NATURE AND CAUSES OF EMPLOYEE RETENTION IN PRIVATE AND

PUBLIC HOSPITALS

A CASE STUDY OF TEMEKE HOSPITAL AND HINDUMANDAL

HOSPITAL IN DAR ES SALAAM

By
Morgan Edwin

A research proposal submitted to the school of public administration and

management in partial fulfillment of the requirement for the degree of
Human Resource Management of Mzumbe University.
2018

Table of Contents
LIST OF ABBREVIATIONS.......................................................................................iii
CHAPTER ONE............................................................................................................1
INTRODUCTION AND BACKGROUND TO THE STUDY......................................1
1.1 Introduction..............................................................................................................1
1.2 Background to the study...........................................................................................1
1.3 Statement of the Problem.........................................................................................4
1.4 Objectives of the Study............................................................................................5
1.4.1 General objective..................................................................................................6
1.4.2 Specific objectives................................................................................................6
1.5 Research Questions..................................................................................................6
1.6 Significance of the Study.........................................................................................6
1.7 Structure of the Research Paper...............................................................................7
CHAPTER TWO............................................................................................................8
LITERATURE REVIEW...............................................................................................8
2.1 Introduction..............................................................................................................8
2.2 Definition of key Terms and Concepts.....................................................................8
2.2.1 Employee...............................................................................................................8
2.2.2 Employee retention...............................................................................................8
2.4 Empirical Literature Review..................................................................................14
2.5 Research Model/Conceptual Framework...............................................................15
CHAPTER THREE...................................................................................................16
RESEARCH DESIGN AND METHODOLOGY....................................................16
3.1 Introduction..........................................................................................................16
3.2 Research Design....................................................................................................16
3.3 Population of study..............................................................................................17
3.4 Sample and Sampling Procedure........................................................................17
3.5 Research Instruments..........................................................................................18
3.6 Data Collection Procedure data types................................................................18
3.7 Data Analysis........................................................................................................18
3.8 Unit of Analysis.....................................................................................................19
3.7 Reliability and Validity of study..........................................................................19
3.7.1 Reliability...........................................................................................................19
TIME SCHEDULE OF THIS PROPOSED STUDY..............................................20
PROPOSED BUDGET FOR THIS STUDY............................................................21
REFERENCES...........................................................................................................22
 LIST OF ABBREVIATIONS

MHSW Ministry of Health and Social Welfare

WHO World Health Organization

FGD Focus Group Discussion

HR Human Resources

HRM Human Resources Management

ICT Information and Communication Technologies

KM Knowledge Management

MNC Multinational Corporation

SASE Selective Accelerated Salary Enhancement

UDSM University of Dar es Salaam

HHR Health Human Resource

NGO Non Government Organization

 CHAPTER ONE

INTRODUCTION AND BACKGROUND TO THE STUDY

1.1 Introduction

This part provides the background to the research topic, statement to the research problem,
objectives of the study, research questions as well as significance of the research to policy,
academia, and increasing knowledge.

1.2 Background to the study

There is a serious human resource crisis in the health sector in developing countries,
particularly in Africa. The World Health Report (2011) estimates that there are 50 countries
with critical shortages equivalent to a global deficit of 2.4 million doctors, nurses and
midwives and these shortfalls are greatest in sub-Sahara Africa.

The World Health Organization (WHO) estimates that out of a total of 59.2 million full-time
paid health workers worldwide, 67% (39,470,000) are health service providers and 33%
(19,750,000) are health management and support workers. On an average there are about 9.3
health workers per 1,000 people worldwide. The total health workforce in Africa is estimated
at 1,640,000, with an average of 2.3 health workers per 1,000 people. Of the total health
workforce in Africa, 83% (1,360,000) are health service providers and 17% (280,000) are
health management and support workers (WHO, 2011).

According to the Ministry of Health And Social Welfare Tanzania Mainland annual report
(2012) HRH data for the three years from 2009 to 2011 show that the number of Medical
Officers has increased from 1,896 to 2,220, representing a 17% increase. Assistant Medical
Officers have increased from 1,627 to 1,938, a 19% increase, Nurses& Midwives have
increased from 15,650 to 19,412, a 24% increase, Pharmaceutical staff and laboratory staff
have also increased from 489 to 811 and 814 to 1,098, representing increases of 65.8% and
35%, respectively.

Overall, ratios of health workers per 10,000 populations have increased from 0.47 to 0.51 for
Medical Officers, from 0.40 to 0.45 for Assistant Medical Officers, from 3.85 to 4.5 for

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nurses& Midwives, from 0.12 up to 0.19 for Pharmaceutical Staff, and from 0.2 to 0.25 for
laboratory staff.

