Tanzania's public healthcare system is grappling with concerns over unpaid overtime allowances for medical doctors, a longstanding issue affecting workers' welfare and the quality of services. Doctors in public facilities often work extended hours, attending to critically ill patients and responding to emergencies, yet they face delays or non-payment of allowances. This has implications for morale, fatigue, and patient safety. The Medical Association of Tanzania (MAT) has raised concerns over the uneven implementation of government directives governing on-call and overtime allowances.
The issue has gained renewed attention following MAT's concerns over the inconsistent implementation of government directives. Public service regulations provide for compensation when employees perform official duties outside normal working hours. However, doctors' complaints suggest that implementation varies between health facilities, with some paying claims on time while others face delays or fail to settle approved claims. In some facilities, doctors complete and sign forms confirming their night shifts, but payments do not appear on their salaries or bank accounts as expected.
The challenge is particularly acute for doctors who complete long daytime shifts and remain at hospitals overnight to perform emergency surgery, manage trauma cases, or attend to critically ill patients. Budget constraints and limited revenue collections in some councils and hospitals have contributed to the issue. Health authorities have attributed some delays to financial pressures facing health facilities, with funds for on-call allowances provided but not always matching demand. Managers need accurate records of staff working hours to reflect actual service demands and plan budgets accordingly.
A government circular issued in April 2024 raised expectations among health workers, revising on-call allowance rates to Sh60,000 a day for specialist doctors, Sh50,000 for general practitioners, Sh40,000 for degree-holder specialists, and Sh30,000 for other clinical professionals. While the revision increased payable amounts, it created additional financial pressure for some institutions. Hospitals with limited resources have had to balance higher allowance obligations against other operational requirements, including medicines, medical supplies, and staff-related costs.
The consequences of unpaid or delayed allowances extend beyond doctors' finances, affecting patient care and the overall quality of services. A health worker operating for prolonged periods without adequate rest or certainty over compensation may experience declining morale and exhaustion. MAT has urged employers and government authorities to recognise on-call payments as obligations arising from work performed outside normal hours, rather than discretionary benefits. The association has also called for stronger oversight of allowance funds to prevent delays and misappropriation.
Administrative barriers, including limited awareness among newly recruited doctors about procedures for documenting and following up claims, have contributed to the issue. Young professionals may not be familiar with the administrative steps required to submit claims, verify approvals, or pursue delayed payments. Concerns about confrontation with supervisors or professional repercussions may discourage some workers from formally pursuing outstanding payments, creating a culture in which employees continue working despite unresolved grievances.
Government officials have maintained that authorities recognise the contribution of public sector doctors and are consulting through established workers' councils to address outstanding concerns. Health officials stress the need to protect the financial stability of hospitals, balancing decisions on allowances against the need to maintain supplies of medicines, reagents, and other essential medical commodities. Doctors affected by repeated delays say assurances are insufficient without timely improvements, highlighting the need for stronger coordination between the Ministry of Health, local authorities, and health facility managers.
Key points
- Uneven implementation of government directives governing on-call and overtime allowances affects doctors' welfare and the quality of services in public hospitals.
- Limited awareness among newly recruited doctors about procedures for documenting and following up claims contributes to the issue of unpaid overtime allowances.
- Stronger coordination between the Ministry of Health, local authorities, and health facility managers is necessary to address the issue and ensure timely payment of allowances.
