NAVIGATING HEALTH SERVICE DELIVERY IN

TANZANIA LOCAL GOVERNMENT

AUTHORITIES AMIDST WORKFORCE
SHORTAGE.
A case of Ilala Municipal Council.

FAYE ALPHONCE ASSENGA

(2022-06-02006)

DEPARTMENT OF POLITICAL SCIENCE AND

PUBLIC ADMINISTRATION, UNIVERSITY OF DAR
ES SALAAM.

MASTER OF ARTS IN PUBLIC ADMINISTRATION

(MAPA).

DR. MAKULILO
1.1. Introduction
The public service is a highly important organ in any
government. For a country to achieve high standards in
terms of public service delivery, it must have an effective
public service which is well nurtured by the government
authorities. The health sector in Tanzania is one of the
primary public services that are delivered to the
people. Health is generally a very delicate matter and to
think that it is not effectively nor efficiently delivered in
many countries including Tanzania is a disgrace. Public
health centers in Tanzania, specifically the Amana hospital
in Dar es Salaam located in Ilala district faces an
unescapable shortage of workers. Multi-tasking is a good
quality in any worker but everything except God comes
with limits. Due to a limited number of staff, workers with
important roles tend to over multitask and as a result, their
original roles are poorly performed hence poor standards
of delivery of the health services.
One may ask, are there really no candidates who could fill
in theempty positions? What about rate of unemployment
in Tanzania? How can these two exist together, the
shortage of workers in local authorities and the plague of
unemployment? There is a missing piece and I ought to
find out what it is and the solutions to this mystery.
Background of the problem
Shortage of workers in LGAs has become a trend in
Tanzania. For many years, Local government
authorities have been facing an immense shortage of
workers compared to the demand. This is notable in
various sectors of public service delivery, especially in the
Public Health Sector where shortage of workers has
affected effective delivery of services
The Annual General Report of the Controller and Auditor
General on the audit of Local Government Authorities for
the financial year 2018/19 provided that there is a
continued decline in staffing level whereby in 185 assessed
LGAs, 169 LGAs had a shortage of 162,342 staff. The
CAG further explained that the noted staff shortage had
adverse impact on service delivery particularly in the
health sector which has been mostly affected (AGR of
CAG, 2018/19).
Again in the financial year 2017/2018, the CAG has
seemingly reported again on workforce shortage on LGAs
whereby there was a shortage of 149,943 staff in 158
LGAs. The most affected sector being the Public Health
Sector as the CAG assessed staff level in 155 LGAs for
Health Sector which includes hospitals, dispensaries and
health centers. There was a shortage of 37,544 staff which
is equivalent to 47% of the entire requirement in the
Health Sector, reports the CAG.
Such deficiency has an impact on the general performance
of the LGAs including inadequate service delivery,
overloading and demotivating the present employees.
The table below provides the trend analysis of shortage of
staff for a period of four consecutive years from 2016/17
to 2019/20.

table from AGR of CAG, 2019/20)

Statement of The Problem

The shortage of workers in Tanzania has been extensively
reported as a national crisis (Chandler, et al., 2009;
MOHSW, 2008). Provided that workforce shortage is
evident in LGAs, thus delivery of public services
especially in the Health Sector is inevitably poor,
unstandardized, less-quality services or no service delivery
at all in some health centers, hospitals and dispensaries.
Therefore, my research aims to see how or what measures
have the health sector specifically Amana Hospital applied
to overcome workforce shortage and to provide
recommendations on how to solve the problem.
 A number of researchers and scholars in different fields
have done a lot of research on public services specifically
in the Health Sector by discerning how services are
provided and the problem of shortage of workers. Despite
that there is no research that aims to provide ways
that various Public Health Sectors in Tanzania can apply to
overcome the problem of workforce shortage.

General objective
To explore and understand the challenges faced by local
government authorities in Tanzania specifically at Ilala
municipal council in navigating health service delivery in
the middle of workforce shortage.

Specific objectives
1. Assessing the current state of health service delivery in
Tanzania’s local government authorities, focusing on key
indicators such as access, quality, and affordability,
considering the existing workforce shortage.
2. Explore the strategies and interventions implemented by
local government authorities in Tanzania to mitigate the
impact of workforce shortage on health service delivery,
evaluating their effectiveness and sustainability.
3. Examine the challenges faced by local authorities in
navigating health service delivery amidst the workforce
shortage, including financial constraints, infrastructure
limitations, and policy gaps.
4. Investigate the perceptions and experiences of healthcare
providers and beneficiaries regarding the quality and
accessibility of health services in Tanzania’s local
 government authorities, and how these relate to the
workforce shortage.
5. Develop evidence-based recommendations and policy
implications for improving health service delivery in
Tanzania’s LGAs, considering strategies to address
workforce shortage.

Research Questions
1. What are the key challenges faced by Ilala municipal
council in delivering health services amid a shortage of
healthcare professionals?
2. What strategies have the local authorities in Ilala
municipality implemented to overcome the workforce
shortage?
3. What are the perceived barriers in effectively
implementing workforce retention and attraction strategies
in Ilala municipal council within the healthcare sector?
4. How do the shortage pf healthcare professionals affect the
utilization of primary healthcare services by local
population in Ilala district?