Within the country, there is shortage of HRH, which is compounded with mal-distribution of
personnel that occurs at various levels. Relatively more health service staff are working in
urban than in rural areas. There is also an inequitable distribution of health care staff between
public and private-not-for-profit sector facilities and between primary, secondary and tertiary
facilities. Imbalances are created when health workers switch between sectors (public,
private, NGO, faith-based) in the same country, but at least the health sector has not lost
these workers. It is of far greater concern when workers choose to emigrate, leading to
wastage and shortage. This section examines in detail the out-migration aspect of worker
movement. Out-migration is a central element in the current debate regarding the causes and
consequences of excessive turnover in the health workforce. In spite of the heightened
interest in the subject, a serious lack of data on migrant flow makes measurement of the
extent of out-migration difficult and creates a problem in determining the magnitude of
attrition. Typically, migration data sets are incomplete, inaccurate and do not compare well
across countries because of inconsistencies in health worker categories. Weaknesses in the
available data limit governments’ ability to manage health worker migration and restrict
international comparisons of the phenomenon (Buchan, 2003). Health officials often tend to
act when the numbers leaving are perceived to be high.

Existing data from source and receiving countries nonetheless reveal that out-migration is on
the rise. Of over 600 medical graduates trained in Zambia since independence only 50
remain (Huddart, 2003). The February 2010 edition of the Bulletin of the WHO reports that
there are more Ghanaian doctors working outside Ghana than in the country itself. The
situation is not very different for South Africa. A total of 82,247 doctors and nurses were
working in the public sector in South Africa in 2011. In that same year, another 34,635 South
African-born workers were practicing a medical profession in an Organisation for Economic
Co-operation and Development country (Lehmann and Sanders, 2012). Out of 5,334
Africans practicing in the US as physicians, 4,587 (86%) originate from only three countries:
Nigeria, Ghana and South Africa (Hagopian et al, 2012).

A pattern is also emerging in which out-migration occurs not only due to migration from
poor to rich countries but also migration from poor countries to less poor countries within

2
regions. For example, there is now a steady flow of health workers from Ghana, Kenya,
Malawi and Tanzania to South Africa and Botswana (Schrecker and Labonte, 2012).

In Tanzania, staff turnover, especially of clinical staff working in private hospitals has
remained persistently high. Available data from exit interviews indicate that over 46% of
leavers in the financial year 2009/2010 joined government services and 2010/2011 about
43% of private health employees joined government hospitals (Ministry of Health
2012:159). Similarly, Onzubo (2011:32) showed that in Uganda, the attrition rates of health
professionals are high especially in the private hospitals. According to Yumkella (2009:1),
worker shortages are linked to three factors including decreasing student enrolment in health
training institutions, delays or freezes in hiring of qualified professionals and the failure to
retain those already employed. She further recognizes the fact that the problem of low
retention of health workers is costly, affects continuity of care and raises the intentions for
turnover of the remaining employees, who suffer stress and burnout from taking on the
additional work burden.

Recruiting and keeping the right staff are key challenges for health policymakers. In any
health system, health human resources (HHR) are a central component and are essential for
the delivery of care to patients. Therefore, recruitment and retention problems should be
appropriately addressed, as staff shortages or an unmotivated health workforce are likely to
have adverse effects on the delivery of health services and outcome of care (Whitt, 2005).

Organizations invest a lot on their employees in terms of training, developing, maintaining

and hence there is a need for retaining them for the organizational prosperity. Therefore,
managers must minimize high employee‘s turnover at all costs. Although, there is no
standard framework for understanding the employees turnover process as whole, a wide
range of factors have been found useful in interpreting employee turnover (Kevin et al.
2004).

The retention of employees has been shown to be significant to the development and the
accomplishment of the organization’s goals and objectives (Alkandari and Hammad, 2009).
Retention of employees can be a vital source of competitive advantage for an organization.
Today, changes in technology, global economics, trade agreements and the like are directly
affecting employee/employer relationships. Until recently, loyalty was the cornerstone of that
relationship (ibid, 2009). The loss of talented employees may be very detrimental to the
company’s future success. Outstanding employees may leave an organization because they

3
become dissatisfied, under paid or unmotivated (Coff, 1996), and while the management
tries to retain employees within the organization, employees may present other challenges as
well such as demanding higher wages, they may decide not to comply with organization
practices, and not interact well with their co-workers or comply with their managers’
directives. Besides these problems, asymmetric information or lack of information about the
employees’ performance may complicate an organization’s endeavour to retain productive
employees. It is argued that without adequate information the organization may not be able
to distinguish productive workers from non-productive ones (Coff, 1996). Employees often
may take credit for the successes and deflect failures to other employees and this is known as
a moral hazard problem. In many instances companies may reward or punish employees for
an organization outcome for which they had no impact (Kerr, 1995).

