i

NATURE AND CAUSES OF EMPLOYEE RETENTION IN

PRIVATE AND PUBLIC HOSPITALS
A CASE STUDY OF TEMEKE HOSPITAL AND
HINDUMANDAL HOSPITAL IN DAR ES SALAAM

ii

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
Ayubu Jumanne

A research proposal submitted to the school of public

administration and management in partial fulfilment of the
requirement for the degree of Human Resource Management of
Mzumbe University

LIST OF ABBREVIATIONS
MHSW

Ministry of Health and Social Welfare

iii

WHO

World Health Organization

FGD

Focus Group Discussion

HR

Human Resources

HRM

Human Resources Management

ICT

Information and CommunicationTechnologies

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 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, faithbased) 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 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 employees 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 organizations 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
companys future success. Outstanding employees may leave an organization because they

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 organizations 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
Tanzanias 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).
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 organizations 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.
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

ii.
iii.

organization.
To identify different methods used by the organizations in retaining their best employees.
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

ii.

organization?
What are the methods used by Temeke and Hindumandal Hospitals in retaining their

iii.

employees?
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
employees retention in Tanzanias 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 Tanzanias 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, 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

10

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 pushpull 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 boards 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

11

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 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 workers 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:

12

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 employees decision to stay or leave the job. Herzbergs twofactor theory and Maslows hierarchy of needs are useful in answering that question.
Herzbergs 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-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 Herzbergs 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.

13

Maslow (1943) suggested that people have five types of need, arranged in a definite hierarchy of
importance. According to Maslows 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 Maslows 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 selfactualisation is the need to fulfil ones 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 selffulfilment and esteem are rarely dominant if the individual is pre- occupied striving to fulfil the
basic physiological, safety and social needs (ibid).
Herzbergs two-factor theory (1966, 1987) is in line with Maslows needs hierarchy in the sense
that Herzbergs concept of dis-satisfiers largely equals Maslows basic physiological, safety
and social needs. Likewise, Herzbergs satisfiers are comparable to Maslows 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.
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

14

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 employees 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,

15

2000): Centralized minor administrative procedures involve various government 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 individuals 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:

16

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 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 selfdeployment 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

17

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 in the job. Second,
training, especially overseas training, is a highly priced opportunity to increase ones 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

18

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 organizations
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.

19

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 researchers 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

20

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 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)

21

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.

22

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

23

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 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.

24

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.
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 () scale to
measure internal reliability. Miller et al (2002) confirmed that Cronbachs alpha () 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 () value which will determine the reliability of the
data. (If <0.7, data not reliable, if =/>0.7, data is reliable).

25

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.

26

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
1

ITEM
Proposal preparation
Stationary
Internet services
Typing and Printing
Spiral binding
Field costs
Travel expenses
Daily allowance (questionnaires work)
Data analysis, reporting and dissertation production
Stationary
Internet Services
Typing and Printing
Professional services for data analysis
Hardcover binding
GRAND TOTAL

AMOUNT (Tsh)
10,000
20,000
20,000
7,000
50,000
100,000
10,000
10,000
20,000
50,000
10,000
317,000

27

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