Table 5 Recife commitments, corresponding objectives, and progress reported: Tanzania

1: “To increase the availability of skilled health workers at all levels of health service delivery from 46 % to 64 % by 2017 based on staffing levels of 2013”

1.1: “To increase the density of health worker to population of the districts with below national average of 1.47 health workers per 1,000 population in 5 regions (Kigoma, Tabora, Rukwa, Shinyanga and Singida) from 0.73 health worker per 1,000 population to the national average”

During fiscal years 2013/2014 and 2014/2015, the 5 regions, which represent 18.5% of the total population, were allocated 20% of 19 566 new posts. Countrywide, the density of skilled health workers increased to 0.903 in 2014/15 after new posts were filled. In all 5 regions, the density has increased: Kigoma from 0.37 to 0.61, Tabora from 0.34 to 0.67, Rukwa from 0.54 to 0.70, Shinyanga from 0.57 to 0.62, and Singida went from 0.60 to 0.73, thus reaching the national average for 2013, but it remains below that of 2015. Out of 25 regions, 10 remained below the national average, 1 is “borderline,” and 14 are above [44]. There is also a proposal to legislate that students trained on public funds will not be registered until they have completed a compulsory 2-year period in rural areas.

1.2: “To continue increasing production of skilled Health and Social workers from 4,364 in 2012 to 9,000 by 2017”

A Production of Health Workers Plan (2014–2024) has been approved; it outlines HRH objectives for the medium-term and provides a framework for short-term plan development. In 2014, the enrollment of allied health workers at certificate and diploma levels was 5 569, an increase of 77% respective to the previous year (3 143). For nurses and midwives, the increase was more modest (7.7%, from 5 135 to 5 533), and for doctors, pharmacists, dentists, and nursing officers, there was a decline from 1 890 to 1 810 [45].

1.3: “To rationalize employment permits for health and social workers based on production and needs in all areas of technical professions”

The MoHSW developed a detailed 5-year recruitment plan which includes the expected production of health workers in each year [46].

2. “To increase financial base (Other Charges and Private sector investment) to operationalize the pay and incentive policy by 2017”

No specific objectives were specified

Tanzania has developed a plan to increase financial resources to attract and retain qualified health workers, and various measures are being taken:

-A pay and incentive policy for public sector employees has been adopted, including subsistence, extra duty, risk, and on-call allowance increases;

-Increase of opportunities for capacity building and professional development and establishment of distance learning centers;

-Improvements in working environment at the level of accommodation, equipment, availability of medicines and supplies, and renovation and expansion of infrastructures;

-Provision of basic amenities in rural areas: water, electricity, and transport;

-Sensitization of students to apply to health training

2: “To develop and implement a Task Sharing Policy on HRH by 2017”

2.1: “To develop an operational guideline based on consolidated 2013 WHO guidelines on task sharing to enhance existing Production and Quality Assurance Systems by 2015”

A Task Sharing Policy Guideline [47] was endorsed by the MoHSW on 2 February 2016. These Policy Guidelines will scale up agreed task-sharing practices at all levels of the health care delivery system (dispensary, health center, and district hospital). The Guidelines cover the development of a regulatory framework, the provision of supervision, mentoring, follow-up at regular intervals, and the definition of roles and associated competencies.

2.2: “To implement a system-wide approach that includes representation from other departments across different health cadres including professional associations, regulatory bodies, training institutions, accreditation bodies and policy makers to decide on common areas for task sharing across healthcare cadres by 2017”

The process of developing the Task Sharing Policy and Guidelines (see 2.1) was participatory. In September 2014, a stakeholder forum was convened, during which a research synthesis and evidence on task-sharing were presented, initial inputs on task-sharing were solicited, and practices and experiences with task-sharing were shared. Additional consultations involved professional councils, boards, and associations in 2015. The next step is to develop an implementation plan.