In recent years, the Tanzanian health care system has suffered from a declining work ethic. The poor motivation of the health workers compromises health care services. The MAP-project, a joint effort by CMI, NIMR, REPOA, the University of Bergen and Bergen University College, shows that patients in the Morogoro and Dodoma regions of Tanzania, systematically receive health services below required levels.

However, administered tests indicate that the level of knowledge amongst the health workers is much higher than their practice suggest. Is it possible to close the gap between the health workers’ knowledge and their performance in real-life situations?

Boosting self-confidence
According to Ottar Mæstad, director and senior researcher at the CMI, there are at least three strategies that may increase health worker motivation inTanzania.  Firstly, the health workers need to believe that their work is important.

-There is a need for a stronger professional ethic amongst health workers. Building this ethic has to be an integrated part of the educational system. Teachers need to highlight the significance of good health care and to show how important qualified and motivated health workers are to the community, says Mæstad.

Secondly, health workers need to be recognized for their performance, by leaders, colleagues and the community as a whole. Better mentoring and supervision are alternatives that could inspire them to do a better job. More than 50 % of Tanzanian health workers perform their examinations of patients without getting any feedback from supervisors or leaders.

Paying to keep up the good work
Some of the clinicians in the MAP-project said that low motivation could be explained by low salaries. Pay for performance-strategies might also have a positive effect, and would be economically feasible in the Tanzanian health sector, according to Mæstad.

Rwanda is one of the countries that have been successful in implementing a pay for performance-strategy. The effects of using a pay for performance-strategy in a country like Tanzania are, however, uncertain. Rwanda is a small country with short travelling distances, and the Rwandan government has made huge efforts to improve health services. It’s not possible to compare Rwanda to Tanzania, neither is better payment guaranteed to improve motivation.