 117549, Singapore, Singapore.|London School of Hygiene and Tropical Medicine, Faculty of Public Health & Policy, Department of Global Health and Development, Keppel Street, London, WC1E 7HT, England.
authors.forename: Zoe Jane-Lara
authors.initials: ZJ
authors.lastname: Hildon
mesh_terms: D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005260:Female; D006268:Health Facilities; D006282:Health Personnel; D006296:Health Services / Q000592:standards; D006801:Humans; D007588:Job Satisfaction; D008427:Maternal Health Services; D009042:Motivation; D010559:Personnel Management / Q000379:methods*; D011247:Pregnancy; D012111:Residence Characteristics; D019035:Rural Health Services / Q000592:standards; D012424:Rural Population; D012449:Safety; D013636:Tanzania; D000078329:Workforce