Skewed distribution of the health workforce is a global phenomenon  that intensifies the well-known crisis of scarce personnel in many countries’ health sectors. This greatly affects low- and middle-income countries (LMIC), although sub-Saharan Africa (SSA) remains the most affected region [2, 3]. The shortage of health personnel in absolute numbers which has received a considerable attention among researchers is one of the health systems’ pressing problems in developing countries [4, 5] including Tanzania . This has been acknowledged as a serious threat towards meeting the Millennium Development Goals (MDG) [7–9]. According to Barden-O’Fallon et al. , accurate knowledge of characteristics of the health workforce that affect health care production is of critical importance to health planners and policymakers. A global picture shows that skewed distribution of the health workforce geographically, and by specific characteristics, poses significant challenges to quality health care delivery . Some forms of the skewness include skill mix, over specialization and gender , the latter being subtly discussed. So far, gender has been much less considered in health workforce-related matters both in the formal and informal systems of health care production [11, 12]. However, a clear gender component reportedly exists in several ways. In formal health care systems, for example, women are less likely to be in senior, managerial and policy making roles than their male counterparts [13, 14], whereas non-institutional care for the sick is often carried out by women . Since poor health care utilization for some individuals due to the absence of a provider of a particular gender has been reported , gender balance in the cadres of health care providers may be an imperative response.
The United Republic of Tanzania’s health workforce is reportedly small, both by international and national standards . In 2006, the Ministry of Health and Social Welfare (MoHSW) estimated a massive shortage in the health workforce by 65% of the staffing requirement . This situation was declared a threat to effective delivery of quality health services . The shortage is aggravated by, among other factors, population expansion and attrition as well as increasing disease burden due to HIV/AIDS, tuberculosis (TB) and malaria . It is noted that the health workforce challenges in the country are significantly related to poor working conditions, a situation that drives some staff, especially highly trained ones, to seek employment outside the country (brain drain); those who remain working in the country become greatly demoralized . A cross-sectional study conducted by Leshabari and colleagues  at the Muhimbili National Hospital (MNH) to assess health workers’ service and care delivery motivation found that nearly 50% of doctors and nurses were not satisfied with their jobs. Low salaries, persistent unavailability of the necessary equipment for service delivery, inadequate performance evaluation and feedback, poor communication between workers and management and lack of participation in decision-making were among major reasons reported for the dissatisfaction.
Moreover, previous evaluations have established that the health workforce in the United Republic of Tanzania is inequitably distributed . There are more health personnel in urban-based health facilities than their rural counterparts . xEven between districts, disparities in staffing levels exist. This is partly due to the fact that some districts host regional or tertiary hospitals, thus requiring more health personnel than the ordinary district hospitals . The problem is more serious in cases where new districts were formed after dividing the original districts. There is also geographical skewness in the skill mix distribution among the existing cadres, whereby the most skilled and specialized personnel are less likely to work in rural facilities . The most qualified health personnel are concentrated in a few centralized locations mainly in urban or peri-urban centres where they can access basic social services and desirable infrastructural facilities, while severe understaffing reigns at dispensary levels, especially those located in rural and peripheral settings .
Apart from these challenges, most of which are basically distributional, there is a general lack of empirical analysis of the status of the gender-based distribution of the health workforce in the United Republic of Tanzania. The slim evidence available shows a link between gender and geographical imbalance in the distribution of the United Republic of Tanzania’s health workforce. Reportedly, while rural facilities are severely understaffed, they are also less likely to be served by female providers . Evidence from other countries shows the presence of more women in lower-status health occupations usually performed by personnel of low education on the one hand and fewer women than men among highly trained professional staff for direct health service delivery and management positions on the other . The distributional skewness favours women among nurses, but women are poorly represented among doctors, dentists, pharmacists, clinical officers and managers . Poor representation of women in higher-status health cadres may lead to poorer understanding of problems that are specific to women . It has been further reported that female general practitioners practice differently from their male counterparts. They are capable of managing a variety of medical conditions with some differences due to patient mix and patient selectivity. On the other hand, research studies reveal that some women in more traditional areas will not seek health care for themselves or even for their children unless they have access to a female provider . It has also been established that women cannot be seen by male doctors in some parts of the world .
While gender imbalance in the distribution of the health workforce may be affecting service production, delivery and utilization in the United Republic of Tanzania, there is no evidence available to reveal the status of gender in the distribution of HWs. The gender-based distribution of the health workforce remains barely addressed, and no literature so far clearly documents the situation in the United Republic of Tanzania. Even the few attempts in other countries that have discussed gender in relation to the distribution of the health workforce, lack details as they did not focus solely on gender. As a result, they have simply reported frequencies, without considering such robust techniques of analysis as regressions, where gender skewness could be assessed while other characteristics, such as location, age, education and so on, were controlled for. This paper, thus, has two objectives: (1) to examine the composition of the United Republic of Tanzania’s health workforce cadres by gender and (2) to assess the predictive effect of gender on each of the United Republic of Tanzanian health cadres surveyed, namely, maternal and child health aide or medical attendant (MCHA/MA), nurse, midwife, clinical officer (CO) and medical doctor (MD), using multivariate logistic regression.