Evidence from the implementation of the Selective Accelerated Salary Enhancement (SASE)
in Tanzania’s Scheme adopted in 2000 suggests that departments were better able to attract
and retain qualified professional, technical and managerial staff; and encourage staff to
undertake further training to aspire for progression and to move up the career ladder.
However, the partial implementation of the SASE scheme gave rise to unfulfilled
expectations, creates greater hostility towards the scheme and created the perception that it
was unfair and discriminatory. Lastly, research from Malawi, Uganda and Tanzania (Wang
and Rakner, 2005) found that low levels of funding were the main constraint on the capacity
of the three countries SASE. In particular, Malawi and Tanzania had had problems retaining
health employees over the years and the situation is worse in private hospitals.

1.3 Statement of the Problem

In Tanzania, attrition among enrolled health workers in public and private not for profit
hospitals rose from 25% in the financial year 2008/2009 to 32% in 2009/2010 before droping
to 30% in 2010/2011 and now to 26% in 2011/2012 (Ministry of Health and Social Welfare,
2012). While retention has remained a challenge to the health sector largely due to financial
constraints, the absolute numbers of staff has always been maintained due to rapid
replacement with fresh graduates. Problems caused by the failure to retain employees
therefore include loss of employees with experience, and the added costs of replacement
(Ministry of Health and Social Welfare, 2012).

4
An analysis of workforce trend points out that generally there is an impending shortage of
health sector employees in Tanzania and more critically highly-skilled employees who
possess the requisite knowledge and ability to perform at high levels, meaning that
organizations failing to retain high performers will be left with an understaffed, less skilled
workforce that ultimately hinders their ability to remain competitive (Rappaport et al., 2009).
Despite the vast literature on employee turnover, which is aimed at identifying factors that
cause employees to quit (Griffeth et al., 2008) much less is known about the factors that
compel employees to stay. Lumley et al., (2010) noted relatively less retention research has
focused specifically on why an employee decides to remain with an organization. Retention
is a critical element of an organization’s more general approach to talent management, which
is regarded as “the implementation of integrated strategies or systems designed to increase
workplace productivity by developing improved processes for attracting, developing,
retaining, and utilizing people with the required skills and aptitude to meet current and future
health sector objectives (Lockwood, 2009).

Replacing exiting employees is costly to organizations and sometimes destructive to service

delivery (Reiche, 2008). It is therefore imperative for management to reduce to the minimum
the frequency at which employees, particularly those that are crucial to its operations leave.
According to Samuel (2008) employee retention became a vital issue and challenge to many
organizations particularly in the health sector. There are factors which promote the
employees to stay or leave an organization. They may be internal factors, external factors or
a combination of both. Human resource practices count a lot in this regard (Hassan et al,
2010). Despite the fact that many studies have been carried out] in the world to establish
factors leading to employee staying or leaving the organizations, employee retention remain
one of the greatest challenges that the health sector is facing in Tanzania. However, there is
no published or documented evidence which indicates that the same study was done in
establishing factors leading to labour retention in Tanzania public and private health sector.
Therefore, this study aims at identifying main factors for the employee retention in Tanzania
public and private health institutions.

1.4 Objectives of the Study

The objectives of this study are divided into two main categories namely the general
objective and specific objectives as follows.

5
1.4.1 General objective

The general objective of this study is to identify the nature and causes of labour retention
among public and private hospitals in Tanzania with a case study of Temeke and
Hindumandal Hospital in Dar es Salaam.

1.4.2 Specific objectives

i. To identify the factors perceived by employees’ as influencing their stay in an
organization.
ii. To identify different methods used by the organizations in retaining their best
employees.
iii. To examine the challenges facing Tanzania health sector in retaining its employees.
1.5 Research Questions
i. What are the factors perceived by employees’ as influencing their stay in their
organization?
ii. What are the methods used by Temeke and Hindumandal Hospitals in retaining
their employees?
iii. What are the main constraints facing Temeke and Hindumandal Hospitals in
retaining their best employees?

1.6 Significance of the Study

The study is expected to make contributions to the limited literature on issues related to
employee’s retention in Tanzania’s Public and Private Hospitals. Results from the study will
also benefit policy makers, non-governmental organizations, civil society organizations and
community based organizations in policy making process and advocacy for the benefits of all
stakeholders in heath sector. Moreover the research paper will be used as a reference material
to other academicians who will use the research document for further reference. Future
researchers may identify the gaps available for further studies. Furthermore, the study is
expected to provide knowledge on the influence of motivation on employees’ performance in
Tanzania’s health sector. The research findings are also expected to come with suggestions
on what ought to be done in enhancing retention in both private and public hospitals in
Tanzania.

