an assessment on the factors influencing employee
TRANSCRIPT
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AN ASSESSMENT ON THE FACTORS INFLUENCING EMPLOYEE
RETENTION IN TANZANIA HEALTH SECTOR:
A CASE OF DODOMA REGIONAL REFERRAL HOSPITAL
By
Steven Daniel
A Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree
of Master of Science in Human Resource Management (MSc - HRM) of
Mzumbe University
December, 2020
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CERTIFICATION
We, the undersigned, certify that we have read and hereby recommend for
acceptance by the Mzumbe University, a dissertation entitled ‘An assessment on the
factors influencing employee retention in Tanzania health sector: A case of
Dodoma regional referral hospital’, in partial fulfillment of the requirements for
the degree of Master of Science in Human Resource Management (MSc. HRM) of
the Mzumbe University.
_______________
Major Supervisor
________________
Internal Examiner
_______________
External Examiner
Accepted for the Board of MUDCC
_______________________________________________
PRINCIPAL, DAR ES SALAAM CAMPUS COLLEGE
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DECLARATION
AND
COPYRIGHT
I, Steven Daniel, declare that this dissertation is my own original work and that it
has not been submitted and will not be submitted to any other university for a similar
or any other degree award.
Signature:…………………………………..
Date:……………………………………….
© 2020
This dissertation is a copyright material protected under the Berne Convention, the
Copyright Act 1999 (Revised, 2000) and other international and national enactments,
in that behalf, on intellectual property. It may not be reproduced by any means in full
or in partial, except for short extracts in fair dealings, for research or private study,
critical scholarly review or discourse with an acknowledgement, without the written
permission of Mzumbe University, on behalf of the author.
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ACKNOWLEDGEMENT
I would like deeply to express my profound appreciation to my supervisor, Dr. Lucy
Massoi for her guidance, patience and intellectual advice, assistance, constant
encouragement, constructive critique received through the research process. Despite
her administrative responsibilities and heavy workloads, devoted her ample time to
guide me through my study.
Many thanks to the Management of the National Audit Office of Tanzania for
granting me the study leave. Similarly, deep gratitude should go to my beloved wife,
Martha Thomas Mtongoli and my sons, Brian and Baraka Stephen for their
consistent prayers, encouragement, patience, and enduring the lonely times during
theprogramme.
I sincerely extend my thanks to all members of staffs of the Dodoma region referral
hospital, my colleague in Master of Science in Human Resource Management for
their support in carrying out my studies successfully.
Lastly, for those whose names do not appeared, it does not mean that their
contributions and support rendered to me are not appreciated. I thank you very much
and wholeheartedly for your kind supports.
I sincerely thank you once again and Almighty God bless you all.
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DEDICATION
To the Habari family especially my parents Late Mr.DanielHabari and Mrs. Merina
SamweliHabari, whose their parental care and love has brought me to this far, and to
my wife Martha Thomas; my son Brain Stephen, Baraka Stephen, have set best an
example for yours to follow.
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ABBREVIATIONS
HRH Human Resource for Health
HRHIS Human Resource for Health Information System
MoHSW Ministry of Health and Social Welfare
SPSS Statistical Package for Social Science
UK United Kingdom
URT United State of Tanzania
WHO World Health Organization
DRRH Dodoma Regional Referral Hospital
BOT Bank of Tanzania
TRA Tanzania Revenue Authority
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ABSTRACT
This study focused on the factors influencing employee retention in Tanzania health
sector specifically in Dodoma regional referral hospital. The study had the following
specific objectives such as to identify the causes of shortage of health workers; to
determine the existing strategies for retaining health workers; to evaluate the factors
influencing health workers to leave employment and to examine factors influencing
the retention of health workers. The study used the expectancy theory and Herzberg
dual factor theory. The study used a case study-oriented research design and mixed
research approaches to collect relevant data from a sample size of 80 respondents
through stratified, simple random and purposive sampling techniques. The study
used interview, questionnaires and documentary review during data collection.
Content analysis was used in analyzing qualitative data and findings are presented
through text and narration; while quantitative data was collected and analyzed using
statistical package and presented in form of frequency, percentage, tables and
figures.
Findings of this study showed that, working environment and career advancement
had a positive influence on staff continuing to work in an organization. Similarly,
work life balance programs and the style of leadership practiced by supervisors and
managers were found to be influencing positively staff’s decisions to remain working
with an organization. Surprisingly, remuneration has been found to have a negative
influence on personnel to continue working within the organization because they
have not been well paid.
The presence of inadequate financial rewards contributes significantly to work
dissatisfaction among existing staffs and thus demotivates them from continuing to
work in the organization. As a result, remaining unaddressed, the retention of staff
will remain cumbersome and will result in staff migrating from the less paid
organization to other high-paying jobs and, consequently, staff shortages. This study,
therefore, recommends that the organization to improve financial incentives and put
in place an effective policy and strategy on retention.
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TABLE OF CONTENTS
CERTIFICATION ........................................................................................................... i
DECLARATION AND COPYRIGHT ........................................................................... ii
ACKNOWLEDGEMENT .............................................................................................iii
DEDICATION ............................................................................................................... iv
ABBREVIATIONS ........................................................................................................ v
ABSTRACT ................................................................................................................... vi
LIST OF TABLES ......................................................................................................... xi
LIST OF FIGURES ...................................................................................................... xii
CHAPTER ONE ........................................................................................................... 1
PROBLEM SETTING .................................................................................................. 1
1.1Introduction ................................................................................................................ 1
1.2 Background of the problem ...................................................................................... 1
1.2 Statement of the problem .......................................................................................... 5
1.3 The main objective of the research ........................................................................... 7
1.3.1Specific objectives of the research .......................................................................... 7
1.4Research question ...................................................................................................... 7
1.5 Scope of the study ..................................................................................................... 8
1.6Significance of the study ............................................................................................ 9
1.7 Justification of the study ......................................................................................... 10
1.8 Organization of thedissertation ............................................................................... 11
1.9 Chapter Summary ................................................................................................... 12
CHAPTER TWO ........................................................................................................ 13
LITERATURE REVIEW .......................................................................................... 13
2.1 Introduction ............................................................................................................. 13
2.2 Conceptual definitions ............................................................................................ 13
2.3 Theoretical review................................................................................................... 14
2.3.1 Expectancy theory ................................................................................................ 15
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2.3.2 Herzberg two-factor theory .................................................................................. 17
2.4 Empirical review ..................................................................................................... 19
2.4.1 Work environment and employee retention ......................................................... 19
2.4.2 Career development and employee retention ....................................................... 21
2.4.3 Leadership style and employee retention ............................................................. 23
2.4.4 Work-life balance practices and employee retention ........................................... 26
2.4.5 Good salary and employee retention .................................................................... 28
2.5. Conceptual Framework .......................................................................................... 30
2.6Research Gap ........................................................................................................... 34
2.7Chapter Summary .................................................................................................... 36
CHAPTER THREE .................................................................................................... 37
RESEARCH METHODOLOGY .............................................................................. 37
3.1 introduction ............................................................................................................. 37
3.2 Research design ...................................................................................................... 37
3.3 Area of the study ..................................................................................................... 39
3.3.1 Description of Dodoma region ............................................................................. 39
3.4 Population of the study ........................................................................................... 40
3.5 Sample size ............................................................................................................. 40
3.6 Sampling techniques ............................................................................................... 42
3.6.1 Stratified sampling technique .............................................................................. 43
3.6.2 Simple random sampling technique ..................................................................... 43
3.6.3 Purposive sampling technique ............................................................................. 44
3.7 Data source and collection methods ....................................................................... 45
3.7.1 Data source ........................................................................................................... 45
3.7.2 Data collection methods ....................................................................................... 45
3.7.2.1 Questionnaires ................................................................................................... 46
3.7.2.2 Interview ........................................................................................................... 47
3.7.2.3 Documentary review ......................................................................................... 48
3.8 Validity and reliability of the study ........................................................................ 48
3.8.1 Validity ................................................................................................................ 48
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3.8.2 Reliability ............................................................................................................. 49
3.9 Data processing and analysis .................................................................................. 50
3.10 Ethical consideration ............................................................................................. 51
3.11 Chapter Summary ................................................................................................. 52
CHAPTER FOUR ....................................................................................................... 53
PRESENTATION OF FINDINGS ............................................................................ 53
4.1 introduction ............................................................................................................. 53
4.2 Response rate .......................................................................................................... 53
4.3 Demographic characteristics ................................................................................... 53
4.3.1 Sex of the respondents ......................................................................................... 54
4.3.2 Job cadre of the respondents ................................................................................ 54
4.3.3Age of the respondents .......................................................................................... 55
4.3.4Level of education ................................................................................................. 57
4.3.5 Length of service with the hospital ...................................................................... 58
4.4Causes of shortage of health staffs at Dodoma regional referral hospital ............... 59
4.5 Existing strategies for retaining health staffs at DRRH .......................................... 60
4.5 Factors influencing employees to leave job at DRRH ............................................ 62
4.6 Factors influencing employee retention at DRRH .................................................. 63
4.6.1 Work environment ............................................................................................... 64
4.6.2 Career development opportunities ....................................................................... 65
4.6.3 Leadership style ................................................................................................... 67
4.6.4 Work life balance practices .................................................................................. 68
4.6.5 Good salary .......................................................................................................... 70
CHAPTER FIVE ........................................................................................................ 72
DISCUSSION OF THE FINDINGS .......................................................................... 72
5.1 Introduction ............................................................................................................. 72
5.2 Causes of shortage of health workers at DRRH ..................................................... 72
5.3The retention strategies available at DRRH ............................................................. 73
5.4Factors influencing employees to leave job at DRRH ............................................. 76
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5.5 Factors influencing the retention of employees at DRRH ...................................... 78
5.5.1 Work environment ............................................................................................... 78
5.5.2 Career development opportunities ....................................................................... 79
5.5.3Leadership style .................................................................................................... 80
5.5.4 Work life balance practices .................................................................................. 80
5.5.5 Good salary .......................................................................................................... 81
CHAPTER SIX ........................................................................................................... 83
SUMMARY, CONCLUSION AND IMPLICATIONS ........................................... 83
6.1 Introduction ............................................................................................................. 83
6.2 Summary of the study ............................................................................................. 83
6.2.1 Causes of staff shortages at DRRH ...................................................................... 84
6.2.2 Existing strategies for employee retention at DRRH ........................................... 85
6.2.3 Factors influencing employees to leave job at DRRH ......................................... 85
6.2.4 Factors influencing employee retention at DRRH ............................................... 86
6.3 Conclusion .............................................................................................................. 87
6.4Recommendations .................................................................................................... 88
6.5Implications .............................................................................................................. 89
6.5.1Theoretical implications ........................................................................................ 89
6.5.1Policy implications to the study ............................................................................ 90
6.6 Limitations of the study .......................................................................................... 91
6.7 Suggestions for areas for further research............................................................... 91
REFERENCE .............................................................................................................. 92
APPENDICES ........................................................................................................... 103
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LIST OF TABLES
Table 3.1:Sample Size Determination ................................................................................. 41
Table 3.2 Sample size ............................................................................................................ 42
Table 4.1: Sex of the respondents ........................................................................................ 54
Table 4.6: Causes of shortage of health staffs at DRRH ................................................... 59
Table 4.13: Good salary ........................................................................................................ 70
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LIST OF FIGURES
Figure 2.1: Conceptual framework on the factors influencing employee retention ..... 32
Figure 4.2: Job cadre of the respondents ............................................................................. 55
Figure 4.3: Age of the respondents ...................................................................................... 56
Figure 4.4: Level of education of the respondents ............................................................. 57
Figure 4.5: Length of service with the hospital .................................................................. 58
Figure 4.7: Retention strategies available at DRRH .......................................................... 61
Figure 4.8: Factors influencing staffs to leave job/relocate to another organization .... 62
Figure 4.9: Work environment ............................................................................................. 64
Figure 4.10: Career development opportunities ................................................................. 66
Figure 4.11: Leadership style................................................................................................ 67
Figure 4.12: Work life balance practices ............................................................................ 69
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CHAPTER ONE
PROBLEM SETTING
1.1Introduction
This section presents the background of the problem and statement of the problem of
employee retention. It also presents general research objective, specific objectives,
and research questions. Similarly, this chapter presents the scope of the study, the
significance of the study, justification of the study, limitation of the study and the
structure of the dissertation with regard to the themes of the following chapters.
1.2 Background of the problem
Human Resources is the foundation of every organization (Reiche, 2007). Studies
indicate that the efficient and effective operation of the health care system depends
heavily on skilled and dedicated employees. Nyonatoret al (2005) argue that retention
of employees is critical in the healthcare sector, which relies heavily on advanced
medical technology and the availability of skilled workers to deliver quality health
services. However, retention of health staff has been described as a major health
sector issue, (World Health Organization, 2006).
A study by Shamdoe et al (2016) has found that 56% of organizations face difficulties
in retaining their skilled workforce. Recent studies have shown that the number of
skilled personnel leaving their organizations is increasing. For instance, Alnaqbi
(2011) reported that around 402 employees of the Sharjah Municipality resigned in
2010 which almost 11% of the workforce.
Moreover, employee retention is a major challenge that faces not only the public
sector, private organizations are also not spared. A study by Litheko (2008) revealed
that government suffers in retaining its competent and talented employees while
Samuel (2009) confirmed that one of the major challenges facing the private sector is
the retention of skilled personnel within their organizations. In 2006, MoHSW
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revealed that in public health hospitals there was approximately 65% shortage of
health personnel and 86% in private health hospitals.
The literature shows that poor employee retention costs almost many organizations.
For example (Ndetei, et al, 2008) found out that the expense of replacing employees
varies from 29% (non-managers) to 46% percent (managers) of the annual salary of
employees. Dolvo (2004) argues that it is expensive to educate health workers. The
Human Resource for Health Country profile (2013) showed that Government lost
money directly from migration of health personnel whose training was sponsored by
the country. In addition, the inability to retain highly skilled and experienced staff
causes dissatisfaction in the health care workers because the remaining employees
forced to assume more responsibility of the departing staff (Dolvo, 2005).
Productivity losses are another result of poor employee retention because a staff who
exits leaves a productivity gap, for example, (WHO, 2006) report that an organization
experienced a productivity loss of about 24% when an employee left the organization.
However, retaining skilled and experienced staff improved organizational
performance, lowered replacement costs and improved competitive advantage in
organizations, (Chankova, 2006).
However, the literature has shown that the personnel retention is a global issue. The
World Health Organisation (2006) found that in 2006 private and public health
organisations in Korea, Japan, India, Singapore, China, and Thailand had a turnover
rate of about 16%. Vietnam is also suffered from employee retention challenge. For
example, Vietnam's Ministry of Health (2009) reported that Vietnam suffered a 75%
drop in many nurses between 1986 and 1996. Studies indicate that the rate of turnover
in Asia is 16% per year. As Zhang (2013) noted, the United Kingdom (UK) turnover
rate projected to reach 29% by 2020.
The health sector in developing countries faces many problems; notably is employee
retention. Chankova (2006) reported that, unlike in other regions of the world, the
shortage of health workers in African countries is considerably worse and has become
one of the main barriers to providing quality health services. A study conducted by
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Chen (2010) found that around 23,000 health personnel relocate annually from
Africa. Oyelere (2007), for example, stressed that Ghana had lost 630 doctors and
11,325 nurses to brain drain and international migration. South Africa has also
experienced poor retention of the health workforce (Kgomo and Swarts, 2010).Many
health workers in South Africa migrate to other countries, especially Australia and
New Zealand (Padarath, 2003). A study by Chikanda (2005) showed that Zimbabwe
has suffered a brain drain for health staffs.For example, due to emigration in 2000,
Zimbabwe loosed about 20% of health personnel, while there were reports of 2,300
nurses seeking employment in the UK (Dolvo, 2004). (Mangham and Hanson, 2008)
noted that, out of 190 registered nurses in a tertiary hospital in Malawi, 114 which is
60% left between 1999 and 2001.
The available literature shows that Uganda had only one doctor per 24,700
population. Richard (2003) reported that Zambia needs 15,000 doctorsfor its health
system to work well, surprisingly only 800 were registered. Chankova et al (2009)
noted that by brain drain, Kenya loses an average of 20 doctors each month. For
example, during the year 2003, the emigration rate of doctors in Kenya was 51% and
the number of nurses was 8% (Jacenta, 2015). This trend has largely contributed to a
massive shortage of approximately 2.4 million health workers in Africa (WHO,
2006). Tanzania also suffers from employee retention challenges among all sectors,
particularly in the health sector (Munga et al, 2009). Empirical studies indicate that
the health sector in Tanzania suffers greatly from the loss of skilled and experienced
health care providers.
The magnitude of personnel retention problems in the health sector in Tanzania is not
well established.(WHO, 2006, Sikika, 2010) reported that in 2009, about 15% of
medical doctors, 8% of pharmacists, and 13% of assistant physicians had quit their
work early. HRH (2011) revealed that 53% of experienced workers in districts intend
to quit their employment. Munga, and Mbilinyi, (2008) reported that healthcare
providers are largely concentrated in urban areas, less in remote areas where 23% of
the country's physician and about 38% of nurses are.
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As stated in the literature (WHO, 2006) on health sector in Tanzania, the number of
health workers is lower than the levels recommended by the WHO. For example, the
WHO has proposed rates of staffing for health workers, including nurses, physicians
and midwives 2.3 per 1000 population; compared to 1.5 per population in Tanzania.
Tanzania ranked 32 among the 36 African countries experiencing acute shortages of
health care staff (WHO, 2006). The available data indicates that there is a huge
shortage of staff at more than 50% of the regional referral hospital, for example,
Tumbi has 44%, Tanga 46%, Iringa 58%, Bariadi 73% andSokoine –Lindi 78%.
(HRH Country Profile Report, 2013). Available data regarding regional distribution
of medical personnel indicate that Dodoma Regional has an average of 2 Assistant
Medical Officers and 1 Medical Officer per hospital (HRH Country Profile, 2013).
Various researchers have uncovered a myriad of factors that contribute to this gap.
Among others include the lack of attractive and retention programs, lack of good
working conditions, absence of training programs, unsatisfactory remuneration and
work-life imbalance (Bakuwa, 2013).
Recent studies have shown that there are different factors influencing retention of
personnel; including non-financial and financial factors. Dovlo and Martineu (2004)
stated that offering good salaries is the most influential factor for maintaining the
workforce in the health sector whereas Samuel (2009) and Snow et al (2011) argue
that non-monetary factors, including training, work-life balance and work
environment are an appropriate panacea for health work force retention challenges.
Ogilvie et al (2007) addressed that the health workforces ’decision to move to other
areas is not only due to low remuneration, but is also caused by the difficult work
conditions that workers are facing.
