The internal migration between public and faith-based health providers: a cross-sectional, retrospective and multicentre study from southern Tanzania

Trop Med Int Health. 2013 Jul;18(7):887-97. doi: 10.1111/tmi.12107.


Objective: To assess the magnitude, direction and underlying dynamics of internal health worker migration between public and faith-based health providers from a hospital perspective.

Methods: Two complementary tools were implemented in 10 public and six faith-based hospitals in southern Tanzania. A hospital questionnaire assessed magnitude and direction of staff migration between January 2006 and June 2009. Interviews with 42 public and 20 faith-based maternity nurses evaluated differences in staff perspectives and motives for the observed migration patterns.

Results: The predominant direction of staff movement was from the faith-based to the public sector: 69.1% (n = 105/152) of hospital staff exits and 60.6% (n = 60/99) of hospital staff gains. Nurses were the largest group among the migrating health workforce. Faith-based hospitals lost 59.3% (n = 86/145) of nurses and 90.6% (n = 77/85) of registered nurses to the public sector, whereby public hospitals reported 13.5% (n = 59/436) of nurses and 24.4% (n = 41/168) of registered nurses being former faith-based employees. Interviews revealed significantly inferior staff perspectives among faith-based respondents than their public colleagues. Main differences were identified regarding career development and training, management support, employee engagement and workload.

Conclusion: This study revealed considerable internal health worker migration from the faith-based to the public sector. Staff retention and motivation within faith-based hospitals are not restricted to financial considerations, and salary gaps can no longer uniquely explain this movement pattern. The consequences for the catchment area of faith-based hospitals are potentially severe and erode cooperation potential between the public and private health sector.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Attitude of Health Personnel*
  • Cross-Sectional Studies
  • Female
  • Hospitals, Public*
  • Hospitals, Religious*
  • Humans
  • Interviews as Topic
  • Male
  • Middle Aged
  • Motivation
  • Nurses*
  • Pregnancy
  • Private Sector*
  • Public Sector*
  • Retrospective Studies
  • Surveys and Questionnaires
  • Tanzania
  • Workforce
  • Workload
  • Young Adult