1.7 Structure of the Research Paper

This work has been organized as follows: The first chapter focused on the introduction,
research background, and statement of the problem, general objectives, specific objectives,

6
and research questions as well as significance of the study. Chapter two dealt with definition
of key concepts, theoretical studies, empirical literatures, provides gaps as well as suggest
model to guide the study. The third chapter forms the Methodology of the study. This
chapter gives details of how the research will be conducted; the tools and the research design
to be used in the sampling procedure, data collection and procedures adopted. Chapter four
gave details of the presentation of analysis and the discussion of data collected. Chapter five
also dealt with the summary, conclusion, recommendation of what came out of the study as
well as further areas for research.

7
 CHAPTER TWO

LITERATURE REVIEW

2.1 Introduction

This chapter is mainly divided into three parts: First, it describes the main approaches in the
literature to understand retention. The theories of Herzberg and Maslow will be presented as
they are useful for understanding the retention mechanisms to the staff. Second, it explains
the push-pull framework which is often used to analyse retention. Critics from the literature
on this framework will be presented. Third, it describes ways of assessing the retention
problem and give examples from the literature of strategies to retain staff. The last section
will present a conceptual model which will guide this study.

2.2 Definition of key Terms and Concepts

2.2.1 Employee

Labour Relations Code defines an employee as a person employed by an employer, and

includes a dependent contractor, but does not include a person who, in the board’s opinion,
performs functions of a manager or superintendent or is employed in confidential capacity in
matters relating to labour relations of personnel (Albright, 2003). ELRA (2004) defined
employee as an individual who has entered into a contract of employment; or has entered
into any other contract under which the individual undertakes to work personally for the
other party to the contract.

2.2.2 Employee retention

Employee retention means keeping the right people on the right jobs for every organization.
Employee retention is all about keeping good people. It is much to do with our culture and
how we treat people.’ Retention is a voluntary move by an organization to create an
environment which engages employees for long term (Chaminade, 2007).

2.3 Theoretical Perspectives

In the literature, there are two main models to understanding retention: Economic and
holistic models (Boyle et al, 1998). From an economic point of view, the health labour
market is determined by money, and health workers will be attracted to, and retained by, the

8
employer who offers the best deal, i.e. the best remuneration (Zurn et al, 2002). The
economic approach does not explain why many health workers are retained in their job in the
public health sector while there are better paid jobs available to them elsewhere. This
suggests that there are other factors than economics which influence the dynamics of the
health workforce (Boyle et al, 1998).

The holistic view is that the health worker’s decision on where to work or whether to work at
all, is not only influenced by economics, but also by a range of other factors originating from
the social, cultural and political context an employee lives in (Lumley et al., 2010). Gender
relations are especially important here (Robinson et al, 1998).

A recent study among female health workers in Pakistan found that if their work was
organized in a way which better enabled them to combine work-related and domestic
responsibilities, then they were more likely to stay in the job (Mumtaz et al, 2005).Studies
with a holistic approach also take the health workers’ commitment to the profession into
consideration. In two recent studies from the industrialized world (Ball et al, 2002)
“vocation” or the wish to “make a difference” was found to be reasons for midwives to
choose to go into the profession. A health facility manager (Global Health Trust, 2003) in
South Africa expressed this as:

…we have a service to deliver, we have people looking up towards us for

help, hope and for survival and you have to be committed, and you have to
have responsibilities to be able to push forward in this profession”

In conclusion, the holistic approach seems useful in understanding Tanzanian health workers
on reasons which attracts employee to stay in their career.

2.3.1 The role of pay in a holistic approach

The holistic approach acknowledges that pay has a role in retaining staff. The question is
then to what extent pay determines the employee’s decision to stay or leave the job.
Herzberg’s two-factor theory and Maslow’s hierarchy of needs are useful in answering that
question.