Besides, the Tanzanian’s government has made notable progress in the public health
sector. For example, introduced various policies and initiatives include Staffing Level
Guidelines (2014), Health Sector Strategic Plan (July 2015 - June 2020), National
Health Policy (2017). Similarly, in 2002 the Government introduced selected
accelerated salary enhancement to attract and retain skilled and experienced
employees. Moreover, improved financial incentives for health professionals like the
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on-call allowance, risk allowance, housing allowance and extra duty pay (Kauzya,
2009; MoHSW, 2013). Despite all these initiatives, there are still persistent problems
with retention of employees in the public hospitals in Tanzania, resulting in a
shortage of health workers. Against that background, this study explores the factors
influencing retention of employee in the health sector in Tanzania.
1.2 Statement of the problem
Since 2006, the Government of Tanzania has taken significant initiatives to improve
the public health sector in order to motivate and retain highly skilled and experienced
medical staff to provide better health services to Tanzanians. However, the public
health sector in Tanzania faces a wide range of human resource issues. In particular,
the overall severe shortage of skilled health workers is aggravated by the high number
oftrained personnel leaving the health sector from remote areas to urban areas and
across international borders (WHO, 2016). Those staff who remains assume the
workload of departing staff hence becomes less committed and greatly demoralized
(Shemdoe et al, 2016).
The Dodoma region in central part of the country is among the most affected in this
regard. It greatly suffers from the shortage of trained health workers. Among the
professional cadres affected by this shortage include medical doctors, dental
therapists, medical specialists, nurses, pharmacists, midwives, and medical laboratory
staff (Health sector performance profile report, 2009; HRH Country profile, 2013). It
is estimated that about 300 nurses and medical doctors leave the public health sector
annually (MoHSW, 2013). In Tanzania, Shemdoe et al (2016) and Kibozi (2018)
reported a turnover of approximately 157 medical personnel in the health sector,
particularly in public health centres. This is an indication that the Tanzanian’s
government has failed to attract, motivate and retain medical personnel in the public
health hospitals. For instance, turnover rate wereIleje DC (51%) followed by Bukoba
DC (44%), Kibondo DC (42%), and Mafia DC (41%) (General audit report,
2018).Thus, affecting the attainment of the main objective of vision 2025 that is
achieving high quality living standards for all Tanzanians include access to better
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health services for everyone and sustainable development goals No.3 which is to
ensure health lives and encourage well-being for all at all ages.
Besides, studies on factors influencing employee retention have been done by
numerous researchers include, Farooq and Hanif, (2013) focused in banking sector;
Khan et al, (2011) focused in hotel industry; Shoaib et al, (2009) focused in telecom
sector; Beynon et al (2014) focused in small and medium enterprises sector; Hassan
et al (2010) concentrated in the leather industry, and Ghansah et al (2011) focused in
the brewery company. Moreover, numerous researchers have used Herzberg two
factor theory (Radivoev, 2005; Michael, 2008; Ng’ethe, 2013; Baah and Amoako,
2011) and expectancy theory (Daly et al., 2006) in describing and understanding
employee retention.
However, these studies have been conducted in different sectors and social-economic,
cultural and political environments, therefore, the amount of available evidence from
developing countries, particularly Tanzania is limited. This also poses the question as
to whether their results can be generalized to other sector, countries and least
developed countries. Furthermore, no studies have focused on the health sector,
especially on identifying causes, retention mechanisms, evaluating factors causing
medical personnel to leave employment and analysing factors influencing retention of
health staffs. With the scarcity of the empirical studies in Tanzania, it has created the
need to advance the knowledge currently available. Thus, to fill the gap the researcher
was interested to conduct a study focuses on determining factors influencing
employee retention in the health sector that are relevant in the context of Tanzania
using Dodoma regional referral hospital as a case of study. The study used the
expectancy theory and Herzberg dual factor theory. The theories are considered
relevant in this study, since it helps to better understand the various dynamics of
motivation on how influences employee retention in the public health sector in
Tanzania's (Samuel, 2009). Studies revealed that motivating employees in the
workplace results in lower turnover rates and improved organizational performance
(Ramlall, 2004, Sikika, 2010). In addition, the selected theories served as a frame of
reference in developing the conceptual framework for retaining employees.
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1.3 The main objective of the research
The main objective of this study was to determine the factors influencing employee
retention in Tanzania's public health sector.
1.3.1Specific objectives of the research
The study was guided by four specific objectives as follows: -
i. To identify the causes of shortage of health workers at Dodoma regional
referral hospital
ii. To determine the existing strategies for retaining health workers at Dodoma
regional referral hospital
iii. To evaluate the factors influencing health workers to leave employment at
Dodoma regional referral hospital
iv. To examine factors influencing the retention of health workers at Dodoma
regional referral hospital.
1.4Research question
The study was guided by the following research questions: -
i. What are the causes of shortage of health workers at Dodoma regional referral
hospital?
ii. What are the existing strategies for the retention of health workers at Dodoma
regional referral hospital?
iii. What are the factors influencing health workers to leave employment at
Dodoma regional referral hospital?
iv. What are the factors influencing the retention of health workers at Dodoma
regional referral hospital?
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1.5 Scope of the study
This study was concentrated on public health hospitals and excluded private hospitals
because the employee management between private and public hospitals is not the
same and that studies of private hospitals have different findings. It deliberately
limited itself to the Dodoma Regional Referral Hospital. The hospital was chosen
because it has an acute shortage of health staffs due to among other reasons
inadequate retention of health workers. For example, the Hospital strategic plan 2012-
2013 shows that the Hospital had 430 (36.9%) while the required staff is 1163. In
addition, currently available staff are 535 minimum the requirements (Annual
External Hospital Performance Assessment for Regional Referral Hospitals report,
2018). The research was limited to medical professionals including physicians,
nurses, pharmacists, laboratory experts because they are actively involved in the
delivery of medical services. This study left out support staff such as cleaners, clerks,
security guards, and office attendants, because they are not directly involved in the
delivery ofmedical services. Dodoma Region was selected because it has the lowest
employee retention rates of approximately 65% compared to other regions such as
Dar es Salaam which has a 99% retention rate in Tanzania (Human resource
information system report, 2013; HRH country report, 2013).Additionally, (Baseline
Survey report on External Hospital Performance Assessment (EHPA), 2017 - 2018;
Kibozi, 2018)noted that Dodoma region had 67.5% retention rate, Lindi region 91%,
Dar es Salaam region 99.5% and Mbeya region had 93.24% .
However, the Controller and Auditor General report (2018) revealed a shortage of
37,544 staff in the health sector which comprises of hospitals, health centers and
dispensary, equivalent to 47% of the entire requirement. Trend analysis of the
shortage of staffs for a period of four (4) consecutive years has indicated an increase
in the percentage of employee requirement from 22% in the year 2014/1015, 30% in
2015/2016, 32% in 2016/2017 and 33% in the year 2017/2018. For example, in the
year 2017/2018 shortage of staff in the health departments in Bahi district council
was 29%, Chamwino district council 42%, Kongwa district council 55% and
Mpwapwa district council 45% (General audit report, 2017/2018, p.386).
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Furthermore, General audit report of LGAs for year ended 30th June, 2019 revealed a
shortage of staff in Bahi 31%, Kondoa town council 40%, Kondoa district council
45%, Dodoma city council 30%, and Chemba district council 54% (Annual General
report of LGAs for the financial year 2018/2019).
1.6Significance of the study
This study provides relevant and useful information that guides the Ministry
responsible for health issues towards developing national health sector retention
policy and strategies. Similarly, the study provides information that will hopefully
help the government to meets the main objective of vision 2025 which is to achieve
high-quality livelihoods for all Tanzanians, including access to quality primary health
services for all and Sustainable development goals No.3 which is to ensure healthy
lives and promote well-being for all at all ages. Moreover, the study provides
information to policymakers and health managers to understand clearly factors that
contribute to the employee retention challenges in the public health facilities and to
design policy interventions accordingly.
The study provides a connection between influencing factors such as training,
working conditions, leadership style and personnel retention. It also increases
awareness and understanding of how independent variables of the study relate to
aspects of staff retention. The study serves as frame of reference for other researchers
on the staff retention issue in public health sector, because staffs retention challenges
and its correlation to influencing factors (training, working conditions, leadership
style) is noted that the field is insufficiently researched in the Tanzania environment,
therefore study it offers new data to test assumptions and theories found in similar
studies in respect of employee retention. Furthermore, the study enables the
management of Dodoma region referral hospital to understand clearly the factors
influencing health care providers’ decisions to stay in, relocate to other organization
and leave employment.
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1.7 Justification of the study
Shortage of health personnel is a worldwide issue. Globally, health personnel
shortages are around 4.3 million (WHO, 2016). For instance, WHO (2006) reported
that around 57 countries have a severe shortage of health care providers and
approximately 36 of them are derived from sub-Saharan Africa countries. Tanzania as
one of the Sub-Saharan country is also not spared (Munga, 2013). To date, the
scarcity of health personnel in Tanzania is estimated to be around 56% (Human
Resources for Health and Social Health Strategy 2014-2019).
Literature revealed that there is a serious shortage of health personnel in the public
health hospitals in Tanzania which is contrary to the requirements of national and
international standards. In Tanzania, for example, the ratio of health workers to
population is estimated at 1.5:1000 which is below the ratio of 2.3 health workers to
1000 recommended by the World Health Organization (WHO, 2006; HRH Country
Profile, 2013; Sicily et al, 2014). The shortages are actually due to the difficulties in
attracting and retaining of health personnel and affect negatively the offering of
health services to the Tanzanians (Munga, 2008; MoHSW, 2008). Furthermore,
WHO (2016) and Kibozi (2018) reported that most of public health centres
particularly in rural faced with attraction and retention challenge. Other factors
contributing to the shortage of health personnel in some health centres are the lack of
retention schemes and retrenchment due to fake certificates (Mondea, Revocatus,
Stephen and Chenge, 2019); poor leadership style and work life imbalance (Songstad
et al, 2011; Mwinyimvua, 2013);unsupportive career development program (Sikika
2010); inadequate compensation and difficult working environment (Munga, 2013).
Available literature indicates that some public health facilities are not operating due
to the absence of health workers. For example, Nkya (2012) pointed out that 59 newly
built facilities in the Tabora region in 2010 were not functioning due to lack of health
staff. Besides, literature revealed that a dispensary built in a remote area of the Rukwa
region has been inoperative for almost 10 years, due to health personnel shortages,
and reportedly to have started operating in 2013 after construction of a staff houses,
(Sikika, 2010; Munga, 2013). However, the magnitude of retention of health workers
11
problems is not well known (MoHSW, 2013; 2014). Literature shows that very little
is known about factors that influencing health personnel’s decisions to stay in,
relocate to other organization and leave the jobs. Against that background, this study
examines the factors influencing staffs retention in the public health sector in
Tanzania.
1.8 Organization of the dissertation
The study consists of six chapters. The sequence and structure are described below:
Chapter one provides the background of the study and statement of the problem of
employee retention. A discussion follows regarding the study objectives and research
questions. In addition, this chapter discusses the scope of the study, the significance
and the rationale of the study as well as the structure of the dissertation. Chapter two
is composed of two sections. Section A discusses theoretical perspectives. Section B
encompasses the review of related empirical researches based on study variables.
Then follows the development of a conceptual structure.
Chapter three presents the introduction and research design. In addition, it explains
the research techniques and discusses the study area, the study population, and units
of inquiry. Similarly covers the sample size, sampling techniques and different
approaches for gathering data including primary and secondary data gathering as well
as research validity and reliability. This chapter discusses and presents the data
analysis and ethical issues.
Chapter four cover the presentation of the results of the study. The findings are
interpreted based on demographic factors, research objectives and questions, as well
as study variables. The findings are presented in term of tables and other relevant
statistics. Chapter five cover discussion of the results. The discussion is focused on
comparing and contrasting the results with literature. Chapter six presents a summary,
and reports on the policy implications. Further, it provides recommendations arising
from the study findings. In the same way, suggests areas for further study and
provides the conclusion.
12
1.9 Chapter Summary
This chapter addressed the background of the study and the research problem on
employee retention challenges. Research objectives and questions were followed.
The scope of the study and the significance of the study are explained. Likewise, the
chapter presents justifications on the study and lastly, structure of the dissertation was
summarized. Additionally, in the next chapter, the review of relevant literature
follows.
13
CHAPTER TWO
LITERATURE REVIEW
2.1 Introduction
This chapter discusses literature relating to retention of employees in the health
sector. The review sets the basis on which a conceptual framework is established,
and focuses on the variables relevant to staff retention issues. Similarly, this chapter
covers the conceptual definitions, theoretical and empirical review, and conceptual
framework. Furthermore, it presents the research gap and summary of the chapter.
2.2 Conceptual definitions
2.2.1 Employee retention
Employee retention is a system in which staff are persuaded to stay with the
organization for the long period of time (Samuel et al, 2009).Employee retention is
seen as the introduction of integrated policies or programs designed to maximize
efficiency in the workplace by implementing better processes to attract and retain
people with the skills and abilities needed to meet the organization objectives
(Chikanda, 2005; Alnaqbi, 2011; and Shamdoe et al, 2016).Litheko (2008) argued
that retention of employees involves management interventions such as rewarding
staff for better performance and maintaining a work environment that is conducive to
attracting and preventing staff from leaving the organization.
2.2.2 Working environment
Workplace environment is defined as the composition of aspects of the technical
environment, such as tools and equipment; the human environment comprises
interaction between peers, bosses-subordinate relationships and the organizational
environment, including procedures, systems and values that operate under
management control (Ssesanga and Garrett, 2005 and Khan et al, 2011). Work
environment encompasses psychological and physical work environment (Mayfield,
2018 and Reinhold, 2016). According to MacRae and Furnham (2017), the work
environment has many factors that may affect both the psychological and physical
14
well-being of employees. Studies revealed that a better working environment leads to
relatively low psychological and physical stress, which facilitates the achievement of
targeted goals.
2.2.3 Work life balance
Work-life balance is the concept used to describe all work activities that aim to meet
the needs of workers and to create a balance between the requirements of their family
(life) and work life(Bashir and Ramay, 2008). A healthy work-life balance helps
organization prosper and makes it possible for workers to combine work with other
aspirations and commitments at the same time.Mubeen and Rashidi (2014) stated
that work-life balance involves creating and maintaining supportive and healthy
work environments, which will enable employees to have a balance between work
and personal responsibilities and thus strengthen employee loyalty and productivity.
Kodz et al (2002) pointed out that through having flexible work hours for workers,
stress will be reduced, employee morale, engagement and productivity increased, and
therefore retention.
2.2.5 Career development
Meyer and Smith (2003) defined career development as the process involve activities
such as career counseling, training, career pathing, skills inventorying, and job
posting that are executed to implement career plans in an organization. Merchant
(2007) emphasis that career development is to balance the needs of the company with
those of the workers whose key attributes are career counseling and training.Samuel
and Chipunza (2009) revealed that lack of career development programs or training
programs resulting in employee turnover and hence, retention becomes difficult to
pursue.
2.3 Theoretical review
This part provides insight into different theories closely related to employee retention
issues. The theories used as frame of reference in the creation of employee retention
conceptual structure. In researching the factors that influencing retention of
employees, it is important to consider motivation theories since motivated workers
15
are likely to be engaged and therefore stay with the organization (Ramlall, 2004; Das
and Baruah, 2012; Keenam,2015; Florida and Nougriaya, 2015). Philip (2003)
argued that retaining employees involves being aware of employees' needs and
showing different strategies for responding those needs, and thus, application of the
expectancy theory by (Vroom, 1964) and the Herzberg's Two Factor Theory
(Herzberg, 1959).
2.3.1 Expectancy theory
The theory of expectancy developed by victor Vroom (1964), with a direct
application to the context of work. The theory focused on the assumption that
workers assume that their efforts will lead to better results and good performance
from their efforts and success will lead to desirable rewards (Vroom, 1964;
Redmond, 2010). The theory composed of three components, namely expectancy,
instrumentality, and valence (Vroom, 1964). Expectancy means that the effort of the
employee will lead to desired performance; while instrumentality is centered on the
belief that acceptable performance will lead to desired rewards; and valence is
defined as the value of the rewards employees receive from their efforts and
acceptable performance at work (Vroom 1964; Porter et al, 1968; Pinder 1987; and
Lunenburg 2011). Additionally, the theory of expectancy is based on the view that
people join institutions with certain expectations, and if those expectations are met
they will stay in an institution for a long time (Werner, 2002).
However, Vroom (1964), Pinder (1987), and Werner (2002) argued that most
managers provide and adjust rewards to the level of performance required. Moreover,
expectancies increased by offering good working tools and equipment, relevant
training, illustrating correct work procedures, and listening to employee performance
challenges (Johns and Alan, 2010). Besides, expectancy theory describes what causes
performance and motivation at the workplace and hence helps in designing a reward
system focused on actual performance (Albattat and Som, 2013).
16
Moreover, in a study by Werner (2002) pointed out that an employee would be
motivated to strive when there is a good chance of a better outcome, and later
become instrumental in supporting that employee achieve his or her personal goals.
Vroom, (1964) and Appelbaum (2005) suggest that when workers feel that the
company does not respect their contributions and rewards them accordingly, they do
not work to the fullest potential. Empirical research shows that failure to recognize
and reward the efforts, desired performance of the employee has significant influence
on outcomes such as turnover, low commitment, and dissatisfaction (Appelbaum,
2005; Lunenburg, 2011). Studies indicates that failure to consider and reward the
efforts, optimal employee performance, has a major effect on outcomes such as
turnover, low commitment, and dissatisfaction (Appelbaum, 2005; Lunenburg,
2011). Expectancy theory helps us to clearly understand the association between
employee's efforts, performance, and rewards resulting from their efforts and
acceptable performance they put at work (Redmond, 2010).
Despite the importance of the theory of expectancy in describing the phenomenon of
employee retention, the theory has been criticized by several researchers, but the
criticism focused on the expansion of the theory to make up for its weaker points and
was not a total rejection. The theory is generally criticized for its difficulty by using
the mathematical equation in describing the motivation issue on retention of workers
(Porter and Lawler, 1968; Lunenburg, 2011). For example, Vroom (1964) illustrated
the relationship of four components namely motivation, expectancy, instrumentality,
and valence, through equation: (Motivation=Expectancy*Instrumentality*Valence).
Moreover, theory was too simple (Lawler and Porter, 1968; Graen, 1969 and Lawler,
1971). They did not believe the theory that it could precisely predict increased efforts
by staff as a response to a reward. For example, the reward may be a promotion, but
if that means more working hours, the employee may not put a high value on it, and
so will not put more effort into it.
What is noted from this theory is that it places a lot of emphasis on individual
perceptions of the environment and therefore interaction occurring due to personal
expectations. In this context, medical employees expect the environment in which
17
they work to be conducive. They expect an environment, for example, with good
working equipment, safety and a hospital with adequate drugs. In addition, human
health resources will be motivated to stay with an organization if they believe that
desired efforts and acceptable performance will result in appropriate rewards.
Therefore, rewards should be based on efforts and performance employees put at the
workplace.
