Background: In many developing countries, health workforce crisis is one of the predominant challenges affecting the
health care systems’ function of providing quality services, including maternal care. The challenge is related to how
these countries establish conducive working conditions that attract and retain health workers into the health care
sector and enable them to perform effectively and efficiently to improve health services particularly in rural settings.
This study explored the perspectives of health workers and managers on factors influencing working conditions for
providing maternal health care services in rural Tanzania. The researchers took a broad approach to understand the
status of the current working conditions through a governance lens and brought into context the role of government
and its decentralized organs in handling health workers in order to improve their performance and retention.
Methods: In-depth interviews were conducted with 22 informants (15 health workers, 5 members of Council Health
Management Team and 2 informants from the District Executive Director’s office). An interview guide was used with
questions pertaining to informants’ perspective on provision of maternal health care service, working environment,
living conditions, handling of staff’s financial claims, avenue for sharing concerns, opportunities for training and career
progression. Probing questions on how these issues affect the health workers’ role of providing maternal health care
were employed. Document reviews and observations of health facilities were conducted to supplement the data. The
interviews were analysed using a qualitative content analysis approach.
Results: Overall, health workers felt abandoned and lost within an unsupportive system they serve. Difficult working
and living environments that affect health workers’ role of providing maternal health care services were dominant
concerns raised from interviews with both health workers and managers. Existence of a bureaucratic and irresponsible
administrative system was reported to result in the delay in responding to the health workers’ claims timely and that
there is no transparency and fairness in dealing with health workers’ financial claims. Informants also reported on the
non-existence of a formal motivation scheme and a free avenue for voicing and sharing health workers’ concerns.
Other challenges reported were lack of a clear strategic plan for staff career advancement and continuous professional
development to improve health workers’ knowledge and skills necessary for providing quality maternal health care