Why measure the retention of health workers within borders? Lessons learned from the ETATMBA program in measuring health workforce retention in Malawi and Tanzania

Health workforce retention is a recognised strategy for alleviating the health workforce scarcity in low-and middle-income countries. However, there is a lack of clarity on what retention is and how it is measured. We followed up with health workers who participated in the ETATMBA program, an in-service training program from selected healthcare facilities in Malawi and Tanzania, once per quarter, for five years, to determine their retention. We measured retention in three aspects: i) duration of stay in target healthcare facilities, ii) retention in clinical roles, and iii) retention in government employment. We tracked 127 participants, 46 in Malawi and 81 in Tanzania. At the end of tracking, the retention in each aspect measured was different. In Malawi, the retention in target facilities was 47.2%, the retention for clinical roles was 69.5%, and retention for government employment was 76.1%. In Tanzania, the rates were 45.7%, 72.8%, and 76.5%, respectively. The extent of workforce retention depends on the parameters chosen to measure it. Standard indicators for workforce retention needs to be outlined to streamline retention measurement, inform health policies and improve human resources for health planning.