2.3.2 Herzberg two-factor theory
This theory is considered important for apprehending the factors influencing
personnel retention in the health field in Tanzania. Herzberg (1959) claimed that
workers are motivated by internal factors rather than factors that are external to their
work. In other ways, motivation is created internally and is driven by variables that
are intrinsic to the work in which Herzberg called motivators. The intrinsic variables
comprise the work itself, achievement, recognition, responsibility, advancement, and
growth. However, certain factors cause dissatisfaction to employees, and these
factors immensely derived from non-work-related variables also called extrinsic
variables. The extrinsic variables were called by Herzberg (1959) as hygiene factors
which, although they do not necessarily motivate employees, however, they must
present at the work setting to make an employee happy as well as retain them.
Herzberg (1959) and George (2014) argued that hygiene factors include the
relationship with subordinates, company policies, supervisor style, physical work
conditions, salary, job security, status, and interpersonal relationship.
Moreover, Herzberg (1959) sated that motivation would merely arise as a
consequence of the use of internal factors; if missing, the employees likely to exit
organization. This theory is pertinent to this study since it recognizes that employees
have two kinds of needs that operate in them, and therefore both should be addressed
accordingly. However, this theory has been criticized for relying too much on
intrinsic factors for explaining personnel retention and degrading the strength of
extrinsic factors, that Herzberg called hygiene variables and not motivators for
retention. On the other hand, Ng’ethe, Iravo, and Namusonge (2012) found that
extrinsic factors include job security, a competitive salary, flexible working
18
environment, and good interpersonal relationship were perceived by personnel as
major motivational aspects that influence to remain working with an organization.
However, Samuel et al, (2009), Sandy and Kumar (2011) argues that Management
does not rely solely on internal factors to influence personnel retention at the
workplace, but should rather be considered a mix of both external and internal
factors as an effective technique for personnel retention at the workplace. Ng'ethe et
al (2012) argued that while external variables do not provide motivation to staffs, this
does not mean personnel are not paying attention to them. Studies revealed that
employees who work in an uncomfortable working environment, tend to decrease
their morale and even leave the company.
The Herzberg two factor theory has been widely used to explain factors namely
intrinsic and extrinsic aspects important for the personnel retention (George, 2014).
Ssesanga and Garrett (2005) applied a model founded by Herzberg to identify the
factors accounts for job satisfaction of scholars in Uganda; Ojakaa et al (2014) used
the theory to establish motivational factors influencing retention of primary health
care providers in Kenya; Radioed (2005) applied the theory to identify variables for
retention of sales consultants, South Africa; Kwasi and Amoako (2011) employed
the theory to assess employee motivation at workplace. Moreover, a study conducted
by Ehiorobo (2000) with regard to motivation and employees' productivity in a
power generating company also used this theory and found that extrinsic variable
such as salary is important as other intrinsic variables like achievement, recognition,
responsibility, advancement. In addition, studies such as (Suthernland, 2004;
Netswera, et al, 2005; Radivoev, 2005; and Michael, 2008) also used this theory, and
their findings have shown that intrinsic variables include training, development and
challenging work; and extrinsic variables such as competitive salary, conducive
working environment, and job security influences employee retention at the
workplace. This is in line with Herzberg two factor theory which concentrating on
intrinsic and extrinsic variables.
19
2.4 Empirical review
The purpose of this section is to review the related literature with respect to
employee retention. In this regard, literature pertaining to the studies done by other
previous researchers in areas such as employee retention based on variables
understudy are reviewed and presented in this section. However, much has been
written with respect to the challenge of retaining employees at the workplace.
Similarly, many studies have been carried out to assess the effectiveness of diverse
human resource management practices in an organization. Therefore, the empirical
review will provide the basis for this study of how an employee perceives the
influencing factors for retention in relation to their decisions to stay or exit the
organization, by exploring related literature discussing the current problem of
personnel retention and experience in diverse countries environments.
2.4.1 Work environment and employee retention
Ramlall, (2004) defined Work environment as setting, conditions, situations, and
circumstances under which employees work. He further added that work
environment includes some association that exists between employees and the
employers as well as the environment in which employees work. Work environment
encompasses psychological and physical work environment (Mayfield, 2018 and
Reinhold, 2016). According to MacRae and Furnham (2017), the work environment
has many factors that may affect both the psychological and physical well-being of
employees. Studies revealed that a better working environment leads to relatively
low psychological and physical stress, which facilitates the achievement of targeted
goals. This often helps to deliver high levels of employee satisfaction and encourages
workers to stay with the company longer (Ramlall, 2004; Samuel and Chipunza,
2009; Das et al, 2012 and Farooq and Hanif, 2013).
Several studies have attempted to describe work environment in diverse areas such as
Job satisfaction (Ssesanga and Garrett, 2005 and Khan et al, 2011); Employee
dissatisfaction and turnover (Albattat and Som, 2013); Job motivation (Dieleman et
al, 2003), Human resource management practice on employee retention (Hong et al,
2012). However, Sutherland (2004); andAlnaqbi (2011) argued that work
20
environment factors positively influence the retention of employees in the
organization. This notion is further supported by Zeytinoglu and Denton (2005) and
George and Jones (2008) who forwarded the view that key factor for retaining
employees is to create a conducive work environment in which employees choose to
work in. Studies have shown that the work environment in many organizations plays
a significant role in the staff's decision whether to quit a job or stay and considered as
the main variable in employee retention. For instance, Kwenin (2013) conducted a
study on the relationship between work environment and career development on
personnel retention, Vodafone Ghana Limited. The research findings showed that
career development and work environment had a significance correlation with
personnel retention and thus, affect decision of the staffs to remain in Vodafone
Ghana Limited. This study highlighted significance of a work environment at the
workplace and suggested that a better work environment should be given at the
workplace so as to make employees more satisfied and to stay with the organization.
Moreover, studies have shown that environment in which health workers provide
services can also be an incentive for retention. For instance, the decision by nurses
and doctors to quit their job for better chances closely relates to the unpleasant
working environment (Dieleman et al, 2003; Bolgeret et al, 2005 and Shoaib et al,
2009). When health care providers perceive the equipment necessary to perform
their work to be inadequate or not existing, retention could be difficult to pursue
(Chikanda, 2005; Hassan et al, 2010; Beynon et al, 2014). Similarly, studies such as
(Willis-Shattuck, Bidwell, Thomas, Wyness, Blaauw, and Ditlopo, 2008) revealed
that health care providers complained of working without necessary equipment like
the microscope, which was a source of demotivation. Literature indicated that the
cleanliness of the hospital environment, its layout or decor, and availability of
medical equipment and appropriate facilities are important to influence retention in
rural areas (Kotzee and Couper, 2006 and Ghansah et al, 2011).
Besides, in a study by Manafa, McAuliffe, Maseko, Bowie, MacLachlan, and
Normand (2009), it was reported that inadequate health care providers in rural and
remote areas are more affected by the employee retention problem rather than
21
recruitment. Researcher such as Chikanda (2005) has found that rural and remote
hospitals are often poorly equipped and inadequately supplied with drugs, the
physical working environment are unconducive and employees are poorly supported
and often feel isolated as well as neglected. Snow et al (2001) shown that doctors in
remote areas in Ghana encountered professional isolation challenges in their working
environment and also highlighted the lack of mentoring and inability to contact peers
to share experiences and discuss cases.
However, there some studies that show opposing findings. For instance, Kibozi
(2018) conducted a study on non-financial factors and personnel retention. The work
environment is among the variables that were checked for the relationship with
employee retention. The findings revealed that the work environment in Tanzania
has a negative influence on personnel retention in the health sector. However, this
finding contradicts findings of previous researches such as Willis-Shattuck et al
(2008) and Winterton (2011) who found that the work environment has a positive
relationship with employee retention and thus, make workers more satisfied to
remain in organization.
2.4.2 Career development and employee retention
Career development is defined as process involve activities such as career
counseling, training, career pathing, skills inventorying, and job posting that are
executed to implement career plans in an organization (Meyer and Smith, 2003).
Merchant (2007) emphasis that career development is to balance the needs of the
company with those of the workers whose key attributes are career counseling and
training. However, career growth and training and development sometimes used
synonymous in the literature. But from their definitions, slight discrepancies can be
noticed. Training is considered as a learning process whereby people get skills,
knowledge, and experiences that helps to improve deficiencies so as to perform their
job better for the attainment of organization's goals; while development is defined as
an educational process which is dealt with the overall growth of the employees (Will
and Cappelli 2003).
22
Numerous studies have indicated the relationship between career development and
employee retention. Ebuehi and Campbell (2011) indicated that career development
has a strong relationship with employee retention. Kotzee and Couper (2006) in their
study found that most of the doctors in South Africa who practice in rural areas were
unwilling to remain and work in such areas due to the absence of career development
opportunities. Samuel and Chipunza (2009) carried out a study on the role of career
development programs on developing and retaining employees in the Altamonte
Springs police department. The results revealed that career development
opportunities positively influence the retention of employees. Willis-Shattuck et al
(2008) enhanced insights into the career advancement methods, process, and
mechanisms that adopted by the company to initiate career growth programs and
strategies. However, the main limitation of this study was the application of a single
source of respondents from the same police department. The findings cannot
therefore be generalized because the needs and opinions of police officers from other
agencies may be different due to the diverse working environments.
Studies revealed that intrinsic motivational variables such as training and
development, job security have a positive influence on the retention of employees in
both public and private sector organizations. The findings are in line with previous
research results. For instance, Samuel et al, (2009) in their study found that career
growth programs as retention strategies being used by employers to retain available
employees at the workplace. A similar study on the relationship between career
development and employee retention includes: Samuel and Chipunza (2009) revealed
that lack of career development programs or training programs resulting in employee
turnover and hence, retention becomes difficult to pursue. Snow (2011) in his
qualitative research on employee retention in the health field in Ghana and El-jardali
et al (2013) conducted quantitative study in the health sector in Lebanon; revealed
that career growth programs positive motivating staffs to remain working in
organization.
23
However, some studies reveal contrary findings on influence of career growth
programs on personnel retention. Bussin (2002) and Bashir, Tirmizi, Noor, and
Shoaib (2009) argued that constant career development opportunities, training, and
development of employees' skills can influence their early turnover in lieu of
reinforcing their retention. Further explained that giving employees the training and
development chances raises their market value and hence, enhancing their mobility.
Consequently, Suthernland (2004); Netswera, et al (2005); Radivoev (2005) and
Michael (2008) advised that managers should not only focus on a single retention
strategy rather than using a combination of various retention strategies include
intrinsic variables such as training, development and challenging work; and extrinsic
variables such as competitive salary, conducive working environment, and job
security as recommended in the literature. Thus, appropriate application of career
development opportunities with a combination of others retention strategies such as a
good working environment and competitive salary have a strong influence on the
employee retention and consequently reduce turnovers (Suthernland, 2004 and
Samuel and Chipunza, 2009).
2.4.3 Leadership style and employee retention
Nor house (2013) defines the term leadership as an ability of the manager to
encourage and influence the behaviour of subordinates' and convince them to follow
a particular course of action. Fiedler (1967) stated that leadership served as a
guidance relationship among superiors and subordinates who intend actual changes
and consequences that reflect their shared aims. Armstrong (2012, p.4) explained that
leadership as the ability of superiors to convince subordinates to act or behave
differently. Similarly, leadership style defined as a certain behaviour employed by
superiors to influence his or her subordinates to attain the organizational objectives
(Northouse, 2013).
Studies reveal that leadership is considered today as an essential aspect of
management in a constantly changing technological, economic and social
environment than before (Armstrong, 2012 and Northouse, 2013). Leadership plays a
vital role in the organization because it is the leaders' behaviour that builds or ruins
24
an organization (Northouse, 2013, and Ng’ethe, 2013). Literature shows that the
direction of an organization depends on the style of the leaders. Leadership style
categorized into two major kinds namely transformational leadership style and
transactional leadership style. Transformational leadership defined as the process of
inspiring and motivating followers to provide newer solutions and attain better
outcomes (Eagly and Carli, 2003; Robbins and Coulter, 2007; Marturano and
Gosling, 2008; Patiar and Mia, 2009). Transformational leadership really applies
charismatic behaviours and persuades subordinates to proffer good outcomes (Eagly
and Carli, 2003). Transformational leadership increases the motivation, morale, and
performance of followers (Robbins and Coulter, 2007). However, transformational
leadership is criticized by concentrating much on processes and outcomes and ignore
situational variables; while the situational factors such as stability of environment
can influence the effects of transformational leadership on followers and work
outcomes (Yukl, 1999).
Moreover, empirical evidence shows that transformational leadership is positively
associated with employee work outcomes, for example, lower turnover rate,
employee satisfaction, creativity, goals attainment and a higher level of productivity
(Keller, 1992; Judge and Bono, 2000; Rubin et al, 2005; Piccolo et al, 2006). On the
other hand, the transactional leadership style described as a leadership style whereby
leaders promote the compliance of their followers through both punishment and
rewards (Robbins and Coulter, 2007). Transactional leadership focuses on the role of
supervision, organization, and group performance. In transactional leadership,
leaders give attention to followers' work so as to find mistakes and deviations (Yukl,
1999).
However, previous research studies have found strong correlations between
leadership style and employee retention. For instance, Ng’eth (2013) researched the
determinants of academic staff retention in Kenya Public Universities. The study
used only intention to stay to investigate the determinants for personnel retention.
The study findings revealed that leadership styles had a strongly significant
relationship with employee retention. Similarly, Mittal (2015) studied the effects of
25
transformational leadership on turnover intentions in information technology small
and medium enterprises. The study was focused on examining the impact of
transformational leadership on building trust and its influence on the commitment
level of the employees to attain the targeted work outcomes. The research results
revealed that transformational leadership increase commitment and created a higher
level of trust among the employees in the information technology small and medium
enterprises.
In addition, Denton (2009) investigated the perceptions of teachers as to how the
style of leadership influences job satisfaction and retention in South Carolina. The
purpose of the research was to discover teachers' opinions and thoughts regarding
how heir principals' leadership styles and practices motivate their job satisfaction and
desire to remain to teach in their schools. The results of the research revealed a
significant impact on the practice of transactional leadership. The majority of
teachers' answers have shown that they prefer a transformational leadership style that
includes them in decision-making so it makes them feel like important team
members. The results in Denton's (2009) research, clearly in line with Cheng et al
(2016) who found that the style of transformational leadership reduce nurses’
turnover.
Numerous studies were done in Tanzania for instance, Mwinyimvua, (2013);
Mbwana, (2013) and Kweka and Sadoyeka, (2014) have researched employee
retention by associating it with factors such as working hours, training and
development, work environment, promotion, and salaries. However, less attention
has been given to leadership which plays a vital role in employee retention. Bycio et
al (1995) revealed that transformational leadership has a strong significant
relationship with employee retention. Khalid, Pahi, and Ahmed (2016) in their study
on leadership and employee retention which was done in the banking sector in
Pakistan found a positive relationship between leadership style and employee
retention.
26
Surprisingly, Martin et al (2001) found that transformational leadership was
inversely related to turnover intention among employee from seven for-profit
business. Long, Thean, and Jusoh (2012) conducted a study on leadership styles and
employee turnover intention in Malaysian colleges. The study findings revealed that
there was negative association between leadership style and employee turnover
intention. Grace, Daniel, Kachori, Josee, and Okibo (2014) found that leadership
style positive influences employee retention in the public health sector in Kenya. The
majority of the participants' perceptions indicated that they preferred a leadership
style that was participatory, and responds to employee matters promptly and involves
the employee in decision making. Duffield et al (2003); Tymon et al (2011); Kroon
and Freese (2013) and Mignonac and Richebé (2013) identified participative
leadership style and supportive supervision as contributing factor to employee
retention.
2.4.4 Work-life balance practices and employee retention
Clutterbuck (2003) defined work-life balance as a situation where individual try to
manage potential demand on his or her time and energy in a way that fulfilled needs
for his or her well-being. Further upheld that, work-life balance involves creating and
maintaining supportive and healthy work environments, which will enable
employees to have a balance between work and personal responsibilities and thus
strengthen employee loyalty and productivity. Kodz et al (2002) stated that through
having flexible work hours for workers, stress will be reduced, employee morale,
engagement and productivity increased, and therefore retention. Bashir and Ramay
(2008) posit that work-life policies enhance employee commitment which in turn
positively affects retention.
However, Mubeen et al (2014) argue that one of the important factors for achieving
and managing work-life balances is working time, since the lack of flexibility in
excess working hours can create imbalances that negatively affect staffs' personal
and social lives. Work-life balance programs reduce stress because employees
working flexibly are more satisfied with their jobs and lives, experience better work-
27
family balance. This can reduce turnover since employees develop a greater sense of
job satisfaction and are less likely to leave the organization (Bussin, 2003).
Jack and Adele (2003) posit that employees want to have a job that they can easily
balance their personal life and their work and if the balance between their work and
personal life interferes they will show high absenteeism and turnover than when the
individual is able to work and meet family needs with the support of organizational
programs. Mubeen and Rashidi (2014) assert that a conflict of work-family leads to a
problem for employees and plays a great role in their turnover intention. Many
studies have shown that the existence of family support such as alternative work
schedules and work-family culture in an organization helps a lot in the retention of
employees (Gaan, 2008). A study which is conducted by Thompson and Prottas
(2005) on the relationship between employer turnover intention and organization
support for instance flex time, supervisor support, and work-family culture found that
organization support reduced employee turnover intention. Similarly, it is proved
through studies that organizations that have good interaction with their employees in
integrating between family responsibilities and work reduce employees' intention to
leave the job (Allen, 2001).
Moreover, Rshid, Rab, Khalil, Zahid, and Moeed (2013) conducted a study on the
relationship between work-life balance and stress with the turnover rate for
employees found that work-life balance has a significant positive correlation with
employee turnover intention. Kar, et al (2013) studied effect of work-life balance
practices on personnel retention in information technology sector, India. The
research findings revealed that work-life conflict is a serious challenge not only
affects workers but also employers and even the community. Many studies indicate
that an organization's commitment to family needs and work-life balance will
ultimately affect the commitment of their employees and the retention rate (Haar and
Spell, 2004; Wang et al 2007). Surprisingly, Noor (2011) found that there is a
negative correlation between work-life balance and employee turnover intention.
28
Hughes et al (2005) examined work-life balance as a cause of work dissatisfaction
and attitudes to withdrawal. The research was focused to explore the views of male
workers in a male-dominated occupation on issues that pertain to work-life balance.
The study was qualitative in nature and data were gathered through interview from
20 bus drivers. The research findings revealed that work-life imbalance was the
major source of work dissatisfaction for respondents. It was also revealed that work-
life imbalance led to a turnover and non-genuine sick absence. This implies the
balance between work and personal responsibilities is also a key issue for staffs.
Deery and Jago (2015) examined work-life balance programs, talent management,
and retention methods within hospitality sector. The research findings revealed that
work-life balance had a strong positive correlation with worker management and
retention. However, a study conducted by Shukla, Somesh, Sinha, and Deepti (2013)
on the identification of major aspects associated with the retention of the
pharmaceutical employees in Dehradun city, found that a majority of employees
want to have an improved quality of work-life which influences them to stay in the
organization for a long period of time.
