Influence of Internal and External Recruitment Strategies on Employee Retention at the Zanzibar Ministry of Health -

The study focused on influence of recruitment strategies on employee retention. Specifically, the study is assessing the influence of internal and external recruitment strategies on employee’s retention at the Ministry of Health and to examine external rec ruitment strategies influence on employee’s retention. Cross -sectional design was used which involved quantitative research approach. The study total population was 3441 employees of the Ministry of Health in Unguja. The sample size was 358 respondents chosen by simple random sampling techniques. The questionnaire was used for data collection and the analysis was done using regression analysis. The findings from regression analysis showed that the facet of internal recruitment strategies (Promotions, Training and Development, Job Rotation, Transfer, Motivation) and external recruitment strategies (Headhunting, Contractors, Retired, Agencies, Expatriate, Social Media) have significant positive impact on employee retention at Zanzibar ministry of health-Unguja. The study concluded that internal recruitment strategies had high influence on employee retention in the ministry of health. External recruitment strategies were concluded to have little influence on employee retention. The study recommended that the government should increase internal recruitment strategies to improve retain employees in the Ministry of Health.


Introduction
Employee retention is one of the major problems facing companies in the competitive environment.The big business challenge is to align your goals with the growing demand for a balanced organizational climate that meets basic human needs and where work is synonymous with personal fulfillment and fulfillment (Silva et al., 2019).In this sense, managers are increasingly convinced that attracting and retaining good employees goes far beyond paying the best salaries in the market.It is imperative to understand the factors that lead people to stay in a job, since all business action requires financial and human resources, and the latter act better when motivated.Thus, implementing an effective employee retention strategy helps the company to ensure better performance by properly utilizing employee capital (Silva et al., 2019).Employees are the most important asset in any organization, whether they are on permanent, contract or temporary terms of service.In order to achieve their goals and objectives all organizations, including Ministry of Health, need to recruit trained, skilled, committed and engaged employees (Muma et al., 2019).On the other hand, employee retention is the ability of the organization to retain its employees.In addition to that, Ampomah and Cudjor (2015) corroborate that the health and long-term success of any organization depends on employee retention.Therefore, it is the prime task of management to encourage employees to stay in business for a long time.
Furthermore, Bodjrenou et al (2016), stated that globalization has made the competition keener and keener across the industries.This situation affects employees' wellbeing in the sense that organizations pressure their employees to remain more competent to be competitive in their respective industries, (Bodjrenou et al., 2016).To do so, organizations attract the best talents and retain them on the job for the long term by fulfilling their personal and professional needs.Organizations spend a lot of resources on attracting the best talent and train them to get acquainted with the organization's work and its culture.Organizations will be suffering a loss when employees leave their job once they are trained, (Bodjrenou et al., 2016).
In Tanzania Employees' turnover in various organizations is a challenge just as how it is in other parts of the world (Kauki, 2020).There are many factors leading to employees' turnover but the problem of dissatisfaction with work on the organization is argued as the common factor of the turnover (Kauki, 2020) A part from that, the Tanzanian government has recognized the role of retaining employees by enacting employee and labour relations laws, policies and procedures which address number of issues including financial and non-financial incentives as motivational strategies to keep employee movement from public organizations (Esther et al., 2021).These laws and policies have defined other employee benefits which are imperative in increasing employee working morale.However, having such policies and regulations within organizations has not stopped movement of employees from organizations because Employees' turnover in various organizations in Tanzania is a challenge (Kauki, 2020).It is therefore imperative to try to understand why retaining employees today seem to be difficult.Furthermore, the importance of health workers to the effective functioning of healthcare systems is widely recognized (Ndetei et al., 2008).Shortages of health workers constitute a significant barrier to achieving health-related Sustainable Development Goals and expanding health interventions in developing countries (Ndetei et al., 2008).
In Zanzibar, internal migration of workers, from rural/poor areas to urban areas, is just as serious a problem as international migration.Shortages in the health workforce are aggravated by the unequal distribution of health workers as a result of economic, social, professional and security factors that all sustain a steady internal migration of health personnel from rural to urban areas, from the public to the private sector, and out of the health profession itself (Ministry of Health, 2017).Moreover, The Human Resources situation in the Ministry of Health, particularly in hospitals and Primary Health Care Units, has been described as critical in many of the key Ministry of Health policy documents (Health Policy 2012, MKUZA II).The shortages of staff are reported to be responsible for the poor progress towards National and International targets and goals (ZHSSP III) (Ministry of Health, 2017).Furthermore, Zanzibar is seeking to address the challenges of retaining and equitably distributing their health workforces through a variety of interventions.This retention guideline is designed to inform policy deliberations on how to improve retention of human resources for health in hard to retain areas in Zanzibar.The retention guideline options outlined here are based on national experiences and the evidence used for the WHO global recommendations (Ministry of Health, 2017).
In addition to that, the Zanzibar government has recognized the role of retaining employees by providing various guidelines, Circular and procedures which address number of issues including financial and non-financial incentives as motivational strategies to keep employee movement from public organizations, guideline and Circular have defined other employee benefits which are imperative in increasing employee working morale.However, having such guidelines, circular and regulations within organizations has not stopped movement of employees from organizations.Similarly, records obtained from MoH (2022) show that, 6 employees had left 2017, 11 employees had left 2018, 16 employees had left 2019, 19 employees had left 2020, 38 employees had left 2021.High rate of employee turnover increases every year, this problem is highly experienced by Ministry of Health.This prompted the researcher to design the study to investigate the influence of recruitment strategies on employee retention in the Ministry of Health -Zanzibar.

