title: Training and deployment of medical doctors in Tanzania post-1990s health sector reforms: assessing the achievements.
abstract: The shortage of a skilled health workforce is a global crisis. International efforts to combat the crisis have shown few benefits; therefore, more country-specific efforts are required. Tanzania adopted health sector reforms in the 1990s to ensure, among other things, availability of an adequate skilled health workforce. Little is documented on how the post-reform training and deployment of medical doctors (MDs) have contributed to resolving Tanzania's shortage of doctors. The study aims to assess achievements in training and deployment of MDs in Tanzania about 20 years since the 1990s health sector reforms.
  
  
  
  We developed a human resource for health (HRH) conceptual model to study achievements in the training and deployment of MDs by using the concepts of supply and demand. We analysed secondary data to document the number of MDs trained in Tanzania and abroad, and the number of MDs recommended for the health sector from 1992 to 2011. A cross-sectional survey conducted in all regions of the country established the number of MDs available by 2011.
  
  
  
  By 1992, Tanzania had 1265 MDs working in the country. From 1992 to 2010, 2622 MDs graduated both locally and abroad. This translates into 3887 MDs by 2011. Tanzania needs between 3326 and 5535 MDs. Our survey captured 1299 MDs working throughout the country. This number is less than 40% of all MDs trained in and needed for Tanzania by 2011. Maldistribution favouring big cities was evident; the eastern zone with less than 30% of the population hosts more than 50% of all MDs. No information was available on the more than 60% of MDs uncaptured by our survey.
  
  
  
  Two decades after the reforms, the number of MDs trained in Tanzania has increased sevenfold per year. Yet, the number and geographical distribution of MDs practicing in the country has remained the same as before the reforms. HRH planning should consider the three stages of health workforce development conceptualized under the demand and supply model. Auditing and improvement of the HRH database is highly recommended in dealing with Tanzania's MD crisis.
authors.affiliation: Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Sweden, Umeå, SE 90185, Sweden. nsirili@yahoo.co.uk.|Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O.BOX 65454, Dar es Salaam, Tanzania. nsirili@yahoo.co.uk.
authors.forename: Nathanael
authors.identifier: 0000-0001-5205-624X
authors.initials: N
authors.lastname: Sirili
authors.affiliation: Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O.BOX 65454, Dar es Salaam, Tanzania.
authors.forename: Angwara
authors.initials: A
authors.lastname: Kiwara
authors.affiliation: Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O.BOX 65454, Dar es Salaam, Tanzania.
authors.forename: Frumence
authors.initials: F
authors.lastname: Gasto
authors.affiliation: Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Sweden, Umeå, SE 90185, Sweden.
authors.forename: Isabel
authors.initials: I
authors.lastname: Goicolea
authors.affiliation: Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Sweden, Umeå, SE 90185, Sweden.
authors.forename: Anna-Karin
authors.initials: AK
authors.lastname: Hurtig
mesh_terms: D000124:Achievement; D003430:Cross-Sectional Studies; D004501:Education, Medical; D005550:Foreign Medical Graduates; D018166:Health Care Reform; D006301:Health Services Needs and Demand; D006280:Health Workforce / Q000639:trends*; D006801:Humans; D010820:Physicians / Q000600:supply & distribution* / Q000639:trends; D011365:Professional Practice Location; D011795:Surveys and Questionnaires; D013636:Tanzania
keywords: Health sector reforms; Human resource for health model; Medical doctors; Planning; Shortage of doctors; Training and deployment