2.4.5 Good salary and employee retention
Better salary is considered the most important factor which used for attracting and
retaining talented employees (Willis, 2000). Further upheld that in today's economic
times, a good salary serves as a primary incentive that leads an employee to perform
better work. Grace et al (2014) stated that money influences employee behaviour
through shaping their attitudes. This implied that a better salary influences the
attraction and personnel retention (Parker et al, 2001). Additionally, Mercer (2003)
reported that employees likely to remain in an organization if they are fairly and
better rewarded, and similarly they may exit if they are poorly rewarded. (Akintoye,
2000) reports that financial incentives such as salary, allowances serve as the most
important strategy of health care providers’ motivation and greatly influence them to
remain in the health care facilities.
29
Studies such as Henderson and Tulloch (2008) found that financial incentives such as
better pay and allowances contribute to the attraction and retention of employees in
most organizations. In Thailand for example, hardship allowances have been
established for doctors to remain in rural and the most remotes districts
(Wibulpolprasert and Pengpaiboon, 2003). Studies have shown that the retention of
health workers in rural areas is a challenging issue. However, in Vietnam doctors
motivated to work in rural areas by paying them with better salaries and allowances
from the state budget (Nguyen et al, 2005). Additionally, Terera (2014) conducted a
study on the impact of reward on job satisfaction and employee retention among
nurses in the Easter Cape Province of South Africa. In his study, he utilized a
quantitative research design and approximately 180 nurses were randomly selected.
His research findings revealed that better-rewarded employee leads to retention and
less job satisfaction. However, Mwakidim and Obwogi (2015) conducted research on
the effect of pay and work environment management on employee retention in the
Hotel industry in Mombasa. The research findings revealed that pay had a weak
influence on retaining employees while the work environment has a positive
influence. They suggested that employers in the hotel industry need to re-examine
the present weaknesses associated with pay.
Research findings have shown that in most developing countries low remuneration
primarily accounts for job dissatisfaction and migration of health care providers
(Dieleman et al, 2003 and Stilwell et al, 2004). This implies that offering a good
salary makes health workers see alternative jobs less attractive. Henderson and
Tulloch (2008) reported that health workers migrate from the public to private health
facilities or to other high rewarding jobs due to the absence of higher salaries in such
public hospitals. WHO (2006) reported that paying health workers with adequate
salaries and allowance on a regular basis considered a key driver of motivation and
retention. In a study of 100 doctors in Bangladesh, it was revealed that doctors in
primary health facilities would decline to take up the private practice if rewarded
higher salaries (Gruen et al (2002). Additionally, in a qualitative study of health care
providers in the rural areas of Malawi, Manafa et al (2009) reported that respondents
30
were of the view that they were rewarded poor salaries and which prevented them
from meeting their individual and family's needs. This implies that paying poor
salaries to employees identifies as a key driver for the discouragement of retention
and better performance (Manafa et al, 2009). Conversely, research conducted by
(Leinfuss, 1998) revealed that better salary is not the long term answer for attracting
and retaining highly skilled employees.
A study by Willis-Shattuck et al (2008) revealed that poor salaries demotivate health
workers as they feel their skills were not valued. Also, it was reported that in Kenya,
nurses complained of insufficient hardship allowance and other financial incentives
that discourage health workers’ willingness to work in rural areas (Mullei et al,
2010). Significantly, offering competitive and realistic salary packages is seen as
recognizing the value of health care providers and rewarding them for better service
in remote areas. Studies have shown that resources hindrance have often led
government in developing countries to provide low salary structures. However, the
significance attached to financial incentives by health workers cannot be
overemphasized. Despite salaries and allowances, benefits such as promotion which
is directly linked to salary increment of health workers have been emphasized
(Willis-Shattuck et al, 2008). Dissatisfaction with remuneration is considered as one
of the key factor undermining the commitment of academics staff to their
organizations and careers, consequently their decision or intent to leave (Tettey,
2006).
2.5. Conceptual Framework
The main objective of the study is to determine the factors that influence employee
retention in the public health sector in Tanzania. Figure 2.1 illustrates the variables
for the conceptual structure. Work environment, career development, style of
leadership, work-life balance programs, and a good salary are independents variables
that have been tested for a correlation with employee retention as a dependent
variable. This study adopted, modified and synthesised the conceptual framework
used by Kibozi (2018); Kinyili (2015) and Ng’ethe (2013). Ng'the's (2013)
conceptual model consider style of leadership, training, salary, and promotion as
31
predictor variables and intention to stay or leave as the outcomevariable.The
conceptual framework of Ng'ethe (2013) did not consider the role of work
environment and work-life balance practices, whereas this research considered the
impact of work environment and work-life balance practices on employee retention.
Kibozi's (2018) conceptual framework categorized work-life balance programs,
career growth, and work environment as predictor variables, and employee retention
as the outcome variable. However, Kibozi's (2018) conceptual framework considered
style of leadership as a mediating variable. This research modified the model of
Kibozi (2018) by considering style of leadership as a predictor variable. In addition,
the Kibozi model (2018) did not consider the role of good remuneration, while this
study considered the effects of good remuneration on the retention of employees.
Furthermore, Kinyili's (2015) conceptual framework identified work-life balance
programs, remuneration, career growth, and work conditions a spredictor variables
and intention to keep working, commitment, duration of services, and loyalty as
predicted variables. However, the Kinyilimodel (2015) did not think about the role of
leadership styles, while this study considered the impact of leadership style on
employee retention. Figure 2.1 illustrates the conceptual framework used in this
study.
32
Figure 2.1: The Conceptual framework on the factors influencing employee
retention in Tanzania's public health sector.
Independent variables
Dependent variable
Source: Conceptual framework adopted, and modified from Ng’ethe (2013); Kinyili
(2015) and Kibozi (2018).
The above conceptual framework illustrates the association between work
conditions, career development, and style of leadership, work-life balance programs,
and good salary as independent variables and employee retention as the dependent
variable. However, all these variables under the study have been thoroughly
discussed in the empirical review section.
Besides, in better understanding employee retention in Tanzania’ public health
facilities, two variables (predictor and outcome variables) have been utilized. The
Work environment
Career development
Work life balance practices
Good salary
Employee retention Leadership style
33
independent variables include work conditions, career development, leadership style,
work-life balance, and good salary. The dependent variable is employee retention.
All these variables of the study are clearly shown in the conceptual framework.
However, the above conceptual framework shows that the predictor variables such as
work environment, career development, leadership style, work-life balance, and good
salary have a direct relationship with the outcome variable namely employee
retention.
The theoretical and empirical literature reviewed (Nguni, 2005; Ng’ethe, 2013;
George, 2014and Kibozi, 2018), the relationships between predictor variables such as
work environment, career development, leadership style, work-life balance, and good
salary and employee retention as outcome variable was anticipated. Das et al (2012)
and Farooq and Hanif (2013) have identified work environment is one of the key
factor that influencing staff’s decision to remain at work within the organization.
Aspects of the work environment, such as relationships, sufficient working space and
availability of medical supplies and equipment, and protective gears are the key
factors that tend to satisfy staffs to remain loyal and committed to stay working with
an organization (George, 2014). Literature documents that when employees have
career development opportunities, they feel that their skills, knowledge, and
capabilities are valued and appreciated, and therefore remain with the organization.
For example, researchers such as Samuel and Chipunza(2009); Snow et al (2011) and
El-jardali et al (2013) in their studies found that career development strongly
influence employee to remain working within an organization.
Studies indicate that the style of leadership has a positive influence on employee
retention. For example, Ng'ethe (2013) was conducting a study in Kenya Public
Universities on determinants of retention of academic staff. The results from the
study showed that leadership style has a significant influence on academic staff to
remain working with the universities. The work-life balance practices such as health
programme for self and dependents, flexible work hours arrangement leave and off-
days are the key factors that influencing employees to stay with an organization.
Literature revealed that when staffs have good work-family opportunities, they
34
develop commitment and loyalty, and thus tend to remain with the organisation. For
instance, Kodz et al (2002); Gaan (2008); and Jack and Adele (2013) in their study
found that providing employees with a flexible working hours enables them to
balance their work and personal life, work-family stress reduced and hence retention
improved. In addition, studies shows that good salaries is key motivator which
enhance loyalty and commitment to staff to continue working with an organization.
Grace et al (2014) found that good salary leads an employee to perform better work,
shaping their attitudes and making them see alternative jobs less attractive and hence
increased retention. WHO (2016) has also reported that providing adequate salaries
and allowances to medical employees regularly strongly influence them to stay
working with public health institutions.
The framework assumes that retention of employees within an organization depends
on the factors such as work environment, career development, leadership style, work-
life balance, and good salary. Researchers such as Goethe (2013); and George,
(2014) claimed that if such factors exist in the organization lead to the retention of
employees and the tendency to leave the job or relocate to some another organization
gets reduced. The above arguments are established on empirical and theoretical,
which showed a significant positive association between the understudy variables.
However, the nature of these associations is not fully known in the context of
Tanzania due to the scarcity of studies carried out in the country especially in the
health sector. In this context, it leads to a study of factors influencing personnel
retention in the public health sector in Tanzania.
2.6 Research Gap
Health workers shortages are a global problem (WHO, 2006). Previous researches
such as Snow et al (2001), Chikanda (2005) and Awofeso, (2010) have been
conducted studies on employee retention centered on rural and remote areas. This
limits the generalization of study results, since the rural environment varies from
urban environment and factors that influences retention of health workers retention
are therefore distinct. However, this study was conducted in an urban setting by
35
examining the factors that influences the retention of health workers in the public
health facilities in Tanzania and hence bridged the research gap.
Although numerous of previous studies have been conducted on factors influencing
retention of employees, most of the existing researches have been done in other
sectors such as banking sector (Farooq and Hanif, 2013), hotel industry (Khan et al,
2011), telecommunication sector (Shoaib et al, 2009; Kwenin, 2013; and Mittal
2015), small and medium-sized enterprises sector (Beynon et al, 2014), leather
industry sector (Hassan et al, 2010), brewery company (Ghansah et al, 2011) and
Higher education sector (Ng’ethe, 2013) with the paucity of such studies in the
public health sector. Besides, the literature review indicates that few studies have
been done on factors that influences retention of employees in the public health
sector in Tanzania and more so none has been done in Dodoma regional referral
hospital and hence there is a research gap. This research in contrast bridged this gap
by investigating the factors that influences retention of employee in the public health
sector in Tanzania using Dodoma regional referral hospital as a case of study.
Globally, numerous studies have focused on doctors and nurses such as Duffield and
O’Brien-Pallas (2003), Chikanda (2005) and Terera (2014), and the fact that doctors
and nurses do not perform their duties in isolation (Chikanda, 2005). Similarly, this
limits generalizing the study findings as different categories of employees have
different needs and the concentrate on doctors and nurses has influenced policy
formulation which has led to unintended consequences of demotivating the other
categories of staff. However, this study in contrast bridged this gap by covering
various medical professionals including nurses pharmacists, doctors, midwives, and
laboratory experts, in order to identify factors that influences the exit and retention of
health workers and to build a model that can help policy makers to develop better
policies and strategies for the retention of medical employees in the public health
sector in Tanzania.
Moreover, the above literature review identifies a plethora of studies related to
personnel retention, conducted in foreign countries with diverse socio-economic,
36
political and cultural backgrounds, and reported contradictory results. This limits the
generalization of study findings to other countries, especially developing countries.
Moreover, factors influencing the retention of health personnel in least developed
countries may differ from those derived from developed nations, as hospitals in
developed countries operate in a solid economic and institutional environment, which
is lacking in least developed countries, particularly Tanzania. This study in contrast
filled this gap by examining factors that influences retention of health workers in the
public health sector that are relevant in the social-economic, political and cultural
environment of Tanzania, adopting Dodoma regional referral hospital as a case
study.
2.7 Chapter Summary
This chapter involved the review of related literature. Expectancy theory (1964) and
Herzberg's Two Factor Theory (1959) are reviewed. Empirical studies on study
variables were also reviewed and presented. Numerous of the earlier studies
investigated the influencing factors such as work environment, training and
development, leadership style, work-life balance, and good salary on personnel
retention and found a positive association. There were also few studies that found an
inverse relationship. However, most of the empirical studies on the factors
influencing employee retention are conducted outside the country and focus on non-
health sector. The conceptual framework was developed based on the literature and
the variables that were being studied. In addition, the research gap is developed
based on the relevant reviewed literature. The research methodological approach is
discussed in the following chapter.
37
CHAPTER THREE
RESEARCH METHODOLOGY
3.1 introduction
This chapter presents the research methodologies adopted to meet the research
objectives. The main objective of the research was to determine the factors that
influences retention of employee in the public health sector in Tanzania. The adopted
methodological techniques in conducting the study, therefore involves the research
design, study area and its justification, population of the study and unit of
inquiry.This chapter also discusses the sample size and sampling techniques, as well
as different methods of data collection including primary and secondary data
collection as well as research validity and reliability. Thereafter, it presented and
discussed the data analysis and ethical issues.
3.2 Research design
Malhotra (2007) states that research design is an overall framework that guides the
researcher in the process of collecting data, measuring, analyzing and interpreting
observations. Kerlinger (1986:279) defined research design as a detailed research
plan, structure and strategy enabling the researcher to obtain answers to the research
questions. However, Robert (2000) opined that research design is a good
arrangement of techniques for gathering and analyzing research data in a manner
consistent with the purpose of the research.
The study used a case study design to collect information on the factors influencing
personnel retention in the public health centers, which were suit with the
environment of Tanzania to bridge the gaps noted in the literature. As literature
reported numerous researches that are related to staff retention, were executed in
different social-economic, cultural and political contexts and shown contradicting
findings. Factors motivating staff retention in least developed countries may vary
from those originating in developed countries and may not be relevant in the context
of least developed countries. Since hospitals in developed countries operate in a
38
stable economic and institutional sense, which in developing countries is lacking
(Masangu and Mpofu, 2013; Kibozi, 2018).
Studies such as Young (2000) and Berg (2001) indicated that a case study design is
suitable for detailed analysis of a single unit of study since it provides a focused and
detailed insight into a possible unclear phenomenon. Since the study sought to
determine the factors influencing retention of employees in the health sector in
Tanzania, a specific case involving the Dodoma regional referral hospital is selected
as the primary concern of the study. Further, a case study design is chosen to guide
and enable a researcher to gather extensively the information needed, and to
understand in depth the factors that influence retention of staffs at Dodoma Regional
Referral Hospital (Chikanda, 2005 and Alnaqbi, 2011). Similarly, it approached the
case study design to enable the studied health workers to better explain the rich
meanings of their retention problem feelings, behaviors and events (Patton, 2002 and
Yin, 2009). The application of case study design helped to assess the strengths and
limitations of the retention strategies of Dodoma regional referral hospital and to
answer the research questions.
However, this study applied a mixed-methods approach namely qualitative and
quantitative methods that are consistent with the nature of the research questions and
research objectives. The mixed-methods approach is crucial since the qualitative or
quantitative method alone would be insufficient to better understand the of staffs
retention problem (Berg, 2001; and Alnagbi, 2011). The mixed method approach
offers reliable insights and study results, as the use of these two approaches
reinforces each other (Malhotra, 2007). Similarly, facilitates easy interpretation of
research findings and enhances the validity of the study results and better
understanding of a research problem from a different perspective (Wallen and
Fraenkel, 2001).
39
3.3 Area of the study
The study was conducted at Dodoma regional referral hospital located in the
Dodoma region. The Dodoma region has experienced a substantial increase in
population in recent years due to government relocation to the country's new capital
of Dodoma; this has implications on the quality and quantity of service delivery in all
sectors and especially in the health sector. Due to the limited and far-reaching health
facilities, Dodoma regional referral hospital (General Hospital) serves many people
who come from different parts of the Dodoma region (Sikika, 2010); this leads to
overcrowding of patients in the Regional Hospital while the hospital faces an acute
shortage of health workers (Annual External Hospital Performance Assessment for
Regional Referral Hospitals Report, 2018). This led a researcher to select a Dodoma
regional referral hospital as an area of study. Moreover, the choice of Dodoma
regional referral hospital is influenced by its proximity, and respondents are expected
to be easily reached. According to the HRH country profile report (2013) and Annual
External Hospital Performance Assessment for Regional Referral Hospitals report
(2018), Dodoma has been described as drought and difficult to reach region facing
retention problems, which shows that serious focus is required to establish the
factors for retention of staffs for well-planned interventions to be taken. This region
is the most vulnerable in central Tanzania and has an insufficient number of trained
health staffs (Annual External Hospital Performance Assessment for Regional
Referral Hospitals report, 2018).
3.3.1 Description of Dodoma region
Dodoma is a region geographically situated in the central part of the country with a
total area of 41,311 square kilometres. It is the capital city of the government of
Tanzania. The total population size is 2,083,588; of whom 1,068,614 (51.3%) are
females and 1,014,974 (48.7%) are males, (National Bureau of statistics, 2012). It
bordered by four regions namely Morogoro, Singida, Iringa and Manyara. The major
ethnic groups are the Gogo, Taturu, and Rangi. Other ethnic groups include
Sandawe, Barbaig, Kimbu, and Hadzabe. Latitudinally, the region is situated south of
40
the equator between latitudes 6o 57 and 3o 82 as well as longitudinally between 36°
26’ and 35° 26’ east of Greenwich, (NBS, 2012).
3.4 Population of the study
Various scholars and researchers have defined the study population in distinctive
perspectives. Avwokeni (2006:92) has defined the study population as the set of all
the targeted participants qualifying for a study. Leonard and Anselm (1973) define
the study population as the total set of observations from which the sample from the
survey is drawn. The population of this study was the medical practitioners including
doctors, nurses, midwives, pharmacist, and technicians in the laboratory. Such cadres
are selected because they are the ones who are specifically involved in delivering
medical care services. In addition, perform the supervision roles and lead various
divisions and sections in day-to-day activities in the provision of health services
(Townsend et al, 2011). The researcher assumed that the selected population of the
study has useful information needed for the study questions. However, this study left
out the support staffs such as cleaners, clerks, security guards, and office attendants
as they are not involved in the provision of health services. The unit of analysis in
this study consisted of the medical staff of the selected hospital who filled
questionnaires and participated in interviews, as they are the ones who might better
express their views of the factors explored in the study.
3.5 Sample size
Creswell (2009) posits that a study sample size is a subset of the entire population.
Adedokuna (2003) defined the term sample size as the number of elements with
common features that can be selected for a study. The sample size is a manageable
portion of a population from which the information needed for the research is
collected or drawn (Adeniyi, Oyekanmi, and Tijani, 2011). Sampling from a
population is very important as it is difficult to cover the entire population, thus
helping the researcher deal with a manageable and reasonable element size
(Avwokeni, 2006; Hammed and Popoola, 2006; Akinade and Owolabi, 2009).
41
Researchers like Sekaran (2000) and Zikmund (2000) further argued that a well-
selected sample helps produce accurate and reliable research results.
The sample of this study was the medical practitioners from Dodoma regional
referral hospital. The study used unrestricted sample methodology as the researcher
personally went to the sampled hospital and had direct access to health personnel.