Herzberg’s two-factor theory (1966) is based on findings from a study on job

satisfaction in the USA. What Herzberg found is that there are two distinct sets of factors
which impact on the way people feel about their job: One set being the so-called “dis-

9
satisfiers”, and the other set named “satisfiers” (Armstrong, 1998). The “dis-satisfiers” are
the factors which are related to the context of the job like, salary and working conditions.
The “satisfiers” are factors which are linked to the content of the job such as achievement,
appreciation/recognition, promotion/advancement etc. In order to make the employee feel
neutral about the job and perform at an average level it is essential that the “dis-satisfiers”
are met. That is to say that the basics such as salary, working conditions etc. are perceived as
fair by the employee. If the employee perceives her salary and working conditions as unfair
(i.e. the “dis-satisfiers” are not met) then it is not likely that appreciation and promotion (i.e.
“satisfiers”) will make her feel satisfied, and she may eventually resign (Milton, 1997). The
key thing in Herzberg’s theory in relation to this study is that recognition, advancement, and
a sense of achievement cannot make up for inadequate salary and working conditions, except
maybe in the short term.

Maslow (1943) suggested that people have five types of need, arranged in a definite
hierarchy of importance. According to Maslow’s model, there are three ‘lower-order’ or
‘deficiency’ needs (physiological needs, safety needs and social needs) and two ‘higher-
order’ or ‘growth’ needs (ego or esteem needs and ‘self-actualisation’ needs). Physiological
needs include food, water, air, shelter, clothing, and . . . sex. (In regard to the last, we need to
note here that Maslow’s model was a general theory of human behaviour both within and
beyond the workplace!) Safety needs cover security, stability and freedom from threat. Social
needs include friend- ship, affection and acceptance. Esteem or ego needs include self-
respect and respect from others, while self-actualisation is the need to fulfil one’s human
potential. These five needs are organized in a pyramid to reflect that there is a hierarchy
among the needs: Once a lower need has been satisfied, then the individual can start focusing
on a higher need. Notably, the needs for self-fulfilment and esteem are rarely dominant if the
individual is pre- occupied striving to fulfil the basic physiological, safety and social needs
(ibid).

Herzberg’s two-factor theory (1966, 1987) is in line with Maslow’s needs hierarchy in the
sense that Herzberg’s concept of “dis-satisfiers” largely equals Maslow’s basic physiological,
safety and social needs. Likewise, Herzberg’s “satisfiers” are comparable to Maslow’s needs
for esteem and self-fulfilment. This review identified few studies conducted in a low income
setting on retention of health staff. Those found, showed that poor pay is a major reason for
resigning.

10
Dovlo, (2003) states that “salary levels are probably the most basic factor in retention” and
he bases this on case studies from countries such as Botswana and Ghana. In Uganda,
increased salaries for physicians have improved retention and even encouraged returning to
the job (Davlo, 2003). In a recent large study on international nurse mobility initiated by the
WHO, the gap between pay levels in the developing and the industrialized countries was
found to be the main factor for nurses to migrate. Other factors such as opportunities for
post-basic education and career were less important (Buchan, 2003).

Based on the theories of Herzberg and Maslow, the i conclude that strategies to retain health
workers in the job which appeal to their higher needs/ “satisfiers” while failing to meet the
basic needs/“dis-satisfiers” are not likely to have a significant and sustainable impact on
retention.

2.3.2 The push-pull framework

The push-pull framework is known from a variety of contexts, ranking from customer
surveys (Gerrein et al, 2003) in the private sector to research in the nineteenth-century
emigration from Europe to the Americas (Gould, 1979). The framework “[compares] the
origin and destination in terms of their overall combination of push factors (repulsions) and
pull factors (attractions)” (Buchan, 2003). In other words, the health worker is likely to leave
the job if she perceives that the combination of push factors from the origin and pull factors
from the destination makes leaving a favourable option (Zurn et al, 2002).

Retention and migration studies typically mention the factors listed below in no significant
order, as push factors out of the health sector. An unfair remuneration package is a common
push factor ( Buchan,2003; Torrington, 2003) The remuneration package is defined as all
monetary rewards that the employee gets in return for her contribution to the organisation,
i.e. basic salary, allowances, pension etc. (Ganster et al, 2002). It is the employee’s
perception of whether her remuneration package is fair or unfair which is important in her
decision to stay or to leave, rather than how the remuneration package compares to a cost of
living index (Ibid).

Delayed payment of the remuneration package is another push factor (Julia, 2008). This can
be for several months (ibid) and is often a result of inefficiently administered payrolls (Boyle
et al, 2000): “Centralized minor administrative procedures involve various government

11
departments and poor information technology can make simple processes a frustrating
experience” (ibid)

Most retention studies list poor working conditions as a push factor (Kassongo et al, 2006).
Herzberg defines working conditions as “the physical conditions of work, the amount of
work or the facilities available for doing the work” (Herzberg, 1987). Since Herzberg
developed his theory in 1966, there has been increasing awareness of work related stress
(Torrington et al, 2002) provoked by “stressors such as high workloads, requirements for
working fast and meeting strict deadlines, conflicting demands and interruption. Problems
are seen to arise when exposure to such demands is chronic and elicits a strong enough
pattern of responses to strain the individual’s physical and mental resources” (Ganster et al,
2002).

