Management and Organization Reforms at the Muhimbili National Hospital: Challenges and Prospects

Objective: To establish the state of organization structures and management situation existing at the Muhimbili National Hospital (MNH) and Muhimbili University College of Health Sciences (MUCHS) prior to the start of the MNH reforms and physical infrastructure rehabilitations. Methods: A checklist of key information items was used to get facts and figures about the organization of the MNH and management situation. Interviews with MNH and MUCHS leaders; and documentation of existing hospital data were done to gather the necessary information. Results: The survey reveals that there are a number of organizational; managerial and human resource deficiencies that are impinging on the smooth running of the hospital as a national referral entity. The survey also revealed a complex relationship existing between the hospital and the college (MUCHS) that has a bearing on the functioning of both entities. Conclusion: In order for the hospital to function effectively as a referral hospital with a training component inbuilt; four basic things need to be put in place among others: a sound organization structure; adequate staffing levels especially of specialist cadre; a functional information system especially for inpatient services and a good working relationship with the college

Rationalising Human Resource Deployment in the Wake of Reforms : the Need for Measuring Health Workers Workload

The ongoing reforms that cut across various sectors in Tanzania encompass as one of the major changes; the disposition and remuneration of civil servants including health workers. Retrenchment of health workers that started in the early 1990s; staff allocation and relocation in the facilities and the introduction of incentive packages have been implemented without the guidance of information on the actual magnitude and distribution of workload among them. This paper presents findings of the outpatient workload for clinicians based on a review of routinely available data from two districts in Tanzania. It was revealed that the average workload was 29 outpatients per clinician per day in health centres and 20 in dispensaries. Workload was found to be higher in Government dispensaries (20 outpatients/clinician/day) compared to private for profit owned facilities (8 per clinician/day). It was concluded from the study that there is an enormous variation in workload among facilities of the same type and between districts. It was therefore recommended that future plans on staff disposition and incentive schemes should take into consideration the burden of work shouldered by health workers at their respective working places. Further research should be conducted in order to establish workload among health workers of other cadres that will encompass services other than OPD