Sampling size of this study was determined using the sample size determination
method developed by Carvalho (1984), also used by Radivoev (2005) and Netswera
et al (2005). The method facilitates the identification and attainment of the correct
sample size. The total study population in this research is 535 in Dodoma regional
referral hospital and the information is adopted in the Annual External Hospital
Performance Assessment for Regional Referral Hospitals report (2018).The 535
employees range between 501-1200 according to Carvalho’s method as shown in
Table 3.1 below. The medium sample size therefore applied in consonance with the
population size given. The sample size for the study was 80 respondents, and a
researcher believed that the sample size chosen for the study provides a better
representation of the target population.
Table 3.1: Sample Size Determination
Population size
Sample size required
Small (Low) Medium Large (High)
51-90 5 13 20
91-150 8 20 32
151-280 13 32 50
281-500 20 50 80
501-1200 32 80 125
1201-3200 50 125 200
3021-10000 80 200 315
10001-35000 125 315 500
35001-45000 200 500 800
Source: Carvalho (1984)
However, while selecting the correct sample size for this study, some of the factors
taken into account by the researcher include the cost of taking samples and the time
consuming for large sample size. Determining the sample size for the study takes
42
into account monetary and administrative matters (Rao, 2002). Studies found that a
total sample size of 80 respondents when the target population is large was the best
medium sample size (Agolla and Ongori, 2009). Similarly, literature revealed that
the sample size greater than 30 is a normal distribution, so the sample size is good
(Baradyana and Ame, 2005). The table below shows the size of the sample for the
study.
Table 3.2 Sample sizeof the respondents
S/N Category description Population Sample
size
Instruments to
be used
1 Heads of Department 20 10 Interview guide
2 Doctors 150 25 Questionnaire
3 Nurses 220 20 Questionnaire
4 Midwives 18 15 Questionnaire
5 Pharmacists 12 6 Questionnaire
6 Laboratory technicians 15 4 Questionnaire
7 Other non-health staffs 100 0
Total 535 80
Source :( Researcher, 2020)
3.6 Sampling techniques
Rao (2002) and Creswell (2009) contend that the sampling technique is a procedure
adopted by a researcher to select items for the sample. In other words, it is a clear
plan for obtaining a sample from a given population because covering the entire
population is complex. Adedokuna (2003) and Creswell (2009) argued that there are
two main goals which the sampling procedure intends to achieve. Firstly, to establish
representatives of what is being investigated and to reduce bias. The second is to
draw inferences from a study results based on sample to an entire population from
which that sample was chosen. The sampling techniques used in this study included
stratified sampling, simple random sampling and purposeful sampling technique. In
addition, literature documents that one sampling technique that works in isolation
may lead to bias or often distort the entire picture of reality that the researcher is
investigating, and hence the application of the above stated three-sampling technique
43
(Creswell , 2009). Besides, the description of each sampling technique is provided
below.
3.6.1 Stratified sampling technique
Adeniyi et al (2011) defined the term stratified sampling as a sampling technique by
which a researcher categorized the study population into various strata or groups.
Avwokeni (2006) and Hammed and Popoola (2006) stressed that if the population
from which a sample is to be selected does not include a homogeneous group, then
the stratified sampling method is generally used to obtain representative samples.
Under stratified sampling, the population is stratified into several sub-population that
are individually more homogenous that the whole population and that subpopulation
are called strata (Sekaran, 2000 and Akinade and Owolabi, 2009). However, this
technique makes easy to classify the population into strata and to ensure that all
employees in an organization are represented in the sample (Young, 2000).
The study employed stratified sampling technique to obtain the right sample that is
representative of the whole population of the sampled hospital. The technique also
used to sample the varied cadre of medical staffs including doctors, nurses,
midwives, pharmacists, laboratory technicians and Heads of Department from
Dodoma regional referral hospital. Each cadre was categorized according to strata as
shown in table 3.2. Further, simple random sampling used after stratification for
selecting the sample respondents for this study. However, Young (2000) argued that
the use of stratified sampling technique lead to more reliable and detailed
information. Similarly, Berg (2001) stated that stratified sampling technique is the
most reliable, accurate, simple, has more statistical accuracy, and best way to capture
representative samples and hence application of the technique in this study.
3.6.2 Simple random sampling technique
Simple random sampling was defined by Sekaran (2000), and Akinade and Owolabi
(2009) as a type of probability sampling by which all members of the population
have an equal chance of being picked up to form a sample. This means that each
member of the population has an equal opportunity to be selected for a study. Studies
44
have revealed that to ensure a proper random sample the selection of required sample
must be done through the table of random numbers or balloting and sometimes even
computer simulation (Popoola, 2011). Literature document that simple random
sampling improve the law of statistical regularity, in which the sample will have the
same composition and features as the universe (Akinadeet al, 2009).
Besides, simple random sampling used to select sample respondents from diverse
cadres of health practitioners as illustrated in table 3.2 above. A total of 70 out of 80
sample sizes of medical staffs were selected randomly to generate quantitative
information (see table 3.2). The use of simple random sampling technique is
important in this study as it eliminates the bias of sampling in collecting information
from medical employees and facilitates the achievement of a high level of
representation (Berg, 2001; Michael, 2008). Therefore, each medical staff at Dodoma
regional referral hospital had an equal opportunity to be selected for the study.
3.6.3 Purposive sampling technique
Recent research contend that purposive sampling is a deliberate collection of
different demographic units for a sample representing the population (Popoola, 2011;
Adeniyi et al, 2011). This research employed purposive sampling technique to pick a
sample based on experience and knowledge of the group to be sampled. Atotal of 10
respondents were purposively picked up specifically from Heads of the department
for interviews in order to generate important information on retention of employees.
The interviewees are important in this study as they are both supervisors and
members of Dodoma regional referral hospital management team, therefore, possess
significance information on the retention of health workers. Heads of department
were sampled purposively to generate relevant information for example statistics on
the number of employees in their sections or units. Similarly, the heads of
department were selected into the study because of their positions and decisions
making roles which have an impact on employee retention at the Dodoma regional
referral hospital. For example, Sutherland (2004) stated that employees leave leaders,
45
not organizations. Therefore, the role of heads of the department is crucial in staff
retention (Sandhya and Kumar, 2011 and Ng‟ethe et al, 2012).
3.7 Data source and collection methods
3.7.1 Data source
Data sources are an important part of any study analysis because the research
findings are focused heavily on what the data shows. The term data is defined as
information of all kinds that a researcher obtains from the study participants.
Adedokun (2003:57) pointed out that the word data refers to any facts and
observations relating to the subject of the study.Data can be obtained from two key
sources, namely primary and secondary. This study used both primary and secondary
data sources. The primary source of data is defined as sources for collecting of
primal data for the study, and Secondary sources as data sources already accessible
in the existing publications (Adeniyi et al, 2011).
3.7.2 Data collection methods
The research used qualitative as well as quantitative data collection methods to
gather data. This research first used the interview method, and documentary review
to collect qualitative data. The questionnaires then structured and administered in
order to obtain quantitative knowledge. These methods have been applied in this
study because one method of research is insufficient to gather reliable and valid data
and to better understand the issue of employee retention (Wallen and Fraenkel, 2001;
Alnaqbi, 2011). As Berg (2001) and Alnagbi (2011) have pointed out, the use of a
single method in data collection tends to mislead the researcher's portrayal of the
reality of the issue under the investigation. In addition, the use of more than one data
collection method in research enhances the validity of study findings and a better
understanding of the factors that influence employee retention in public hospitals
(Wallen and Fraenkel, 2001; Malhotra, 2007). However, a description of each data
collection tools is provided below.
46
3.7.2.1 Questionnaires
A questionnaire was defined by Adeniyi et al (2011) as a research tool consisting of a
series of questions to gather relevant information from the study respondents. Hair et
al (2011) reported that the questionnaire provided a collection of organized
structured questions with alternative answers allowing the respondents to choose the
correct and most appropriate response among the alternatives. The questionnaire
consists of closed-ended and open-ended questions. Closed-ended questions offered
structured responses, while open-ended questions offered semi-structured responses
(Adedokun, 2003).
Data collection can be carried out in the sense of survey studies using four types of
procedures defined by Saunders et al, (2012). It includes questionnaire, record
reviews, interview surveys and observation. In order to respond to the objectives of
this study, the researcher used questionnaire survey to obtain quantitative data.This
method is used in this study due to its ability to cover the broad respondents in a
short timeframe, the ability to give the respondents ample time to provide well
thought-out responses and its merit in offering standardized answers and easy data
analysis (Babbie, 2004). In addition, its ability to reduce random error and hence
increased reliability and validity of the study findings. In addition, since this method
can be applied to large respondents, a total of 70 questionnaires were distributed to
the various medical staff of the Dodoma Regional Referral Hospital for filling, and
only 68 questionnaires were returned to the researcher for analysis and interpretation.
The structured questionnaires composed of five sections. Section I focused on the
study participants ‘demographic characteristics of the. Section II concentrated on the
causes of the shortage of health workers. Section III focused on retention strategies
available at Dodoma regional referral hospital (DRRH). Section IV focused on
factors influencing health workers to leave the job (exit analysis) and section V
concentrated on factors influencing retention of health workers (retention analysis).
The questionnaires were structured in a five-point Likert scale using terms like
strongly agree, agree, strongly disagree, disagree and neutral to assess the influence
47
of identified factors on personnel retention in the health sector. Likert scale is
preferred in this study as it is relatively easy to structure, smooth quantification of
responses, and facilitates ranking of items easily thus tendencies can be determined
and the respondents are more likely to respond to all the statements contained in the
questionnaire and can best help to capture the views of the respondents (Kothari and
Garg, 2014). In addition, Likert's five-point scale was used to allow study
participants to express their views and opinions on each aspect of their work
(Dundas, 2004).
3.7.2.2 Interview
Hair et al (2011) argued that interviewing as a data collection tool involves verbal
interaction between the interviewee and the interviewer in collecting data on the
subject at hand.Adeniyi et al (2011) considered the interview to be a structured
process involving the exchange of views between the interviewee and the interviewer
on a subject of mutual interest.This study used structured interview guide to obtain
qualitative data for identifying factors influencing health personnel' retention because
of its ability to provide flexibility to ask for clarification in order to uncover
information which cannot be revealed by questionnaires (Yin, 2009). The interview
guide included topics that were considered relevant to the study.
Besides, an interview were conducted to collect data from ten (10) heads of
department who are both supervisors and members of Dodoma regional referral
hospital management team. Using this method, the researcher was able to collect
first-hand information from the respondents on their views, ideas, experience and
understanding of the retention of staff in order to validate and clarify the information
collected through questionnaires. However, the choice of these respondents is
influenced by the fact that they are the ones who directly responsible for retaining of
employees because they are leaders who are expected to ensure there are
motivational strategies for retention (Battacherjee, 2012). Questions in the interview
instrument were structured in terms of easy to comprehend by the interviewees. The
interview guide was piloted with five people who are knowledgeable in the field of
48
study to ensure clarity of the questions. The interview structure consisted of
introductory and main section. Introductory questions cover the interviewee's profile.
The main questions focused on the influencing factors of personnel retention.
Generally, the interview guide served as a conversational guide rather than a list of
questions to be asked by the participants (Adedokun, 2003; Adeniyi et al, 2011).
3.7.2.3 Documentary review
A review of published and unpublished documents was undertaken, in particular
those considered to be more relevant to the study. The researcher gathered secondary
information through a review of various documents, such as health sector incentive
plans, health performance reports, health-related policies such as the Human
Resources Policy 2005, the Human resource for health and social welfare strategic
plan 2014 - 2019, Primary health development programme 2007 – 2017 as well as
Health sector staffing levels guideline 2014 – 2019. The review of these documents
offered useful information on employee retention approaches, compensation
programs available in public facilities and on how they influence or discourage the
retention of employees in public hospitals. Similarly, policy information collected to
determine whether, as advocated in those policies, it creates a pleasant working
environment for employees.
3.8 Validity and reliability of the study
3.8.1 Validity
The validity of the research was described by Adedokun (2003) and Cavana,
Delahaye and Sekaran (2001) as a situation where the findings of the research are
consistent with what is designed to find out. Yin (2009) also added and emphasized
that research validity is the strength of propositions, inferences and conclusion. This
is further underlined by Creswell (2009) that a researcher must demonstrate to his or
her audience that the procedures applied in particular research are both valid and
reliable before considering the conclusion of his or her research. In addition, the
validity of the research means that the research instrument measures what it needs or
intends to measure (Bollen, 1989; Hair et al, 2010). This means that the validity of
49
the study indicates whether the measure is in line with the definition being measured.
Cavana et al (2001) argued that research validity deals with the consistency of
accuracy, fact, correctness, and meaningfulness of an instrument used in study.
However, in order to improve the validity of the study, the different research validity
techniques and methods used by the researcher reduce the possibility of systemic
bias due to a specific methodology. Data collection approaches such as
questionnaires, interview and documentation review were used to support and check
one another's validity.The researcher also used experts in the field to review and
examine the interview guides and questionnaires to ensure the validity of the
contents. Before the final questionnaires were distributed, the researcher checked the
questionnaire with a few respondents for understandability and readability of its
contents to see whether the questionnaire is understood or needs improvement. The
factors checked up includes language, the flow of questions, clarity, logic and time to
complete the questionnaires. Cooper and Schindler (2005) argued that before
continuing with the research, a pilot study of data collection tools assists in finding
flaws in research methodologies and data collection methods. Additionally,
procedures for collecting and analysing data were carefully planned, documented and
followed up. In addition, data collected from the field was cleaned up so that
incorrect pieces of information could be detected and deleted accordingly.
3.8.2 Reliability
Yin (2009) and Saunders et al (2000) described the term reliability as the situation
whereby the research instruments give consistent results when repeatedly used in
research. Reliability means consistency in results if repeatedly applied (Hair et al,
2014).When study tools were applied to similar respondents under similar conditions
and obtained similar results, the instruments were assumed to be reliable (Creswell,
2009). Researchers such as Hair et al (2010) expressed the view that the more similar
results from research instrument contribute to greater reliability. Saunders et al
(2009) stated that three reliability assessment techniques exist, namely internal
consistency, test re-testing, and alternative form. Test re-testing includes conducting
the same questionnaire twice to respondents under similar conditions as possible and
50
correlating the collected data. This approach is complicated as it is difficult to
convince the same person to answer the same questions again. Internal accuracy
means matching the answers in the questionnaire to those of other questions using
measures such as the alpha of the Cronbach (Creswell, 2009; Saunders et al, 2009).
The alternative form involves correlating the response of the same questions or set of
questions to alternative forms. This approach is difficult to execute as it requires a
longer questionnaire, so making sure the questions are the same is difficult to
achieve. This study used Cronbach's alpha to evaluate the internal consistency of the
measurement items, due to the difficulty of the previous assessment techniques.
Studies have shown that the Cronbach alpha coefficient of at least 0.7 suggests a
reasonable degree of reliability for statistical testing (Creswell, 2009; Saunders et al,
2009; Hair et al, 2010). In addition, a pilot test was conducted to assess reliability of
the instrument. The Cronbach's alpha value of this analysis was 0.9 and the items
were highly accurate according to Creswell (2009) and George et al, (2003).
3.9 Data processing and analysis
Literature document that the data have to be processed and analysed after it has been
collected. Kothari (2004) described the term processing as an aspect that involves the
editing, coding, classification and tabulation of the data collected in order to facilitate
the analysis and to draw up accurate and relevant findings from study. The word
analysis also refers to a systematic process of applying statistical and logical
approaches to the calculation of certain measures and the identification of patterns of
correlation between data groups (Kothari, 2004; Yin, 2009; Adeniyi et al, 2011).
However, researchers such as Adeniyi, Oyekanmi, and Tijani (2011) and Popoola
(2011) argued that the data analysis implies summarizing and organizing the
collected data in a way that answers the research questions. Various techniques of
data analysis may be used by the researcher in the conduct of the research. For
example, Yin (2009) and Adeniyi et al (2011) stated data analysis can be done using
Statistical package for social science (SPSS) version 21 and Analysis of Moment
Structure (AMOS). However, the nature of research and the type of data gathered are
the main aspects to be considered during data analysis (Kothari, 2004).
51
In this study, both the qualitative and quantitative applied in data analysis. Studies
have shown that qualitative data described phenomenon deeply and exhaustively
(Kothari, 2004), and thus, used in the factual and logical interpretation of data. On
the other hand, the quantitative data were used in the data presentation to illustrate
statistics such as frequencies, tables, graphs, and percentages. Devices such as
computer software packages such as the Statistical Package for Social Science
(SPSS) version 21 and the Excel spreadsheet, calculators used to analyse the data
collected to draw reliable and valid research findings. Data processing and analysis
enable a researcher to get useful information that able to respond research questions
and ultimately to achieve objectives of the study (Kothari, 2004; Yin, 2009; Popoola,
2011).
3.10 Ethical consideration
Literature document that all professions are guided by a code of ethics. Yin (2009)
argued researchers are bound by the ethics of research. This means researchers
should abide by the ethical requirements when conducting research. The researcher
adhered to the research ethics and guidelines by obtaining approval from the relevant
departments, officials and individuals who participated in the study. However, the
researcher sought permission from the office of the Vice-Chancellor, Mzumbe
University to be used as a letter of introduction to the DRRH where the research was
conducted. The researcher provided an overview of the research, its main objectives,
the reason for the data collection assignment and requested permission for sampled
respondents to participate in the study. The researcher observed the research ethical
principles such as voluntary participation, the principle of anonymity, right of
withdrawal and confidentiality. The literature revealed that it is unethical to share
information about the respondent with others for purposes other than research. The
information provided by the respondents and those derived from the documentary
analysis secured and remained both confidential and anonymous.
52
3.11 Chapter Summary
This chapter presents the research methodologies used in the study. It describes the
research design and rationale of using the mixed methods design (qualitative and
quantitative approaches) in the study. Similarly, presents the study area and the
rationale of its selection, and population of the study as well as unit of analysis. It
also presents the sample size of the study, sampling techniques, and the
methodologies used to collect primary and secondary data. This chapter also presents
the validity and reliability of the study, the data analysis and the ethical issue.
Presentation of findings and discussion of findings, and summaries, conclusions and
policy implications are presented and discussed in chapter four, five and six
respectively.
53
CHAPTER FOUR
PRESENTATION OF FINDINGS
4.1 introduction
This chapter presents results and analyses the findings of the study that examined the
factors influencing employee retention in the public health sector in Tanzania. The
study was guided by four objectives: to identify the causes of shortage of health
workers at Dodoma regional referral hospital; to determine the existing strategies for
retaining health workers at Dodoma regional referral hospital; to evaluate the factors
influencing health workers to leave employment at Dodoma regional referral
hospital; to examine factors that influences the retention of medical staffs at Dodoma
regional referral hospital.
The presentation of results is organized into five sections. Section one presents and
analyses the findings on the demographic characteristics of the research participants.
Section two presents result on causes of shortage of medical employees. Section
three presents result on the existing strategies for employee retention. Section four
present results on factors that influences medical staffs to leave job and section five
present results on factors that influences employee retention at Dodoma regional
referral hospital.