Remoteness from urban centers is a common problem in many countries including Tanzania
(Ibid) and this is a push factor out of the public health sector (Gerein et al, 2003). Remote,
rural positions in the public health sector are perceived as unattractive (Agyepong et al,
2004) and they are thus a push factor. This is even more so for a female work force: “Socio-
cultural factors often preclude women from accepting positions in rural, remote areas for
extended periods of time. In addition, in countries that impose rural compulsory service as a
requirement for graduation and professional certification, women may not be able to
graduate or exercise their professions” (Dussault et al, 2003).

Another push factor is lack of job satisfaction (Mumtaz et al, 2003) Herzberg found that
“satisfiers”, such as a sense of achievement and recognition, should be met in order for the
employee to feel satisfied with the job (Kogan, 1998). A pharmacist in South Africa has put
is as: “If you are right, there is silence – no recognition. If you are wrong – you hear from
everyone” (Global Health Trust, 2003).

Exposure to HIV/AIDS in the work place is a push factor, especially from obstetrics and
surgery. This is against a backdrop of health systems stretching to cope with the combination
of increased case load and increased attrition of staff, both largely due to the HIV/AIDS
epidemic (Kassongo et al, 2006).

“Increasing levels of illness, absenteeism and death are to be expected among

health workers in high-prevalence countries, threatening the ability of health
systems to provide care. HIV transmission through needle-stick injuries

12
 within the hospital is a small, but real, risk, and a significant worry for many
staff. Limited data suggest that staff recruitment is being adversely affected
and that self-deployment away from perceived risky activities such as
obstetrics and surgery is already taking place” (Ibid).

2.3.3 The Pull factors

Pull factors were defined slightly differently in different studies; in some research, pull
factors were factors which attract the health worker to the destination (Zurn et al, 2002). In
other studies, the factors which pull the health worker to stay in their place of origin were
considered as pull factors (Ball et al, 2002). The latter definition is used in this review and
also consistently throughout this research paper. In other words, pull factors are here factors
which attract the health worker to stay in the public or private hospital.

These factors include; attractive retirement package, i.e. end of service payments of various
kinds is a pull factor. This is illustrated in the cases of Namibia and Lesotho. The two
countries remunerate health workers similarly except in terms of the retirement packages:
Namibia offers a more attractive retirement package and also has better retention of staff
(Dovlo, 2003). However, studies suggest that generous retirement packages are not enough
to make young and middle-aged staff stay in a job that they are otherwise dissatisfied with.
The retirement package is mainly a pull factor for the older employees (Portes and Boyle,
1998).

A study among Pakistani female health workers found that “flexibility in time use,
particularly in relation to the taking of leave for family commitments and emergencies…
could reduce the dropout rate” (WHO, 2003). In a study among British midwives, it was
found that “midwives who left health workerry because of their ‘family commitments’ are
more likely to consider returning than midwives who left for other reasons”(Ball et al,
2002).

In a recent study among public health workers in the UK it was found that job security
attracted people to the sector (Dussault et al, 2003).

Having an Access to post-basic training is another pull factor (Dovlo et al, 2002). There
might be more reasons for this. First, training and professional development is a way of
meeting the need for esteem and self- fulfilments as described by Maslow (Kagan, 1998)
Thus an employee who can develop and apply her potential and skills is more likely to stay

13
in the job. Second, “training, especially overseas training, is a highly priced opportunity to
increase one’s market value to complementary employers and to migrate to cities or even
internationally” (Lerberghe et al, 2008).

2.4 Empirical Literature Review

Glen (2006) examined effective, practical and holistic people strategies that addressed key
skills retention, employee engagement, and employee motivation and attendance gaps, with a
view to positively impacting on organization costs, productivity and business performance.
He also thought to examine the value of assessment and feedback in talent engagement and
retention, and looked at developing employees via experience-based development initiatives.
The study assessed the matrix of the ‘‘hot buttons’’ or ‘‘predictors’’, which needed to be
consciously managed with significant potential returns, where managed well. It examined a
holistic matrix of nine employee engagement predictors: process; role challenge; values;
work-life balance; information; stake/leverage/ reward/recognition; management; work
environment; and product. Reference was made to a case study in which this matrix formed
the basis of the organization’s people management strategy. The study revealed that, a
holistic view of the key elements of the business most were likely to impact team
engagement, motivation, attendance and retention, linking individual assessment directly to
the key drivers of the business, and recognized that key talent was likely to thrive on
experience-based career leverage opportunities.