Statement of the Problem
Employees' retention is emerging as a challenge to most of the organizations.Organizations use a diverse array of approaches to retain their efficient employees, because high turnover rate increases the expense of recruiting and training new employees and affect the profitability of the organization (Hussainy, 2019).However, this needed to be proved by the research especially in the context of developing countries including Tanzania, whereby the area of influence of recruitment strategies on employee retention is less researched especially in public organization (Sekiete, 2019).In addition to that, Revolutionary Government of Zanzibar through President Office Constitution, Legal Affairs, Public and Good Governance provides various circular; guidelines and regulation for all Ministries including Ministry of Heath that make employee feel healthy, motivated and satisfied through head of division and unit (POCLAPGG, 2021).
Even after Government of Zanzibar measures including adding incentives in public sectors especially in the Ministry of Health still the problem of high rate of employees turn-over increases every year.The employees who left the Ministry of Health every year were: 2017= 6, 2018= 11, 2019= 16, 2020= 19 and 2021= 38 (Ministry of Health, 2022).This situation leads to decreased performance of the organizations.Various studies have been conducted by researchers such as in Oman by Hussainy (2019), in Malaysia by Rasdi &Chen (2018) andHaider et. al (2015), in Pakistan by Shakeel & But (2015) in Brazil by Silva et. al (2019), is that most of the researchers have focused on the factors that influence employee retention.Therefore, this study focused on the Influence of internal and external recruitment Strategies on Employee Retention at the Ministry of Health so as understand how recruitment strategies influence employee retention.

Theoretical Literature Review
This study used three theories, these are; Herzberg's two factor theory, Maslow's hierarchy of needs theory and the Carrot -and-Stick Theory.
Two-Factor Theory (Herzberg's motivation-hygiene theory): Herzberg (1959) proposed a twofactor theory after he study the factors in the work environment that caused satisfaction and dissatisfaction among the workers, hundreds of workers were interviewed during the times when they were highly motivated to work and other times when they were dissatisfied and unmotivated at work.According to him there were some job factors that resulted in satisfaction while there were other job factors that prevent dissatisfaction.According to Herzberg, the opposite of "Satisfaction" is "No satisfaction" and the opposite of "Dissatisfaction" is "No Dissatisfaction" Herzberg classified these job factors into two categories; hygiene factors and motivation factors.
Maslow's hierarchy of needs theory: This theory was introduced by Abraham Maslow, who saw the human needs in the form of hierarchy ascending from the lowest to the highest (Maslow, 1943).People are motivated to satisfy five levels of needs.The needs were: -Physiological needs, Security needs, Belongingness needs, Esteem needs and Self-Actualization.The Carrot -and-Stick Theory: The Carrot-and-Stick theory of motivation according to McGregor (1960), works under certain circumstances.The means for satisfying main physiological and safety needs can be provided or withheld by management.Employment itself is such a means and so are wages, working conditions, and benefits.By these means the individual can be controlled so long as he is struggling for subsistence.