4.2 Response rate
A total of 70 questionnaires were distributed to study participants and only 68 were
filled and returned. This represented a response rate of 97%. This response rate was
appropriate for data analysis and consistent with Mugenda (2003) and Angolla and
Ongori (2009), who opined that the response rate of 70 percent and above was
adequate and acceptable.
4.3 Demographic characteristics
This section presents the demographic characteristics of the study participants. The
respondents’ demographic characteristics considered in the study was sex, job cadre,
age group, education level and work experiences. However, Shamdoe et al (2016)
54
and Ng’ethe (2013) have argued that the approach for responding to study objectives
is normally influenced the demographic information of the participants. Sahi and
Mahajan (2014) noted that individuals from different demographic backgrounds such
as sex, age, level of education and work experience can hold diverse views.
4.3.1 Sex of the respondents
The study participants were asked to indicate their sex in order to ensure that the
findings obtained captures the views of the both sex of medical staffs regarding issue
of retention. Table 4.1 below indicates the sex of the respondents.
Table 4.1: Sex of the respondents
Details Category Frequency Percent (%)
Sex
Male 29 43
Female 39 57
Total 68 100
Source: field data (2020)
The findings revealed that 43% of the participants were male and 57% were male
respondents. This suggested that there were more female staff in the DRRH than
males. Literature found that majority of nursing workers were in the public sector
and that women are often considered to dominate the nursing profession. Recently,
however, males had joined the nursing profession, as did more females entering the
physician’s profession.
4.3.2 Job cadre of the respondents
The respondents were requested to indicate their job cadre. Job cadre was significant
aspect for the respondents to indicate the factors that influence the retention of
medical staffs in the Dodoma regional referral hospital. The findings were as
indicated in the figure 4.2 below.
55
Figure 4. 1: Job cadre of the respondents
Source: field data (2020)
With regards to job cadre of the respondents, the findings indicated that 44% were
nurses, followed by doctors 31%, then laboratory technicians 10%, and pharmacists
9%, with the minority of midwives 6%. This indicated that there were more nurse
staffs in the Dodoma regional referral hospital, as revealed also by Oyelere (2007)
and Kinyili (2015) that nurses comprise the biggest group of the organization staffs.
However, studies showed that routine health activities constitute a lot of nursing
duties than physician’s duties, and these statistics are consistent with the rates
defined by the HRH (2013).
4.3.3Age of the respondents
The researcher also collected information on age of the respondents. The study
respondents were asked to indicate their age group and this was vital for the study so
as to establish the influence of respondents’ age on retention. The findings presented
in figure 4.3 indicated the distribution of responses on the age of the respondents.
56
: Age of the respondents
Source: field data (2020)
The findings showed that Dodoma regional referral hospital is composed of staffs
with different age groups. The descriptive statistics from table 4.3 above indicated
that majority of respondents were aged between 31-40 years (50%) followed by
those aged between 41-50 years (37%), then under 30 years (7%), with the minority
having been aged between 51-60 years (6%). The findings pointed out that the
hospital had relatively low number of elderly staffs and majority of the staffs were
young and employees who are about to retire are few and hence, low replacement
cost. Studies revealed that young employees were most productive, therefore,
retention of these staff members to ensure competitive advantage is very crucial.
57
4.3.4Level of education
The study participants were requested to indicate their level of education attained.
Also this was an important aspect in order for the respondents to show the factors
that influenced retention of employees in the Dodoma regional referral hospital. The
figure 4.4 below shows the education level of the respondents.
Figure 4.4: Level of education of the respondents
Source: field data (2020)
The findings from figure 4.4 indicated that majority of the respondents 36.8% had
bachelor’s degree, followed by those holding a diploma 20.6%, then certificate
17.6%, an advanced diploma 11.8%,a master’s degree 10.3%, and with a minority of
2.9% holding a PhD. These results indicate that only few medical staffs in Dodoma
regional referral hospital (DRRH) have high academic qualification of PhD (only
2.9%), and the largest number have bachelor degree (36.8%) as indicated in the
figure 4.4 above. Similarly, the findings suggested that staffs at DRRH when they
attained higher education are likely to leave job if not pleased with rewards and
58
working environment and this conforms to Bussin (2002) and Bashir etal (2009)
who argued that constant training of staffs enhanced their skills, raises their market
value and could influence their early turnover in lieu of reinforcing their retention.
4.3.5 Length of service with the hospital
The respondents were asked to indicate the duration of service with the hospital.
This was important in order to identify respondents' understanding of the hospitals
and its impact on the retention of staffs. The findings presented in the figure 4.5
below indicated the views of respondents who had worked in the hospital on diverse
period of time.
Figure 4.5: Length of service with the hospital
Source: field data (2020)
59
The findings showed that 6% of the respondents had worked in Dodoma regional
referral hospital (DRRH) for a period of less than 5 years, 51% of the respondents
shown that they have worked in the hospital for a period of between 5 to 10 years
while 18% of the respondents indicated that they had worked in the hospital for a
period of between 10 to 15 years and 25% of the respondents said that they had
worked in the hospital for 16 years and above. The results imply that majority of the
respondents 51% had working experience between 5 to 10years. This was an
indication that most of the employees do not stay long with organization. Based on
the results, it appears that the hospital is experiencing retention challenges.
4.4Causes of shortage of health staffs at Dodoma regional referral hospital
The findings under this section address the first specific objective that aimed to
identify the causes of shortage of health staffs at Dodoma regional referral hospital.
The employees were provided statements on causes of shortage of health staffs to
indicate their level of agreement. Their responses were measured aLikert scale of
five (5) from strongly disagreed, disagreed, neutral, agree, and strongly agree. For
the case of analysis, the strongly disagree and disagree were grouped as disagree
while the neutral were termed as undecided and agree and strongly agree were
grouped as agree. The table 4.6 below indicates factors that led to a shortage of
healthcare personnel at DRRH.
Table 4.6: Causes of shortage of health staffs at DRRH
Causes of shortage of health staffs at Dodoma
regional referral hospital
Disagre
e (DA)
Undecide
d
Agree Tota
l (A)
No % No % No % No
Lack of attraction and retention programs within the
organization 13
1
9 5 7 50
7
4 68
Difficult work environment staff face while in a
work place 20
2
9 18
2
6 30
4
4 68
Unsatisfactory financial incentives for health
professionals 15
2
2 9
1
3 44
6
5 68
Lack of opportunities for professional development 21 3
1 14
2
1 33
4
9 68
Presence of work life imbalance practices 30 4
4 15
2
2 23
3
4 68
Low rate recruitment and retrenchment due to the
fake certificates 15
2
2 8
1
2 45
6
6 68
Source: field data (2020)
60
The results show that the majority of respondents 74% agreed that lack of attraction
and retention programs was one of the factor that led to shortage of healthcare staffs
at DRRH, whereas 19% disagreed and 7% were undecided. The findings also
revealed that 44% of respondents agreed that difficult work environment was the
contributing factor to shortages of staffs while 29% disagreed and the rest 26%
respondents were undecided. Similarly, results show that 65% of the respondents
agreed on the unsatisfactory financial incentives while 22% disagreed and the
remaining 13% were undecided. Further, the findings indicated that 49% agreed that
lack of professional development opportunities contribute to a shortage of staffs
while 31% disagreed and 21% of respondents were undecided. The findings also
revealed that 34% of the respondents agreed on the work life imbalance practices
whereas 44% disagreed and 22% of respondents were undecided. Furthermore, the
findings showed that 66% of respondents agreed that low rate recruitment and
retrenchment due to fake certificates is the causes of a shortage of staffs while 22%
disagreed and 12% of respondents were undecided. This quantitative findings agreed
with the qualitative findings from one of the respondents in DRRH who reported
that: ‘the shortage of staff in the hospital was largely caused by the government’s
decisions to freeze recruitment for the removal of ghost workers in the public
payroll who had fake certificates of education’’ (interview, 2020).
4.5 Existing strategies for retaining health staffs at DRRH
This section presents the results for the second objective of the research that was
sought to determine the existing strategies for retaining health workers at Dodoma
regional referral hospital. The figure 4.7 below shows the retention strategies
available at DRRH.
61
Figure 4.7: Retention strategies available at DRRH
Source: field data (2020)
The findings revealed that the majority 59% of the respondents agreed that improved
hospital environment with good working tools is one of the employees retention
strategy while 37% disagreed and the remaining 4% were undecided. The findings
also indicated that 54% of the respondents agreed that the career development
opportunities are offered by the hospital whereas 34% were disagreed and 12% were
undecided. Moreover, the findings showed that majority 62% of the respondents
agreed that work life balance as one of the staff’s retention strategy while 31%
disagreed and 7% of the respondents were undecided. The findings also revealed
that 29% of the respondents agreed on the competitive salary as strategy for
employee retention whereas 59% disagreed and 12% were undecided. Furthermore,
the findings showed that 56% of the study participants agreed that good supervisory
as well as leadership style as a retention strategy while 29% disagreed and the
remaining 15% of the respondents were undecided.
62
Moreover, findings from interview indicated that flexible working hours and
improved hospital working environment have been used by the hospital in retaining
its staffs. For example, one of the respondent in DRRH said that: ‘‘We have
provided flexible working hours and shift to staffs to enable them balancing their
work and personal responsibilities which enhance comforts in working with the
hospital for a long period’’ (Interview, 2020).
4.5 Factors influencing employees to leave job at DRRH
This section address the findings for the third specific objective of the research that
was sought to evaluate the factors influencing health workers to leave job/relocate to
another organization. The results presented in the figure 4.8 below shown the
perceptions of respondents on the factors that influences health staffs to leave/
relocate to another organization.
Figure 4.8: Factors influencing staffs to leave job/relocate to another
organization
Source: field data (2020)
63
The findings revealed that 60% of the respondents agreed that poor management and
supervisory style influences employees to leave job or relocate to another
organization while 34% disagreed and the remaining 6% were undecided. The study
found that 34% of the respondents agreed that poor flexible working hours as the
factor influencing staffs to leave job or organization whereas 57% disagreed and 9%
were undecided. The findings also revealed that 62% of the respondents agreed that
unconducive working environment was one of the factor influencing staffs to leave
job or to relocate to another organizations while 35% disagreed and 3% were
undecided. Further, the results indicate that 74% of the respondents agreed that poor
financial incentives as a factor for leaving job or organization while 25% disagreed
and 1% were undecided. Similarly, the findings showed that 50% of the respondents
agreed that lack of professional development and continuing education influence
staffs to leave job or relocate to another organizations while 43% disagreed and 7%
of the respondents were undecided. Regarding of poor interpersonal relationship,
results indicated that 56% of the respondents agreed with the factor while 32%
disagreed and 12% of the respondents were undecided.
Moreover, results from interviews concur with those of the questionnaires where the
respondents revealed that uncompetitive salaries demotivate employees to stay
working with the hospital. For instance, one of the respondent said that: ‘‘our staffs
are well compensated, although they complain about salary that is not sufficient
compared to other organizations such as Bank of Tanzania (BOT)and Tanzania
revenue authority (TRA), where their employees are paid better salaries than
doctors’’(Interview, 2020).
4.6 Factors influencing employee retention at DRRH
Retention strategies play vital role in the organization. Therefore, organization must
put in place good retention approaches to retain committed and talented workers and
reduce turnover. However, this study sought to establish from the study participants
the factors that influence retention of medical staffs at Dodoma regional referral
hospital.
64
4.6.1 Work environment
The respondents were asked to indicate the influence of work environment on the
medical staff’s retention. The working environment gives staffs a sense of being
valued that makes them strive to work and remain with an organization. The study
results are presented in the figure 4.9 below.
Figure 4.9: Work environment
Source: field data (2020)
The above figure 4.9 indicates factors that can be employed to retain medical staffs
at DRRH. The findings indicated that 65% of the respondents agreed that the
hospital had adequate available of medical supplies and equipment while 26%
disagreed and 9% were undecided. The findings also showed that 50% of the
respondents agreed on the good relationship between subordinates and management
while 46% disagreed and 4% were undecided. Similarly, the findings showed that
48.5% of the respondents agreed that the hospital had adequate availability of
65
protective gears while 39.7% disagreed and 11.8% of the respondents were
undecided. The results indicated that 60% of the respondents agreed that the hospital
had sufficient work space for effective work operations while 24% disagreed and
16% were undecided. Also, the findings showed that 54.4% of the respondents
agreed that workplace support whenever needed were provided by supervisors,
administration and colleagues while 38.2% disagreed and the remaining 7.4% of the
respondents were undecided.
In addition, the findings of the interviews were consistent with those of the
questionnaires where the respondents have shown that a favorable working
environment motivates employees to stay working with the organization. For
instance, one respondent in DRRH reported that: ‘‘the working environment at
Dodoma regional referral hospital is conducive and attractive. We have
rehabilitated some of the hospital buildings and we plan to build houses for our
doctors and nurses. I believe that there are no staff who will leave the hospital due
to a poor working environment” (Interview, 2020).
4.6.2 Career development opportunities
The respondents were asked to indicate the influence of career development
opportunities on the retention of medical staffs. However, studies indicate that when
staffs are unable to predict their career development path in the organization, they
were likely to leave the organization as soon as they get a chance in another
organization. The findings are set out in the figure 4.10 below.
66
Figure 4.10: Career development opportunities
Source: field data (2020)
The findings showed that 56% of the respondents agreed that the hospital had a good
training policy while 40% disagreed and 4% were undecided. The findings also
indicated that 48.5% of the respondents agreed that adequate training opportunities
were provided in the hospital while 45.6% disagreed but 5.9% were undecided.
Further, the findings showed that 48.5% of the respondents agreed that regular
career counseling were provided in the hospital while 39.7% disagreed and the
remaining 11.8% were undecided. The study findings revealed that 60% of the
respondents agreed that the hospital had a tuition payment reimbursement policy
while37% disagreed and only minority 3% were undecided. Moreover, the findings
showed that 47% of the respondents agreed that the hospital offer paid study leaves
for professional development while 44% disagreed and the remaining 9% were
undecided.
67
Moreover, interview findings concurred with those of the questionnaires where the
respondents revealed that the hospital provided its staff with various training
opportunities which motivate employees to stay working with the organizations. For
example, one of the respondent said that: The hospital offers various opportunities
of refresher courses and long term training to its employees. The training is relevant
to their responsibilities and most of the staffs have been satisfied with the training
(Interview, 2020).
4.6.3 Leadership style
Studies indicated that style of the leadership can influence staffs either stay or leave
the organization. This study sought to establish the influence of leadership style on
medical employee’s retention. The figure 4.11 presented findings from 68 returned
questionnaires regarding the perception of employees on the influence of leadership
style on retention of medical employees in the Dodoma regional referral hospital.
Figure 4.11: Leadership style
Source: field data (2020)
68
The findings showed that the majority of the respondents 59% agreed that they were
allowed to take part in decision making while 40% disagreed and 1% were
undecided. The respondents 47% agreed that their leaders were encourage good
work relationship, whereas 37% were disagreed and 16% were undecided. The
findings also revealed that 54.4% of the respondents agreed that their leaders were
provided mentoring and advice staffs on the job while 41.2% disagreed and the
remaining 4.4% of the respondents were undecided. Similarly, the findings showed
that 51% of the respondents agreed that their leaders understand subordinates’ job
challenge and give them encouragement and assistance, whereas 46% disagreed and
3% were undecided. The majority of the respondents 50% agreed that they were able
to accomplish work under supervision of their leaders while 26% disagreed and 24%
were undecided.
4.6.4 Work life balance practices
The respondents were asked to indicate the influence of work life balance programs
on the personnel retention. Studies indicated that work life balance practices can
serve as an incentives for retention of staffs in the organization and thus the need to
understand its influence on the medical staff retention. The findings are presented in
the figure 4.12.
69
Figure 4.12: Work life balance practices
Source: field data (2020)
The findings revealed that 63% of the respondents agreed that availability of health
programme for self and dependents influences employee retention while 34%
disagreed and 3% were undecided. The findings also revealed that 69% of the
respondents agreed that work life balance reduce job stress because employees
working flexibly and hence influencing retention of staffs, whereas 25% disagreed
and 6% were undecided. Similarly, the findings showed that 56% of the respondents
agreed that work life balance reduced conflict with family activities and family
members while 28% disagreed and 16% were undecided. Also, the findings showed
that 54.4% of the respondents agreed that ample time for recreational activities
influenced employee retention while 35.3% disagreed and 10.3% were undecided.
Furthermore, the findings indicated that 52.9% of the respondents agreed that work
life balance practices led job satisfaction while 39.7% disagreed and 7.4% were
undecided.
70
In addition, results from interview show that work life balance programs had been
used as employee retention strategy by the hospital. For example, one of the
respondent in DRRH reported that: ‘‘the hospital provides its employees with
flexible work schedule which enable them to attending their personal arrangements,
and this has been motivating many employees to continue working in the hospital’’.
I believe that there is no employee who will leave this hospital because of the work
life balance issues (Interview, 2020).
4.6.5 Good salary
The respondents were asked to indicate the influence of good salary on medical
workers retention. Competitive salary that organizations provide to the staffs play
vital role in boosting performance of employee, productivity and motivation and
thus the need to understand its influence on the retention of medical employee. The
findings are presented in the table 4.13.
Table 4.13: Good salary
Good salary
Disagree
(DA)
Undecide
d
Agree Tota
l (A)
No % No % No % No
Competitive salary package provided 38 55.
9 2 2.9 28
41.
2 68
Salary payment is based on employee’s efforts
and performance 36
52.
9 12
17.
6 20
29.
4 68
Provision of risk and on call allowances 26 38.
2 6 8.8 36
52.
9 68
Overtime and extra duty allowances offered 32 50.
0 2 2.9 34
47.
1 68
Good retirement benefits offered 24 44.
1 14
20.
6 30
35.
3 68
Source: field data (2020)
The findings revealed that 41.2% of the study participants agreed that competitive
salary package offered to employees while 55.9% disagreed and 2.9% were
undecided. The findings also revealed that 29.9% of the respondents agreed that that
salaries were paid on the basis of employee efforts and performance while 52.9%
disagreed and 17.6% of the respondents were undecided. Moreover, the findings
71
revealed that 52.9% of the respondents agreed that the organization provides risk
and on call allowances to employees while 38.2% disagreed and 8.8% were
undecided. It was noted that 47.1% of the respondents agreed that their organization
offer overtime and extra duty allowances while 50.0% disagreed and 2.9% were
undecided. Furthermore, 35.3% of the respondents agreed that the organization
provides good retirement benefits while 44.1% disagreed and 20.6% were
undecided. This imply that employees were dissatisfied with the amount of pay they
earned for their work, which demotivates their retention.
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CHAPTER FIVE
DISCUSSION OF THE FINDINGS
5.1 Introduction
This chapter addresses discussion of the study findings reported in chapter four. The
discussion is organised in accordance to the four specific objectives of the study
which include: to identify the causes of shortage of health workers; to determine the
existing strategies for retaining health workers; to evaluate the factors influencing
health workers to leave job or organization; and to examine factors influencing the
retention of health workers.
