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SAFM is the largest English language current affairs radio station in South Africa. In its 'Workers on Wednesday' slot the host, live studio guests and call-in audience discussed the reasons for migration of health workers - from rural to urban areas, from the public to the private sector, and from South Africa to other countries - and the effectiveness of incentives to retain health workers in the South African public sector.

The Tanzanian public health sector is losing workers to internal and external migration. This paper examines the implementation of policies to govern non-financial incentives to retain health workers. It examines a range of non-financial incentives, including training; leave; promotion; housing; and a safe and supportive working environment. It also examines the systems for managing personnel and the implementation of incentives as a factor in retention, including the participatory personnel appraisal system; worker participation in discussing their job requirements and welfare; supervision; recognition and respect. Drawing on a review of policy, published and grey literature and on a field stidy of seven districts, including five underserved districts, the paper finds that while a number of incentives exist in policy, their sustainability is eroded by the absence of special earmarked funding for their implementation. Decentralised districts also lack adequate powers and authority to manage health workers weakening their ability to implement non-financial incentives. There was general consensus from health workers and managers that interventions such as training and education, promotion and the provision of safe working and living environments, can be strong motivators if implemented in an effective and sustainable manner. In contrast, health workers interviewed pointed to the demotivating effect of poor implementation of available non-financial incentives. The management and resource barriers to implementing non financial retention incentives are further explored in the paper and recommendations made to strengthen the implementation of incentives. The authors conclude that analysis of issues driving retention needs to take into account both individual and structural factors that shape individual health workers' preference structures and the complex nature of the health care labour market. A trivialised pull and push factors framework in analysing complex problems like retention, will not guide sustainable solutions, which need to be based on an understanding of factors that not only guide the design of incentive regimes, but also the resources, management systems and other factors that enable their implementation in practice.

Public policy can make a difference to people’s health. Health improves with increased wealth. But countries with low per capita national incomes have been able to achieve very high health outcomes when they have directed resources towards primary health care and district health services. Parliaments can contribute to these health outcomes in their debate on, review and approval of government budget allocations and oversight of public spending by the executive. This function is often seen as separate to the legislative role of parliament. But this leaflet argues that in fact, rights and their expression in law can be a powerful tool for parliamentarians when they are arguing the case for increased budget allocations, especially for health, and for these resources to be directed at the areas of health that matter most for equity.

The Tanzanian public health sector is losing workers to internal and external migration. This paper examines the implementation of policies to govern non-financial incentives to retain health workers. It outlines a range of non-financial incentives set in policy in Tanzania, including training; leave; promotion; housing; and a safe and supportive working environment. It also examines the systems for managing personnel and the implementation of incentives as a factor in retention, including the participatory personnel appraisal system; worker participation in discussing their job requirements and welfare; supervision; recognition and respect. Drawing on a review of policy, published and grey literature and on a field study of seven districts, including five underserved districts, the paper finds that while a number of incentives exist in policy, their sustainability is eroded by the absence of special earmarked funding for their implementation.