passages: PMC-2837610-sec-05__text
passages: sec
passages: 1. Background
  The United Republic of Tanzania, is among the many countries in sub-Saharan Africa facing a human resources crisis in its health sector, with a small and inequitably distributed health workforce [1] that shoulders a disproportionately high burden of disease[2]. Although all poor countries in the world face a severe human resource crisis in their health sectors [3,4], the problem is most acute in Sub-Saharan Africa, in which an estimated workforce of 750 000 health workers in the region serves 682 million people [2]. By comparison, the ratio is 10 to 15 times higher in developed countries. Moreover, this estimated workforce of doctors, nurses and allied health workers in Sub-Saharan Africa constitutes 1.3% of the world's health workforce, while Africa suffers from 25% of the world's burden of disease [2].
  A minimum level of a health workforce of 2.5 health workers per 1000 people is required to achieve the Millennium Development Goals [5]. Africa is far from this level with a health workforce density that only averages 0.8 worker per 1000 people, while the world median density of health personnel is 5 per 1000 people [5].
  There is a positive correlation between health worker density and various health indices, most notably infant mortality rate, maternal mortality rates, and various disease specific mortality and morbidity rates [6,7]. An increase in the number of health workers per capita is associated with a notable decline in the rates mentioned above. As a consequence, it has been argued that health worker shortages have impeded the implementation of development goals in many poor countries [8].
  
  