5.2 Causes of shortage of health workers at DRRH
This objective sought to identify the causes of shortage of staffs at Dodoma regional
referral hospital. As indicated in the previous chapter, mixed findings were found.
The study findings revealed that the major factor contributing to the shortage of
employees is lack of attraction and retention programs which recorded higher
percentage (74%). Other factors included low recruitment rates (66%),
unsatisfactory financial incentives (65%) and unpleasant working environment
(44%). This imply that the hospital does not have in place attraction strategies and it
seems that retention programs are poorly implemented. The findings were consistent
with previous studies, which found that lack of attraction strategies and poor
retention programs leads to staffing gaps in many organizations (Farooq et al, 2013;
Ojakaa et al, 2014).
The findings also revealed that shortage of staff at DRRH attributed by difficult
work environment. Similar findings were reported by Chankova et al, (2009) and
Das (2012) that most of employees leave their job or organization for better
opportunities due to the unconducive working environment. The findings implied
that the environment in which employees work could also be an incentive for
employee retention and reducing staffing gaps. Similarly, the findings indicated that
unsatisfactory financial incentives as one of the factor that contributing to a shortage
73
of employees because employees were not remunerated well. Studies shown that
offering poor salaries to employees influenced their mobility and result in personnel
gaps; as employees likely to move from one institution to another in search for
competitive or higher salaries.
Other factors were identified were lack of professional development opportunities
(49%), and low recruitment and retrenchment due to the fake certificate of education
(66%). In addition, interview findings showed that freezing recruitment by the
government is largely contributing to a shortage of staffs in the hospital. The results
found to be consistent with the earlier studies such as Munga (2009) and Masangu et
al (2013) who reported that the factors contributing to a shortage of employees are
low recruitment because of budget constraint and lack of training and development
opportunities.
Moreover, studies indicated that work life imbalance practices demotivate
employees to stay longer in their organization. However, it was surprising that the
work life imbalance has not been reported as a factor leading to staff shortages. The
findings were in tandem with Noor (2011) and Zhang (2013) who found that there is
no relationship between a flexible work schedule and employee turnover intention
between executive and middle level employees. However, The results contradicted
findings from earlier researches, such as Kroon and Freese (2013) who asserts that
work life imbalance are positively related to personnel shortages.
5.3The retention strategies available at DRRH
The second objective sought to analyze available retention strategies at DRRH so as
to understand whether the DRRH has the strategies for staff retention and those
strategies are well implemented. The findings showed that the hospital has improved
its working environment through the provision of work-related needs, including
clinical equipment, adequate work space and a good facility environment that is used
as a strategy for retaining employees. This findings were consistent with those of the
interview findings, for instance, one of the respondent in DRRH said that: ‘‘The
working environment at Dodoma regional referral hospital is conducive and
74
attractive. We have rehabilitated some of the hospital buildings and we plan to build
houses for our doctors and nurses. I believe that there are no staff who will leave the
hospital due to a poor working environment’’.
This means that the hospital has successful improved its working environment
which motivate employees to stay working with the organization. This findings
concurred with the previous studies; for example, Shoaib et al (2009) and Shemdoe
et al (2016) who reported that conducive working environment aspects such as
adequate working tools, sufficient working space served as an incentives for
retention of employees.
The findings also revealed that the organization offers career development
opportunities to its employees, especially doctors, nurses and other medical
employees. As mentioned in the interview: ‘‘the hospital offers various
opportunities of refresher courses and long-term training to its employees that are
relevant to their responsibilities and most of the staffs have been satisfied with the
training’’. These findings concurred with that of Ojakaa et al (2014) who reported
that in order for organization to be able to retain its staff for longer period of time, it
is crucial for that organization to invest on training and career development
programmes.
The results showed that the majority 59% of the respondents were of the view that
they were paid uncompetitive salary. The interview results also revealed that low
salaries demotivate employees to stay working with the hospital. For instance, one
of the respondent reported that: ‘‘our staffs are well compensated, although they
complain about salary that is not sufficient compared to other organizations such as
Tanzania revenue authority (TRA) and Bank of Tanzania (BOT), where their
employees are paid better salaries than doctors’’. The results are consistent with the
earlier studies such as Mullei et al (2010) and Shemdoe et al (2016) who said that
inadequate salary and other financial incentives such as hardship allowance can be a
source of discouragement for retention of staffs.
75
The findings revealed that work life balance programs which recorded higher
percentage (62%) as the major strategy used by the hospital in retaining its
employees. This results are consistent with the interview findings which revealed
that flexible working schedule has been used by the hospital in retaining its staffs.
For example, one of the respondent in DRRH said that: ‘‘We have provided flexible
working hours and shift to staffs to enable them balancing their job and personal
responsibilities which increase comforts of working with the hospital for a long
period’’.
The findings also correspond to the results of the previous studies such as Kroon and
Freese (2013) who asserts that work life balance programs are positively influencing
personnel retention. This means that if employees unable to successfully handle
family and work roles due to a work life imbalance, it may have negative effects on
their retention. Therefore ,it is important that organizations to track and monitor the
work life balance issues encountered by employees on a regular basis, and take
corrective action in good time.
As discussed in the literature, good leadership style plays a very important role in
employee retention. The results revealed that 56% of the respondents were pleased
with the supervision and leadership style. The majority of the respondents reported
that the style used by supervisors and leaders in a work place were good and this is
the reason for staying. These results imply that good supervisory and leadership
style is one of the strategies used by DRRH in retaining its employees. This supports
the previous argument that leaders and supervisors have an important role to play in
staff retention. The results also are consistent with the previous studies such as Pang
et al (2002) and Dovlo (2004) who found that good leadership style influence
employees’ decision to continue working in the organization.
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5.4 Factors influencing employees to leave job at DRRH
The third specific objective of the study was to evaluate the factors that influence
health workers to leave employment at Dodoma regional referral hospital. The
findings revealed that poor management and supervisory style had a strong influence
on employees leaving work or moving to another organization, as a majority of 60%
agreed that poor leadership styles could play avitalrole in increasing the mobility of
staffs and thus leave staff gaps in the organization. These findings imply that the
leadership aspect plays a very important role in promoting the retention of
employees and that, if an organization wishes to continue improving the retention of
its employees, it should make serious use of an effective style of leadership. This
result, supports the findings of the earlier studies such as Rubin et al (2005) and
Samuel et al (2009), argued that leadership style was found to be a very important in
the establishment employee’s retention.
The results indicated that 57% of the respondents did not agree that provision of
poor flexible working hours by the hospital was one of the key reasons why medical
staffs left for work elsewhere. This indicates that the decision’ employee to leave is
motivated not by flexible working hours, but other factors. However, the results
contradict with the results of the previous researches such as Kinyili’s (2015) assets
that offer poor flexible work schedules to employees are significantly related to the
turnover of employees. It can be seen from recent literature that work life balances
aspects such as good flexible working hours have become a good driver of the
positive behavior of employees, include staying with the organization for a longer
period of time.
Moreover, the results revealed that majority of the respondents agreed that poor
working conditions in the hospital strongly influence employees to left employment.
This means that poor working environment has a significant contribution on the
decision of the staffs to left employment. However, this result concurs with the
earlier studies such as Kwenin et al (2013), asserts that a favourable work
environment in the workplace makes staffs more pleased to remain in the
77
organization. Similarly, Willis-Shattuck et al (2008) observed that work
environment components such as adequate working tools are necessary to influence
the intention of health personnel to stay. They also described the organization's
infrastructure, such as the availability of medical equipment, as important
motivating factors for medical staff, which positively influencing personnel to
remain working with the organization.
Also, the findings revealed that 74% of the respondents were of the opinion that
provision of low salaries to employees by the organization was one of the primary
reasons why medical personnel left for employment elsewhere. The results imply
that the majority of respondents were not satisfied with the salary they received for
their work compared to those of their friends outside the organization and this
influence them to left employment. The findings are consistent with those of the
previous studies such as Chikanda (2005) and Chankova (2009) who found that
financial incentives such as competitive salary were an important aspect in the
employee retention.
It was also noted that 50 % of the respondents agreed that lack of professional
development and continuing education was one of the reasons for employees leaving
to work elsewhere. The results suggest that when employees are not satisfied with
the training practices and development opportunities offered by the organization,
they tend to leave work or move to another organization offering good training
practices. As discussed in the literature, professional development through seminars
and short courses for workers, is critical as it gives them a forum for sharing ideas
and keeping up with current trends in their field, and this influences their retention.
The results also agree with those from earlier studies such as Samuel et al ( 2009)
and Sandhya (2011), found that lack of training and development opportunities
significantly motivated workers to leave.
Furthermore, the results showed that poor interpersonal relationship influenced
employees to leave work as the majority 56% of respondents accepted that the
78
presence of unsatisfactory interpersonal relationship within the organization
substantially influenced employees to leave work. This implies that it is important
for organizations to maintain good interpersonal relationships in order to discourage
employees from leaving work or moving to another organization due to poor
interpersonal problems.The findings also agree with those from earlier studies such
as Sikika (2010) and Sirili et al (2013), which found that poor interpersonal
relationship plays an important role in influencing employees to left employment.
5.5 Factors influencing the retention of employees at DRRH
The fourth specific objective was to examine factors influencing the retention of
health workers at Dodoma regional referral hospital (DRRH). It analyzed the
following aspects, work environment, career development opportunities, leadership
style, work-life balance practices and good salary to understand its influence on the
employee retention.
5.5.1 Work environment
The findings of the study indicate that working environment aspects such as
adequate available of medical supplies and equipment, good working relationships
between subordinates and management, adequate availability of protective gears,
sufficient work space for employees to work efficiently and effectively, and support
by supervisors, administration and colleagues were found to be adequately
influencing employee retention. The results are consistent with the studies conducted
byKwenin et al (2013) and Willis-Shattuck et al (2008) which suggested that a
favourable working environment such as adequate work facilities and sufficient
drugs plays a significant role in retaining health personnel in public health hospitals.
[
As commented by one of the respondents at DRRH reported that: The working
environment at Dodoma regional referral hospital is conducive and attractive. We
have rehabilitated some of the hospital buildings and we plan to build houses for
our doctors and nurses. I believe that there are no staff who will leave the hospital
due to a poor working environment’’. These statements suggest that there is some
kind of relationship between the aspects of the work environment and job
79
satisfaction at the workplace that ultimately influence retention of employees.
However, the findings are in line with Herzberg's dual factor theory which suggests
that, although hygiene aspects do not motivate employees, this does not mean that
staffs do not consider them. As a result, staffs who perceive they work under
unpleasant work environment tend to leave an organization.
5.5.2 Career development opportunities
The results revealed that career growth opportunities at DRRH influence staffs
retention, whereas the majority of the study participants agreed that there is a good
training policy, sufficient availability of training opportunities, presence of regular
career counseling, presence of tuition payment reimbursement policy, and provision
of study leaves with pay for professional development. The results have shown that
career growth plays an important role in the retention of staff.As shown in the
qualitative findings, the organization provides its staff with a variety of training
opportunities: as one of the respondents from DRRH said: ‘‘the hospital offers its
staff various opportunities for refresher courses and long-term training. The
training is relevant to their responsibilities and most of the staffs have been satisfied
with the trainings” (Interview, 2020).These statements mean that staffs were pleased
satisfied with the organization's career development programs.
The findings showed that most respondents had the perception that career
advancement was a strong driving factor in retention of employees. Career
advancement as an intrinsic factor according to Herzberg’s two factor, plays a very
important role in employee retention as it provides opportunities to workers to
develop within the organization in terms of knowledge, skills, abilities, and
experience. It is seen as motivating factor because employees expect to advance in
terms of promotion in order to be able to master their activities and gain status at the
workplace rather than stagnate in their positions. However, the findings are
consistent with earlier studies such as Dieleman et al (2003); Dolvo (2005) and Das
et al (2012), found that career development increases retention and commitment to
employees to stay. From the results, it can be concluded that career development to
80
the medical staffs influenced their retention since career development exist in the
hospital.
5.5.3Leadership style
The study sought to establish the influence of leadership style on health workers
retention. The results revealed that the style of leadership influenced the health staffs
to remain working in an organization as the majority of employees agreed that they
were allowed to participate in decision-making, leaders encouraged goods working
relationships amongst staffs, provided mentoring and counseling to employees,
understood the job challenge of subordinates and gave them encouragement and
assistance, and were able to carry out work under their supervision. This means that
employees preferred a more participatory leadership style, involves staff in decision-
making and regularly communicates practices.
However, the findings are consistent with earlier studies such as Keller (1992);
Judge et al (2000); and Keenam (2015) which found leadership style to be an
effective strategy for personnel retention. Researches have shown that employees in
rural areas by having supportive management and good leadership were motivated
well and kept working with the organization despite hard working condition and
low financial incentives. Samuel et al (2009), noted that improving the relationship
between managers and subordinates encourages the retention of employees. Garcia-
Morales et al (2008) revealed that workers frequently leave leaders not organisation
in a sense that workers prefer leaders who addresses concerns of their welfare.
5.5.4 Work life balance practices
Literature revealed that the existence of work life balance programs such as flexible
working hours within the organization contributes a lot in the retention of
employees. The results indicate that work life balance programs influenced health
employee retention as majority of study participants agreed that there are health
programme for self and dependents; reduce job stress because employees working
flexibly; reduce conflict with family activities and family members; available
adequate time for recreational activities and increases job satisfaction at the work.
81
As commented by one of the respondents from DRRH that: ‘The hospital provides
its employees with flexible work schedule which enable them to attending their
personal arrangements, and this has been motivating many employees to continue
working in the hospital’’. I believe that there are not employee who will leave this
hospital because of the work life balance issues (Interview, 2020)’’.These statements
suggest that employees are pleased with the work-life balance programs
implemented by the organization, which ultimately influence their retention.The
results are consistent with previous studies such as Padarath (2003) and Ogilvie
(2007) assets that better work life balance practices enhance the level of job
satisfaction and reduce turnover of staffs.
5.5.5 Good salary
The respondents were asked to indicate the influence of good salary on employee
retention. Studies show that rewarding employees with sufficient salaries and
allowances influencing employee retention (WHO, 2006). As pinpointed by
Ramlall (2004) and Radivoev (2005) that improving employee retention requires the
provision of good financial rewards that make employees see alternative work as
less attractive. The results show that the salary was not paid on the basis of
employee’s efforts and performance; the salary was not competitive to motivate
retention; overtimeand good retirement benefits were not provided to employees. It
was further noted that the minority of the respondents consented that the
organization provides employees with risk and on call allowances. The results
suggest that there are inadequate salaries and unequal payment of employees, which
greatly discourages them from staying.
According to Herzberg's two-factor theory, salary is an important hygiene factor that
encourages employees to perform well because of the level of satisfaction with
payment which in turn leads to retention. Despite the high value attached to salaries,
the study found that majority of employees felt that salaries and other incentives
such as risk and on call allowances were inadequate and inequitable compared to
other organizations such as TRA and BOT. As commented by one of the
82
respondents from DRRH that: ‘‘our employees are well compensated, although they
complain about salary that is not sufficient compared to other organizations such as
Bank of Tanzania (BOT), where their employees are compensated better salaries
than doctors’’.
Perceived inadequate salaries and unequal payment of employees in public hospitals
adversely affected the motivation of employees to stay. The results reflect the
findings of the study conducted by WHO (2006) and Ndetei et al (2008), which
indicated that low salaries and inequitable payment in public hospitals had a
negative relationship with retention of workers.It can be inferred fromthe study that
a good salary did not influence the retention of employees as theywere not
compensated well, offered competitive salaries and good retirement benefits.
83
CHAPTER SIX
SUMMARY, CONCLUSION AND IMPLICATIONS
6.1 Introduction
The purpose of this chapter is to present summary and conclusion on the study. This
chapter also provides recommendations for appropriate measures to be used with
regard to retention of employees. Similarly, it highlights policy implications and
limitations of the study. Lastly, outlines areas for future research.
6.2 Summary of the study
Thestudy investigated the factors influencing personnel retention in Tanzania health
sector. Four specific objectives and four research questions were developed to guide
the study. The existing gap from various interventions for responding staff shortages
in hospitals has prompted the search for factors that influencing personnel retention
in the public health sector in Tanzanian. Literature on retention of employees has
been reviewed. The conceptual framework of the studywas developed from the
reviewed theoretical and empirical literatures.
A case study research design and mixed-methods design (qualitative and
quantitative methods) was used to best understand the phenomenon of employee
retention. The study population was medical employees from Dodoma regional
referral hospital (DRRH) who were chosen through stratified sampling, simple
random sampling and purposive sampling. Data were gathered from both primary
and secondary sources. The study used qualitative and quantitative data gathering
instruments (interview guide and questionnaires) to collect data. The data collected
further processed, analysed and presented in tables and figures. However, the
summary of the study is presented on the basis of the four specific objectives of the
study as shown below.
84
6.2.1 Causes of staff shortages at DRRH
Good attraction and retention programs play an important role in personnel retention
(WHO, 2006).The results revealed that the majority of the respondents had
perceptions that the retention programs was inadequate implemented which caused
dissatisfaction of staffs to continue working in the organization, and results in
staffing gap. As (2012) pointed out good working conditions can be incentive for
employee retention and strategy for reducing staffing gaps. The findings of the study
however revealed that the working environment of the organization is unpleasant
which demotivate employees to remain in their workplace and results in shortage of
staffs.
Literature documents that offering competitive salary to employees motivate them to
remain in their place of work. This study found that unsatisfactory financial
incentives as one of the factor that contributing to a shortage of employees because
employees were not remunerated well. Ndetei et al (2008) commented that
perceived low salaries and unequal payment of employees negatively affected
employee motivation to stay in their workplace.
Other factors were identified are lack of professional development opportunities, and
low recruitment and retrenchment due to the fake certificate of education. Munga
(2009) and Masangu et al (2013) identified the factors contributing to a shortage of
employees are low recruitment because of budget constraint and lack of training and
development opportunities. Studies indicate that work life imbalance practices
demotivate employees to stay in their organization. However, it is surprising that the
work life imbalance has not been reported as a factor leading to staff shortages. The
findings contradict the results of the earlier studies, for example, Kroon and Freese
(2013) who asserts that work life imbalance practices are strongly associated with
staff shortages.
85
6.2.2 Existing strategies for employee retention at DRRH
Studies revealed that pleasant working environment enhances job satisfaction and
motivate staffs to remain in their organization. The study observed that good
working environment, is one of the strategies used by DRRH in retaining its
staffsAlso, the study found that the organization offers career development chances
to its staffs as retention strategy. Ojakaa et al (2014) mentioned that in order for
organization to be able to retain its staff for longer, it is crucial for that organization
to invest on training and career development.
Moreover, the study found that work life balance and good leadership style are other
strategies used by the DRRH in retaining its employees. As discussed in the
literature, good leadership style plays a very important role in staff retention. The
results of this study indicated that 56% of the respondents were satisfied with the
supervision and leadership style.Mullei et al (2010) and Shemdoe et al (2016) who
reported that inadequate salary and other financial incentives such as hardship
allowance can be a source of discouragement for retention of employees. The results
showed that the majority 59% of the respondents were of the view that they were
paid uncompetitive salary, and therefore this retention strategy was not in place.