Taylor et al (2004) investigated the reasons for employees leaving or staying. They said that
over 12,000 academic and practitioner studies have been performed relating job satisfaction
with voluntary turnover. However, researchers had been frustrated in explaining more than
20 percent of the variance in turnover. Their study presented the notion that traditional
measures of job satisfaction might not fully capture the reason for staying or quitting. A new
construct was presented that examined the congruence of fit between the job and the person's
quality of life goals. They used a PLS structural equation model on a sample of 135
information systems workers. This construct was empirically shown to be a better predictor
of various measures of turnover decision (that is thoughts of quitting, expectation of quitting,
and intention to quit) with an average explained variance of 0.50.

There are a number of gaps left by different reviewed literature ranging from geographical,
methodologies used to time as well as the nature of organization studied.

14
Hassan et al (2010) conducted a study on employee retention as the vital challenge in all
organizations. Their study focused on one industry that was the leather industry of Pakistan
which was facing the same problem of retention of employees due to many reasons. Despite
their study relevance, the studies were conducted in Pakistan where geographical attributes,
political inclination and socio- cultural values differ from Tanzania.

Hong and Kaur (2008) researched on a relationship between organizational climate,

employee personality and intention to leave. Their study aimed to examine the relationship
between organizational climate, employee personality and their intention to leave an
organization in the Malaysian context. These researchers left a gap of geographical location
of study as well as time. Ngozwana and Rugimbana (2010) assessed the talent retention
strategies by using a case of large South African companies (CAC). South African companies
operate in an advanced working environment compared to those found in Tanzania.
Therefore their findings cannot be generalized to the Tanzania environment. Despite the fact
that, many studies were conducted to explore factors for the retention in work organizations,
most of them were carried out in other countries particularly those found in Asia. Few
studies were carried out to investigate the factors for retention in African organizations
including those in Tanzania. This study aims to fill gap left by the previous researches
specifically the investigating the factors influencing employee retention in Tanzania health
sector organizations.

2.5 Research Model/Conceptual Framework

The study will be guided by the researcher’s conceptual model (See figure 2.1) as designed
because it took into account many factors for the employees’ retention including those
related to organization itself, employees as well as critical psychological states of the
employees in work organizations. Organizational factors/strategies/conditions include among
other issues: - The levels and competitiveness of the remuneration schemes. The assumption
is that, the health sector organizations which have an attractive remuneration package are
likely to retain their employees while those with weak remuneration package are likely to
lose their employees.

The model will assume that, the organizations which have opportunities for personal
development and advancement have also an advantage in retaining its employees. Likewise,
organizations which provide opportunities for personal development and advancement are

15
likely to retain their best employees. Similarly, organizations which have supportive working
environment as well as organizational justice and prestige have ability of retaining their best
employees. On other hand, employees’ retention can be determined by the psychological
states of the employees.

Figure 2.1: Conceptual Framework for the study

(Source: Developed by the researcher, 2013)

16
 CHAPTER THREE

RESEARCH DESIGN AND METHODOLOGY

3.1 Introduction

This chapter discusses the method used in collection of data. It specifically takes a critical
look at the research design, population, sample and sampling procedure, research instrument,
and Data collection procedure and data analysis plan.

3.2 Research Design

The researcher will use mixed methodology in this study. Mixed method is a philosophical
assumption that integrates qualitative and quantitative research approaches within a subject.
This study will use exploration and descriptive design. Fraenkel and Wallen (2000)
pronounces that in using descriptive research which is a survey research, obtaining answers
to a set of carefully designed and administered questions to a large group of people lies at the
heart of a survey research. The researcher will use a descriptive survey method for the
collection and analysis of the information in order to answer the questions which will be
posed.

3.3 Population of study

The target population of the study consists of all junior and senior staff employees (present
and past that 2012) personnel of Temeke Hospital and HinduMandal hospital. The two
hospitals will be chosen for this study because the researcher needs to make a comparison
study between private and Government owned hospitals.

17
The accessible population will be all senior staff employee and junior personnel in Temeke
Hospital and Hindumandal hospital who will be willing to participate in the study.
Management and senior staff employees will be selected because they serve as key
informants who could be of tremendous help in providing very vital information and other
preference materials necessary for the study.