Empirical Literature Review
A study carried out in South-Eastern Finland University of Applied Science by Bogatova, (2017) on improving recruitment, selection and retention of employees.They used a survey design.The findings show that one of the most productive methods of employee retention is motivation.Without motivation, nobody will have a desire to do the job.Unfortunately, Dpoint group Company is quite poor and need to be enhanced.However, this study is different from this research in term of scope and methodology.Also, the study was conducted few population and it led to be incomplete and inaccurate result.However, this previous study dealt with factor of Employee retention in private sector.
The study carried out in Malaysia by Haider et al (2015) on the Impact of Human Resource Practices on Employee Retention in the Telecom Sector, this study focuses on telecom sector of Pakistan.The most important HR practices have been identified with the help of literature.These practices are training and development, compensation and culture.The findings show that, the results of multiple regressions revealed a significant impact of HR practices on employee retention.Compensation and culture has a positive relationship with employee retention whereas training and development has a negative one.This study guides the management to devise the effective strategies to improve the employee retention.
Another study conducted in Pakistan by Khalid and Nawab (2018) on Employee Participation and Employee Retention in View of Compensation.They used descriptive statistics, correlation, univariate analysis.They used Self-administered questionnaires and distributed to first-line and middle-level employees.The findings of this study show impact of compensation on participation-retention relationship in both sectors, positive relationship with employee retention.However, this study dealt with industries rather than other sectors.
Furthermore, another study in UK by Mathimaran and Kumar (2017) on Employee Retention Strategies -An Empirical researcher used descriptive research to report the factor as such happen.This Study used exploratory research to find the cause and effect.The primary data are those which are collected a fresh and for the first time and thus happen to be in original character.For this project, Primary data were collected with the help of a questionnaire and informal interview was also conducted to get the direct responses of the employees regarding critical factors.Secondary data are those data available already in the books of records.Secondary data was collected from company records and annual reports.The statistical tools were used for analyzing the data collected Percentage method, Mean and standard deviation, Correlation, Chi-square, Weighted average.The finding of this study shows that, it has been inferred that most of the respondents are preferred Flexible working hours in the organization, then the second preferences is a high level of job security.The respondents are given a third rank for team relationship, and then the fourth rank is the nature of the work.And the last rank is held by remuneration, where the employees are respondents' low level satisfaction by remuneration.This study is different of the situation in Zanzibar.Esther et al (2021).Assessment of Factors for High Employee Turnover Rate on Organizational Performance in Ndala Mission Hospital Tabora Tanzania.The finding was, Tanzania specialists, who comprise are not satisfied with working environment.They have long working hours, attending a big number of workloads with poor equipment's while having inadequate remuneration compared to the work load and cost of living.From this study it can be easily noted that demand for specialized staff is the high standard of living as the pull factors which is contributed by economic prosperity of other countries which motivated Tanzanians to leave their current jobs because of substantial differences in earning which reaches up to four times compared to Tanzania remunerations.The study concluded that structural causes are failure of reform in the in Tanzania, particularly human resource management, leading to migration of professionals.The study did not focus on employee retention rather emphasized on factors of employee turn-over.
The study conducted in Kenya by Mbugua et al (2015) on Relationship between Strategic Recruitment and Employee Retention in Commercial Banks in Kenya; In this study A survey design was used to gather the information needed to achieve the objectives.Moreover, Qualitative and quantitative techniques were used.Also, Questionnaires were used to collect the data.The data was analyzed using descriptive statistics mainly percentages and frequency distribution.Correlation and regression analysis were used to test the relationship between the variables.This study found that, there was positive relationship since the coefficient of strategic recruitment is 0.806 which is significantly greater than zero.The t statistics (7.095) was also greater than zero.This demonstrated that the strategic recruitment had a positive influence on the employee retention.With the significant coefficient value of 0.000 which is less than the p-value of 0.05, we reject the null hypothesis that there is no significant relationship between strategic recruitment and employee retention in commercial banks in Kenya.The researcher therefore accepts the alternative hypothesis that there exists a significant relationship between strategic recruitment and staff retention in commercial banks in Kenya.
Another study conducted in Kenya by Muma, et al (2019) on Influence of Recruitment Strategies on Retention of Employees in Universities in Kenya.The study adopted descriptive design and stratified random sampling technique also used Questionnaires were the primary data collection tool.They used a survey design the findings of this study show that delayed communication throughout the recruitment process increases uncertainty and there is lack of transparency in the process not only that, but also found that public universities in particular have poor retention policies and strategies.Also, this study found that 58.5% of retention of employees in universities in Kenya was explained by recruitment strategy.The main findings from the study indicated that recruitment strategies influenced retention of employees in universities in Kenya.Also, this study found that 58.5% of retention of employees in universities in Kenya was explained by recruitment strategy Another study conducted in Tanzania by Sekiete (2019) Influence of Recruitment and Selection Process on Individual Performance in Tanzanian Public Institutions at Tanzania Electric Supply Company Limited (TANESCO), the findings of this study show that, TANESCO uses various recruitment methods to recruit new candidates.Such methods include job advertisements, employee transfer, employee promotion, employment agents, company websites, walk-Ins, Write-Ins, professional bodies and education institutions.Also, the study used Questionnaires and interview to collect data.Furthermore, findings revealed that recruitment and selection process at TANESCO is faced by various challenges including poor HR planning, fewer qualified candidates in the labor market and inefficient job analysis.High value of hiring and selecting favoritism, nepotism, higher positions being subjected to contract employees, lack of adherence to recruitment and selection policy and procedures.All these challenges threaten the organization from obtaining potential candidates and affect individual and organization performance.A part from that, Respondents also perceived the process not to be based on job analysis and that it consumes a lot of time that affects organization performance.

