Contribution of Human Resources for Health competence and skill mix on compliance with healthcare quality standards among Primary Healthcare Facilities in Tanzania: evidence from dispensaries

Globally, it is known that, there is a close correlation between the concentration of qualified Human Resources for Health (HRH) and key health outcomes. Inadequate numbers with poor skill mix compromise health system functioning that negatively affect delivery of quality healthcare services. This study aims to study the effect of HRH skills and competence mix on the compliance with healthcare quality standards (HCQS) among dispensaries in Tanzania. This is a quantitative secondary data analysis using the Star Rating Assessment (SRA) data collected in the fiscal year 2017/2018 involving 4239 dispensaries majority of which were rural located (81.2%) and public owned (83.6%). Compliance with HCQS was measured by considering service delivery areas of SRA. HRH availability that estimated skill mix status were deduced by considering its recommended number by staffing levels guidelines. Proportions of skill mix status and compliance with HCQS were compared by chi square test while Prevalence Ratios were estimated by Multivariable Poisson Regression with 95% Confidence Interval. On average, 36.8% of dispensaries had skill mix. Results indicated that, the higher the skill mix, the more the compliance with HCQS. Dispensaries with optimal skill mix (APR = 2.68, P < 0.001, 95% C.I = 2.00–3.59), Desirable skill mix (APR = 2.41, P < 0.001, 95% C.I = 2.03–2.86) and poor skill mix status (APR = 1.72, P < 0.001, 95% C.I = 1.48–1.99) were more likely to comply with HCQS compared to dispensaries with no skills mix at all. This study demonstrates the critical role that HRH skill mix has in ensuring adherence to HCQS. The observed challenge of HRH availability and hence skill mix should be worked on. Given that, over two-thirds of Tanzanians who reside in rural areas rely on dispensaries for accessing healthcare services, to achieve equity in healthcare accessibility, deliberate measures including increasing recruitment budgets and equitable distribution of available HRH should be taken to address the challenge.