3.4 Sample and Sampling Procedure

The major aim of this step is to determine the specific population that will be surveyed, to
decide on an appropriate sample, and to determine the criteria that will be used to select the
sample (Marczyk, et al, 2005). A sample of 65 employees will be used for the study
comprising 30 senior and 35 junior staff respectively from the each hospital. A purposive
sampling technique will be used to include all employees because of the nature of the
research problem which called for the non-rejection of any of the respondents because they
are privy to the information that the researcher is seeking. The 65 respondents will be
selected through stratified random sampling. Two strata of present and past employees will
be carved. From each stratum a proportionate number of employees will be drawn to make
the total sample. Stratified random sampling will be used because each of the present and
past group of employees from 2002 to 2012, of which employees will need to be drawn and
studied to help achieve the objectives of the study.

3.5 Research Instruments

Data will be collected from the management and employees of both hospitals. The
instruments that will be used by the researcher are interview and a questionnaire. The
researcher therefore will develop and use a questionnaire to survey the views of the
respondents. The use of questionnaire will enable employees to be free while filling in the
required information, and will enable reaching a large number of respondents within a
shorter period of time.

3.6 Data Collection Procedure data types

The researcher will personally administer the questionnaires to the respondents. An

introductory letter will be taken from the University of Dar es Salaam to the management of
Temeke and Hindumandal Hospitals to officially seeking permission for the employees to
participate in the study. After permission had been granted the researcher will brief the

18
employees as to what the study is about in order to get the needed attention, support and co-
operation of the staff. The questionnaires will be hand-delivered to all the respondents by the
researcher. The researcher then will guide the respondents to complete the instrument
without inferring with the choice of responses. The assistance may involve the explanation of
instructions or terminologies (Including some translation) so as to get the most valid data for
inclusion in the analysis. Respondents will be given three weeks to complete the instrument.
To ensure an effective return rate, follow up telephone calls as well as personal visits will be
made to encourage the respondents to complete the questionnaires. Secondary data for this
study will be collected from books, journals, reports and newspapers, both published and
unpublished, as well as from online sources. Secondary data will be used to support and
complement the primary data in the study findings.

3.7 Data Analysis

The data collected will be edited and eliminate any incomplete questionnaire. The valid
questionnaires will be coded to reflect their corresponding categories in accordance with the
following scoring key: Strongly agree-1, Agree-2, Disagree-3, strongly disagree -4, Neutral-
5. Afterward the scored questionnaires will be analysed using Statistical Package for Social
Sciences (SPSS) into the desired descriptive statistics. Since a descriptive sample survey will
be used in gathering data, it will be prudent for the researcher to use the same descriptive
method in analysing the data that will be obtained. Descriptive surveys do not typically
require complex statistical analysis. However, descriptive statistics (mean, standard
deviations, frequencies and percentages) will be used in analysing the data that will be
gathered.

3.8 Unit of Analysis

The unit of analysis is the major entity that is being analysed in the study. It is the 'what' or
'whom' that is being studied. In social science research, typical units of analysis include
individuals (most common), groups, social organizations and social artefacts. Under this
study the unit of analysis will be individuals who filled questionnaires, and those involved in
an interview as well as those who will be key informants.

19
3.7 Reliability and Validity of study

Data qualities will be explored through validity and reliability of the information to be
collected from the field.

3.7.1 Reliability

This study will adopt the construct validity to validate data and Cronbach Alpha (α) scale to
measure internal reliability. Miller et al (2002) confirmed that Cronbach’s alpha (α) should
be at least 0.70 or higher to retain variables in adequate scale. The reliability test will be
performed using SPSS and the results will give an alpha (α) value which will determine the
reliability of the data. (If α<0.7, data not reliable, if α=/>0.7, data is reliable).

3.7.2 Validity

Churchill (2007) defined validity as the extent to which the instrument accurately measures
what was intended and supposed to measure. The questionnaires for this research will be
pilot- tested to 20 employees including management and non-management cadres of Temeke
Hospital through interview and results will be used to modify the questionnaires so as to be
able to capture the required information.

20
 TIME SCHEDULE OF THIS PROPOSED STUDY

MONTH November December January February March

WEEK 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4
Proposal writing and
Submission
Proposal Correction and final
draft submission
Resources mobilization
Data collection and
compilation
Data analysis and Report
writing
First draft submission
Correction and Final draft
submission

PROPOSED BUDGET FOR THIS STUDY

S/No ITEM AMOUNT (Tsh)

1 Proposal preparation
 Stationary 10,000
 Internet services 20,000
 Typing and Printing 20,000
 Spiral binding 7,000
2 Field costs
 Travel expenses 50,000
 Daily allowance (questionnaires work) 100,000
3 Data analysis, reporting and dissertation production
 Stationary 10,000
 Internet Services 10,000
 Typing and Printing 20,000
 Professional services for data analysis 50,000
 Hardcover binding 10,000
GRAND TOTAL 317,000

21
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