Methodology
This study employed cross-sectional research design involving Ministry of health Zanzibar.The study used a cross-sectional research design because the design attempts to establish cause-effect relationships among the variables (Kothari 2004).The researcher in this study used Quantitative approach.A quantitative approach because taken to analyze and solve problems of complexity and also helps in the decision-making process in addition to that, quantitative approach used to observe situations or events that affect people (Sekaran and Bougie, 2016).The population of this study was all staff at Ministry of Health Zanzibar were chosen for the aim of generating required information which was comprised of a total 3441 staff.(MoH, 2022).A simple random sampling was used to select a sample of 358 from the total population of this study.A questionnaire survey was used for data collection method and it was administered personally.The researcher used the regression analysis to determine the influence of the independent variables to dependent variable (Sekaran and Bougie, 2016).

Study Findings a) Demographic characteristics of respondents
The demographic characteristics analyzed were based on age, sex, number of years worked in the Ministry, level of education and job status.These features are essential because they may suggest the possible reasons for the responses from the participants.The findings in Table 1 indicates below 25 years were 10(2.8%),36-35 were 85 (23.7%), 36-50 were 200 (55.9),51-60 (40 (11.2) and 60 and above years were 23 (6.4%).This implied that all respondents were adults and capable of expressing their experiences with regard to recruitment strategies on employee retention.On the other hand, it also shows that all ages were represented.The data implied that both genders are well represented in the study and thus the findings were free from gender bias.The results in Table 1 imply that the respondents were sufficiently educated and therefore they were in a position to assess recruitment strategies and retention of employees.Also, the findings in Table 1 imply that all the respondents had spent some minimal time in the Ministry and therefore they could be able to give accurate information about recruitment strategies and retention of employees.

