Tanzania, the Ministry of Health and Social Welfare urgently needs health workers to serve hard-to-reach communities. "They're in desperate need of hiring people in rural districts," says Shari Adler, who has been working with the Capacity Project in Dar es Salaam.

In the country's response to HIV, the Ministry has deemed its shortfall in human resources for health (HRH) as an emergency. To begin to address this gap, the Ministry is expanding antiretroviral therapy services through an Emergency Hiring Program that will bring 365 new health workers to 25 underserved districts in two phases. The first phase, now underway, will place 176 new hires in 19 districts.

Partnering with the Ministry, "the Benjamin William Mkapa HIV/AIDS Foundation handles the new hire aspect," Adler explains, "while the Capacity Project handles the HRH system strengthening aspect" by helping district leaders develop long-term solutions to recruitment and retention problems.

Armed with significant experience in human resources, Adler joined the Capacity Project in January 2007 as a Pfizer Global Health Fellow. This is a volunteer program in which Pfizer provides financial support for selected employees to become short-term members of organizations such as IntraHealth—lead partner of the Capacity Project—that are involved in health care in developing countries. Based in the Project's Tanzania office, Adler contributed her expertise on a full-time basis for six months.

Retention is a particular challenge for health professionals who work in rural areas, Adler notes. As one of her contributions, she developed a toolkit that will be used "to train HRH leaders on improving working conditions, enhancing employee satisfaction and creating ways to retain employees. The idea is to make these HR processes comprehensible, identify leadership roles and bring these procedures into everyday practice."

Mary Simagom is the Ministry of Health and Social Welfare's eastern zone coordinator. "The toolkit was developed to give district managers something to help them" create a good work climate for the new emergency hires and the existing workers in their districts, she remarks. "It does a good job of describing all the different things that need to be thought of, for workers to do a good job and feel part of the [decision-making process]." The toolkit will contribute to strengthening the country's health system, Simagom asserts. "It's a good reference tool for the zonal trainers, with a lot of useful information and guides, and it will be a good help for the members of the HRH working groups we need to have in each district."

At a recent consultative session with Ministry staff, "we got their opinions and received really good feedback on the draft toolkit," Adler reports. "Once the final draft is approved it will be delivered to rural, hard-to-reach districts and could help create better working environments, motivate health workers and improve health services."

At first Adler wasn't sure if her work would make an impact. "When I was creating the toolkit, I thought it might not be used," she admits. "But what I did really took shape. I saw that it would be rolled out to people, and I think it will do well." Simagom agrees, and adds that it's important that "all managers or supervisors of the emergency hires have access to the toolkit. That is something the district managers need to help with."

The Project is moving ahead with finalizing the toolkit and organizing trainings. In addition to the Emergency Hiring Program, the Project is engaged in a number of activities—on the mainland and in Zanzibar—designed to increase the country's ability to carry out long-term planning for recruiting, retaining and effectively utilizing health workers. "I think the Capacity Project in Tanzania is really going to take a huge step forward," Adler concludes. "I felt incredibly lucky to be in Tanzania. It brought things into perspective for me and presented me with a different angle for viewing my life."

The Capacity Project, funded by the United States Agency for International Development (USAID) and implemented by IntraHealth International and partners (IMA, JHPIEGO, LATH, MSH, PATH, TRG), helps developing countries strengthen human resources for health to better respond to the challenges of implementing and sustaining quality health programs.

The Voices from the Capacity Project series is made possible by the support of the American people through USAID. The contents are the responsibility of IntraHealth International and do not necessarily reflect the views of USAID or the United States Government.