Manager and Provider Perspectives of the Work Environment Experienced by Associate Clinicians, Nurses and Midwives Who Deliver Emergency Obstetric Care in Tanzania

摘要

Positive practice environments promote the health, safety and well-being of health workers by supporting professionalism, acknowledging performance and ensuring opportunities for professional growth. According to the International Collaborating Partners of the Positive Practice Environments Campaign, positive practice environments foster a motivated, productive and high-performing pool of workers who deliver high quality care. Research shows that achieving positive practice environments for health care professionals is problematic worldwide. In Tanzania, the capacity of human resources for health managers to implement deliberate and strategic action to plan for and effectively deploy health workers, as well as safeguard their practice environments, is severely diminished. The basic strategic human resources management (SHRM) components model was used to guide understanding of the relationship between people management practices and the practice environment. This dissertation examined the people management practices that have been implemented in Tanzania and their impact on the practice environment experienced by associate clinicians (ACs), nurses and midwives who deliver emergency obstetric care (EmOC). Interview and survey data obtained from frontline ACs, nurses and midwives and members of Council Health Management Teams (CHMTs) tasked with planning for and deploying health human resources offered provider and managerial perspectives of the practice environment within which EmOC is delivered in Tanzania. The eight people management practices specified in the basic SHRM components model were applied in varying extents across the 48 districts assessed. Partial implementation contributed to loss of motivation and undermined the performance of ACs, nurses and midwives who deliver the essential interventions constituting EmOC in Tanzania.