b) Influence of Internal recruitment strategies on employee's retention
The regression analysis technique was used to test the predictive power of a set of variables and to assess the relative contribution of each individual variable.Thus, the regression analysis was done to examine the influence of internal recruitment strategies as independent variables on employees' retention as dependent variable.assess the strength of the relationship between the dependent variable and predictor variables as well as the importance of the predictor to the relationship.The beta values were positive and thus implied positive relationship of the predictor variables with the dependent variable.This means that increase of independent variable (predictors) leads to increase of the dependent variable (employee retention).The results in Table 2 show that, the increase of one unit of promotions increases employee retention by 37.3% with significant of 0.001, the increase of one unit of Training and Development increases employee retention by 17.9%, the increase of one unit of Job Rotation increases employee retention by 36.7%, the increase of one unit of Transfer increases employee retention by 59.2%, the increase of one unit of Motivation increases employee retention by 30.7% The internal recruitment strategies were: Promotion; when employees guarantee their movement from officer to head of division, head of unit and others they will be ready to remain in the organization.,Training and Development; when employees get opportunity to participate in the training, seminar or workshop they will be ready to remain in the organization.,Job rotation; when organization rotates employees from different division or department make employees be motivated, satisfied and feel healthy that leads employee to remain within the organization.,Transfer; when employees guarantee with transfer leads more effective in attracting and retaining and reduces turnover and last Motivation like a right to participate in decision making is more suitable which helps in attracting and retaining employees in the organization.
This means that internal recruitment strategies had strong influence on employee retention.This answered the first research question on assessing the influence of internal recruitment strategies on employee retention.The results concurred with the results of Muma et al (2019), who investigated Influence of Recruitment Strategies on Retention of Employees in Universities in Kenya.Although the two studies were of different countries and organization the results seemed similar in that both studies found that internal recruitment strategies influenced employee retention.However, the finding differed with the findings of Sawaneh & Kamara (2019) who evaluated retention strategies on job performance in that the influence of internal recruitment strategies was slightly less with lower correlation coefficients.The regression analysis found the increase of one unit of internal recruitment strategies increases employee retention with significant of less than 0.05.The study findings were slightly different from the study of Rasdi & Chen (2018) who found the correlation coefficients of internal strategies were above 0.987 which indicated strong relationship and strong influence on employee retention.This was because the study was conducted in China which is more developed that Zanzibar and the internal recruitment strategies were more pronounced in developed countries.
c) The influence of External recruitment strategies on employee's retention Also, in this part a researcher use regression analysis as above in order to examine the influence of external recruitment strategies on employees' retention at the ministry of health Zanzibar.The study results in Table 3 show that external recruitment strategies influenced employee retention dismally.The rise with one unit of Headhunting raises employee retention by 3.5%.The rise with one unit of Contractor raises employee retention by 6.8%.The rise with one unit of Retired raises employee retention by 8.0%.The rise with one unit of Agencies raises employee retention by 6.5%.The rise with one unit of Expatriate raises employee retention by 9.0% and the rise with one unit of Social Media raises employee retention by 3.1%.
The external recruitment strategies investigated were: Headhunting, Contractor, Retired, Expatriate and Social Media.The external recruitment strategies had low coefficient ranging from 0.31 to 0.9 displaying the little impact on employee retention.The values of Sig (2-tailed) were less than 0.05, (p <0.05).This implies a relationship between external recruitment strategies and employee retention however it had little impact.The study findings were similar with the findings of Shakeel (2015) which investigated factors of employee retentions as he associated the elements of external recruitment with low influence on employee retention.The findings were also similar to the findings of Silva et al (2019) in Brazil who investigated determinants of Employee Retention and found that external recruitment strategies influenced employee retention in a low manner.

Conclusion
The study concluded that internal recruitment strategies had high influence on employee retention in the ministry of health.External recruitment strategies were concluded to have little influence on employee retention.Human resources are the key and most valuable asset to an organization to achieve competitive advantage; therefore, an effective recruitment strategy that helps to retain employees in the organization is very important to the Ministry of Health.Retaining and attracting key employees is always a challenge, because it has become more difficult due to the competition for skilled employees.Apart from that, given the growing needs for organizations to retain its best employees in the face of competition, the findings of the study suggest that the level of internal recruitment strategies are crucial in influencing the employees' decision to either leave or remain in an organization.

Recommendations
The study recommended the following; the government should increase internal recruitment strategies to improve employee's retention in the Ministry of Health.This included timely promotions, compensation, work environment, training and development etc. this is because it makes employee feel value and belongingness of the organization, comfortable, and satisfied that leads employees to remain in the organization.From the questionnaire responses it was evident that the respondents through regression analysis reveal that internal recruitment strategies have high relation and high influence to employee retention respectively.External recruitment strategies were found to influence employee retention dismally however some of these strategies therefore; the government of Zanzibar through the Ministry of health should have a strategy to protect its employees from adverse effects of these strategies.This strategy helps MoH to improve the growth prospects and also import new perspectives and ideas into the Ministry as well as increase sustainable development of the Organization.

Table 1
Profile of the respondents

Table 2
Coefficients Table for Facet of Internal Recruitment Strategies on Employee Retention

Table 3
Coefficients Table for Facet of External Recruitment Strategies on Employee Retention