6.2.3 Factors influencing employees to leave job at DRRH
The findings revealed that poor management and supervisory style had a strong
influence on employees leaving work or moving to another organization, as a
majority of 60% agreed that poor leadership styles could play vital role in increasing
mobility of staffs and thus leave staff gaps in the organization. The results also
indicated that 57% of the respondents did not agree that provision of poor flexible
working hours by the hospital was one of the key reasons why medical staffs left for
work elsewhere. This indicates that the decision’ employee to leave is motivated not
by poor flexible working hours, but other factors such as poor leadership style.
Moreover, the results revealed that majority of the respondents agreed that the poor
working conditions in the hospital strongly influence employees to left employment.
This means that poor working environment has an important contribution on the
86
decision of the employees to left employment. Also, the findings revealed that 74%
of the respondents were of the opinion that provision of low salaries to employees
by the organization was one of the primary reasons why medical personnel left for
employment elsewhere. The results imply that the majority of respondents were not
satisfied with the salary they received for their work compared to those of their
friends outside the organization and this influence them to left employment. It was
also noted that 50 % of the respondents agreed that lack of professional development
and continuing education was one of the reasons for employees leaving to work
elsewhere.
Furthermore, the results showed that poor interpersonal relationship influenced
employees to leave work as the majority 56% of respondents accepted that the
presence of unsatisfactory interpersonal relationship within the organization
substantially influenced employees to leave work. This implies that it is important
for organizations to maintain good interpersonal relationships in order to discourage
employees from leaving work or moving to another organization due to poor
interpersonal problems. The findings also agree with those from earlier studies such
as Sikika (2010) and Sirili et al (2013), which found that poor interpersonal
relationship plays a significant role in motivating staffs to left employment.
6.2.4 Factors influencing employee retention at DRRH
The findings of the study indicated that working environment aspects such as
adequate available of medical supplies and equipment, good working relationships
between subordinates and management, adequate availability of protective gears,
sufficient work space for employees to work efficiently and effectively, were found
to be adequately influencing personnel retention. The results also revealed that
career development opportunities at DRRH influence employee retention, whereas
the majority of the respondents agreed that there is a good training policy, sufficient
availability of training opportunities, presence of regular career counselling,
presence of tuition payment reimbursement policy, and provision of paid study
leaves for professional development.
87
Career advancement as an intrinsic factor according to Herzberg’s two factor, the
findings showed that career advancement was a strong driving factor in retention of
employees. The results of the study revealed that leadership style influenced the
retention of employees as the majority of employees agreed that they were allowed
to participate in decision-making, leaders encouraged goods working relationships
amongst staffs, understood the job challenge of subordinates and gave them
encouragement and assistance. The results also indicated that work life balance
influenced health personnel retention as the majority of the respondents agreed that
there are health programme for self and dependents; reduce job stress because
employees working flexibly; reduce conflict with family activities and family
members; available adequate time for recreational activities and increases job
satisfaction at the work.
According to Herzberg's two-factor theory, salary is an important hygiene factor that
encourages employees to perform well because of the level of satisfaction with
payment which in turn leads to retention.The perceived poor salary has a significant
influence on outcomes such as turnover, low commitment, and job dissatisfaction
(Appelbaum, 2005; Lunenburg, 2011).The study found that majority of employees
felt that salaries and other incentives such as overtime and extra duty allowances
were inadequate compared to other organizations such asBank of Tanzania (BOT)
and Tanzania Revenue Authority (TRA).
6.3 Conclusion
The determinants of shortages and retention of medical personnel in the health
sector in Tanzania are not well known (MoHSW, 2013). However, this study found
that the causes of shortage of staffs in some health Centre were low recruitment due
to budgetary constraints, retrenchment which were done due to fake certificate of
education, unpleasant working environment that induces employees to move from
employer to another, lack of attraction and retention programs, poor management
and supervisory style, low salaries, lack of professional development and poor
interpersonal relationship.
88
Moreover, this study revealed that friendly working environment, career growth
opportunities, good leadership style and work-life balance programs are very critical
in bringing about intentions to remain within the organization and employers have to
be very conscious of them. It can be concluded from the above that the effective and
efficient implementation of these best human resource management practices can
lead to a reduction in staff turnover or enhance the retention of staff within the
organization.
6.4Recommendations
The following are the recommendations made by the researcher based on the results
of thestudy. Results from this study revealed that health workers are leaving
employment because of poor working environment and insufficient work facilities.
An organization should therefore prioritize the rehabilitation and development of
work infrastructure, such as the provision of adequate working tools and facilities,
accommodation and ensure adequate physical space for efficient work operations to
reduce work-related stress.
Another critical policy recommendation to the DRRH and policy makers to improve
personnel retention in public health hospitals is focused on the development of
attraction and retention interventions. Evidence from this study has shown that
healthcare facilities face difficulties in attracting and retaining staff, as a
consequence, experiencing an acute shortage of staffs.
Another field recommended for improvement is compensation packages with a view
to improving retention of personnel. Despite the high value of salaries, this study
found that the majority of employees felt that salaries and other incentives, such as
risk and call allowances, were inadequate and inequitable compared to other
organizations. Therefore, the DRRH should upgrade and provide good compensation
packages such as competitive salaries to its employees as a retention strategy.
89
It is also recommended that the DRRH to invest in leadership development
programs for the purpose of developing leadership and supervisory style skills for its
leaders as the study revealed that good leadership style is positively linked to
retention of employees.
6.5Implications
6.5.1Theoretical implications
The research variables examined in this study were developed based on aspects of
Herzberg's dual theory (1959) and expectancy theory by Vroom (1964). From
Herzberg’s dual theory perspective, the study found that the external components
such as work environment, style of leadership and work life balance programs have
an important role to play in the retention of personnel. The study also found that the
motivation and retention of medical workers is more reliant on the fulfillment of
external factors than on intrinsic factors, which also contrast with Herzberg's (1959)
findings that the fulfillment of extrinsic factors does not make employees motivated
as well as satisfied in the workplace. It can therefore be confirmed in this study that
work environment, leadership and work-life balance programs are not only hygiene
components, as Herzberg put it, but an overall motivating factor for personnel
retention. This study has broadened the understanding of employee retention
problem and contributed new insights to the theoretical contribution by
acknowledging that there are two types of needs for workers that motivate them and
that both needs should be addressed and viewed as an effective retention strategy.
Expectancy theory developed by Vroom (1964) revealed that rewards such as salary
should be based on employees’ efforts and performance they put at work in order to
motivate them remain working in the organization for a long period of time.
However, Vroom considered valance to be the most significant motivator factor and
positively related to employee retention. The findings revealed that a majority 52.9%
of the respondents disagreed that salaries were not paid on the basis of employee’s
efforts and performance, while 29.9% agreed and the remaining 17.6% of
respondents were undecided. As noted in this study, factors such as work
90
environment, leadership style, career growth and work life balance programs have a
significant influence on personnel retention.
However, the salary factors reward found to be negatively influencing staff as
employees were not well compensated, which is also deviates from Vroom’s
expectancy theory (1964) which considered rewards such as salaries(valance
factor)as the most significant motivating driver and positively associated with
employees’ retention. This suggests that retention of staffs is influenced by factors
other than remuneration (such as work environment, style of leadership as well as
work life balance programs).This has added knowledge to the theoretical
contribution in that it recognizes that retention of staffs is not influenced by a single
factor, such as rewards, as Vroom (1964) argued, but rather by different factors.
Similarly, this has bridged the gap noted in the literature regarding unidimensional,
as argued by Ng’ethe (2013) and the multidimensionality of Kinyili (2015) on
employee retention variables, which contributed to inconsistencies in literature.
Another contribution of this study, based on the conceptual framework, is that it has
provided new insights into the relationship between the independents variables such
as work environment, career development, leadership style, work life balance
practices, remuneration and retention of staffs as dependent variable. As found in
this study, the independents variables such as work environment, career
development, leadership style, work life balance programs are positively influence
personnel retention. Surprisingly, remuneration found to be negatively influencing
staff retention as a majority 55.9% of the respondents disagreed that they were not
well compensated, and therefore did not see salary as motivating them to remain in
their place of work.
6.5.1Policy implications to the study
The main priorities of the HRH Strategic Plan 2014-2019 were to reduce workforce
shortages from 52% in 2014 to 30% in 2019; and to ensure that 70% of employees
posted to districts are retained in the health sector. However, this study revealed that
health care facilities face difficulties in attracting and retaining staff, as a
91
consequence, experiencing an acute shortage of staffs. The results of this study
indicate the need to establish a national employee attraction and retention policy that
is reflects the nature of work to address the health workers crisis in the health field
in Tanzania. This will also contribute a lot to the attainment of some targets of the
HRH Health Strategic Plan 2014-2019; sustainable development goals (SDGs)
specifically goal no.3; and Tanzania development vision 2025.
6.6 Limitations of the study
The study merely investigated the role of work environment, career growth
programs, leadership style, work life balance programs and competitive salary and
their influence on employee retention. The study did not take into account certain
aspects of employee retention, like job security, promotion, recognition and
organization policies. The scope of the study left out the private health sector; the
whole sample was taken from the public institution. This means that the research
results cannot be generalized employees in the private sector.
6.7 Suggestions for areas for further research
Similar studies should be carried out in the private sector to determine the factors
that influence the retention of health workers and to identify retention strategies
established and adopted by health facilities in the private sector in order to learn how
these strategies are implemented within the working environment of the organization
dynamics. It is also suggested that future studies on retention of employees should
be carried out by considering other aspects of retention of employees left out in this
study so as to have a broader understanding of the factors that account for staff
retention in the health field. Furthermore, the study was carried out from a single
institution and, since different institutions have diverse cultures and philosophies,
these results cannot represent the whole health sector in Tanzania, as far as retention
of employees is concerned. Therefore, future studies should gather data from
multiple cases in order to have a broader picture of the issue of personnel retention
in the public health sector.
92
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APPENDICES
Appendix 1: Quantitative study measurement instrument
Cover letter for the questionnaire
Steven Daniel,
Administrative studies,
Mzumbe University, Dar es Salaam Campus College,
P.O.Box 950,
Tel: +255 743 989 736,
E-mail Address: [email protected]
Dear Participant
Re: Application to participate in research
I am a postgraduate student at the University of Mzumbe, Dar es Salaam Campus
College, Tanzania and I am currently doing research into retention of staff. The title
of the research is: An assessment on the factors influencing employee retention in
Tanzania’s health sector: A case of Dodoma regional referral hospital. The
Administrative Studies, University of Mzumbe, fully endorsed this research.
Employee retention is an important aspect in the health sector for the better health
services delivery to Tanzanians. Therefore, this study aims to find out the factors
influencing employee retention in Tanzania health sector. The research findings will
benefit both the Dodoma region referral hospital and the country as a whole in the
provisionof health services, astheresultsfrom this research will help in the
establishment of an effective health personnel retention programme in the health
filed.
Therefore, I would like to invite you to take part in the research. The questionnaire
requires 30 minutes to be completed. Sharing your knowledge, views and experience
by responding the questionnaire will be useful to me. All information you provide
will remain confidential between you and myself. If you have any queries or
concerns, do not hesitate contact me using my mobile number provided above.
Alternatively, you can contact Mzumbe University, Dar es Salaam Campus College
on +255 689 455 588.
I thank you for your cooperation,
Kind regards,
S. Daniel
10 May, 2020
104
QUESTIONNAIRE:
This questionnaire has five sections. Please respond to each item in all sections.
Section 1: Questions on demographic characteristics of the respondents
This section involve questions about demographic characteristics of the respondents.
Please answer the questions in the spaces given by putting a tick mark (√) in the box
that matches your answer.
1. What is your sex?
a) Male ( ) b) Female ( )
2. What is your job cadre?
a) Doctor ( ) b) Nurse ( )
c) Midwife ( ) d) Pharmacist ( )
e) Laboratory technician ( )
3. What is your age group?
a) Under 30 ( ) b) 31 to 40 ( )
c) 41 to 50 ( ) d) 51 to 60 ( )
4. What is your highest level of education?
a) Certificate ( ) b) Diploma ( )
c) Advanced Diploma ( ) d) Bachelor’s degree ( )
e) Master’s degree ( ) f) PhD ( )
5. How long have you been working with Dodoma regional referral Hospital?
a) Less than 5 years ( ) b) 5 to 10 years ( )
c) 10 to 15 years ( ) d) 16 years and above ( )
105
Section II: The causes of shortage of health staffs at Dodoma regional referral
hospital.
This section aims to find out the major causes of shortage of health employees at
Dodoma regional referral hospital. The following set of statements relates to causes
of shortage of health employees. Please indicate the degree of agreement or
disagreement with each item on a five-point scale: strongly disagree (SDA)-1,
disagree (DA)-2, neutral (N)-3, Agree (A)-4, or strongly agree (SA)-5. Please put
tick mark (√) where is appropriate.
Statements
Responses
Strongly
disagree
Disagree Neutral
Agree
Strongly
agree
1 2 3 4 5
Lack attraction and retention
programs within the
organization
Difficult work environment
staff face while in a work
place
Unsatisfactory financial
incentives for health
professionals
Lack of opportunities for
professional development
Presence of work life
imbalance practices
Low rate recruitment and
retrenchment due to the fake
certificates
106
Section III: Retention strategies available at Dodoma regional referral hospital.
This section aims to identify the strategies used by Dodoma regional referral hospital
for retention of its medical employees. The following set of statements relates to
employee retention strategies. Please indicate the degree of agreement or
disagreement with each item on a five-point scale: strongly disagree (SDA)-1,
disagree (DA)-2, neutral (N)-3, Agree (A)-4, or strongly agree (SA)-5. Please put
tick mark (√) where is appropriate.
Statements
Responses
Strongly
disagree
Disagree Neutral
Agree
Strongly
agree
1 2 3 4 5
Improved hospital
environment with good
working tools and equipment
Career development
opportunities offered
Work life balances practices
implemented
Competitive salary package
offered
Good supervisory and
leadership style applied in a
work place
107
Section IV: Factors influencing health employees to leave job/relocate to other
organization (exit analysis).
This section focus on employees exit analysis for identifying the factors influencing
health employees to leave employment at Dodoma regional referral hospital. The
following set of statements relates to factors influencing employees to leave
employment. Please indicate the degree of agreement or disagreement with each item
on a five-point scale: strongly disagree (SDA)-1, disagree (DA)-2, neutral (N)-3,
Agree (A)-4, or strongly agree (SA)-5. Please put tick mark (√) where is appropriate.
Statements
Responses
Strongly
disagree
Disagree Neutral
Agree
Strongly
agree
1 2 3 4 5
Poor management and
supervisory style
Poor flexible working hours
due to the absence of work
life balance programs
Unconducive working
environment
Poor financial incentives such
as low remuneration
Lack of professional
development and continuing
education
Existing of poor interpersonal
relationship in the work place
108
Section V: Factors influencing employee retention at Dodoma regional referral
hospital. (Retention analysis).
This section focus on determine factors for employee retention. To what extent do
the following aspects of the job retention factors influence you to continue working
in the Dodoma regional referral hospital?.Please indicate the degree of agreement or
disagreement with each item on a five-point scale: strongly disagree (SDA)-1,
disagree (DA)-2, neutral (N)-3, Agree (A)-4, or strongly agree (SA)-5. Please put
tick mark (√) where is appropriate.
Statements
Responses
Strongly
disagree
Disagree Neutral
Agree
Strongly
agree
Work environment 1 2 3 4 5
Adequate available of medical
supplies and equipment
Presence of good working
relationships between
subordinates and management
Adequate availability of
protective gears
Employees have ample work
space to function efficiently
and effectively
Support by supervisors,
administration and colleagues
Statements
Responses
Strongly
disagree
Disagree Neutral
Agree
Strongly
agree
Career development
opportunities
1 2 3 4 5
Available a good training
policy
109
Sufficient availability of
training chances
Presence of regular career
counselling
Presence of tuition payment
reimbursement policy
Provision of study leaves with
pay for professional
development
Statements
Responses
Strongly
disagree
Disagree Neutral
Agree
Strongly
agree
Leadership style 1 2 3 4 5
Employees are encouraged to
engage in decision taking
Encourage good work
relationship
Mentoring and advice
employees on the job
Supervisor can understand my
job challenges and give me
encouragement and assistance
I can do my job under the
supervision of my supervisor.
Statements
Responses
Strongly
disagree
Disagree Neutral
Agree
Strongly
agree
Work life balance practices 1 2 3 4 5
110
Availability health
programme for self and
dependents
Reduce job stress because
employees working flexibly
Reduce conflict with family
activities and family members
Ample time for recreational
activities
Good job satisfaction at the
work place
Statements
Responses
Strongly
disagree
Disagree Neutral
Agree
Strongly
agree
Good salary 1 2 3 4 5
Competitive salary package
provided
Salary payment is based on
employee’s efforts and
performance
Provision of risk and on call
allowances
Overtime and extra duty
allowances offered
Good retirement benefits
offered
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Appendix 2: Qualitative study measurement instrument (interview guide)
Re: Consent agreement for the interview
I am a Postgraduate student at Mzumbe University, Dar es Salaam Campus College –
Administrative studies, and I am presently conducting research on employee
retention. The research title is: The factors influencing employee retention in
Tanzania’s health sector: A case of Dodoma regional referral hospital. You can
help in this research by consenting to complete an interview. As a participant you
will be asked to express your perception and opinion on the present employee
retention strategies in an organization and to identify the key factors influencing
retention in the work place.
Therefore, I would like to invite you to take part in the research. Your participation is
voluntarily, and all information you provide in this study will remain confidential.
However, the research data gathered for this research may be published, provided
that neither your organization nor you are identified. If you have any queries or
concerns, do not hesitate contact me using my mobile number: +255 743 989 736.
You may also contact Mzumbe University, Dar es Salaam Campus College on +255
689 455 588.
If you are willing to participate in this research, could you please complete the details
provided below:-
Name of participant: ………………………………….................................................
Signature: ……………………………………….. Date: …………………………
Researcher: ……………………………………..........................................................
Signature: ………………………………………. Date: ………………………
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Interview questions
1. May you give me your demographic information aboutsex, jobs, age, and
education level, please?
2. How long have you been working with Dodoma regional referral Hospital?
3. What kind of strategies have been implemented in your organization to enhance
health personnel retention?
4. What is the required number of health workers in your organization as per
population ratio recommended standard by World health organization?
5. What is the current number of health workers per cadres and specialization in
your organization?
6. What is the current deficit number of health workers in your organization?
7. What do you think are the factors that lead to the shortage of health workers in
your organization?
8. What do you think are the factors influencing health workers leave job/shift to
another organizations?
9. What are the factors influencing health workers to stay and working within your
organization?
10. What do you think should be done so as to retain health staffs within your
organization?
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Appendix 3: Introduction letter
114
Appendix 4: Research acceptance letter