Health care managers’ perspectives on workforce licensing practice in Ethiopia: A qualitative study (original) (raw)
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Background Evidence suggests that not all human resource departments have hired their facility staff based on federal licensing standards, with some hiring without an active license. This is common in some, if not all, parts of the country. The paucity of healthcare experts, high turnover rates, employee burnout, and challenges in training and development issues were all key recruiting challenges globally. Objectives To assess the practice of health professionals’ licensing and its predictors among hiring bodies in Ethiopia, March 24/2021 –May 23/ 2021. Methods A quantitative technique was used in this institution-based cross-sectional study. From March 24 to May 23, 2021, the study was conducted in selected regional health bureaus, zonal health departments, district health offices, and both private and government-owned health facilities across Ethiopia. A stratified sampling strategy was used per region, followed by a simple random sampling technique. Samples were assigned proporti...
Global Health Research and Policy
Background Health workforce regulation plays key roles in ensuring the availability of competent health workers and improving performance of the health system. In 2010, Ethiopia established a national authority aiming to ensure competence and ethics of health professionals. Subsequently, subnational regulators were established and regulatory frameworks were developed. Although there were anecdotal reports of implementation gaps, there was lack of empirical evidence to corroborate the reports. We conducted a national study to explore health professional regulation practices and gaps focusing on registration, licensing, ethics, scope of practice, and continuing professional development. Methods We conducted a mixed methods cross-sectional survey using structured interview with a national representative sample of health professionals and key informant interviews with health regulators and managers. We used two stage stratified cluster sampling to select health professionals. The quanti...
Framework and Enforcement Strategy for Health Professions Regulation in Ethiopia
2012
This thesis examines the best system for health professions regulation in Ethiopia with a view to sketch the roles of state and non-state actors in that system. It argues for statist regulation as self-regulation is worrisome for its tendency to promote private interest instead over public protection. A statist regulation is an efficient system that is more capable of establishing accountable and procedurally fair processes and strengthening public trust than a system of self-regulation. But the state lacks capacity, expertise, and legitimacy, and risks capture and corruption. These could be resolved through an enforcement strategy rooted in responsive regulation theory. That strategy should emphasize soft regulatory instruments, which requires utilization of the capacity and motivation of non-state actors, particularly health professional associations. A statist regulatory framework that harnesses the contribution of non-state actors in implementing soft regulatory strategies would effectively protect patients and improve the quality of health care services in Ethiopia.
Human Resources for Health, 2017
Background: The introduction of a systematic framework for the licensing of health care professions, which is a crucial step in ensuring the quality of human resources for health (HRH), is still evolving in Lao People's Democraic Republic. The aim of this study was to review and document the evolution of Lao HRH policies and the development of its national licensing system. Case presentation: A qualitative descriptive case study methodology was applied to document and describe how Lao People's Democratic Republic laid the foundation for the development of a licensing system. The results demonstrate that Lao People's Democratic Republic is currently in the process of transitioning the focus of its HRH policies from the quantity and deployment of services to remote areas to improvements in the quality of services. The key events in the process of developing the licensing system are as follows: (1) the systematic development of relevant policies and legislation, (2) the establishment of responsible organizations and the assignment of responsible leaders, (3) the acceleration of development efforts in response to the Association of Southeast Asian Nations Mutual Recognition Arrangement for standard qualifications, (4) the strengthening of educational systems for fostering competent health care professionals, (5) the introduction of a 3-year compulsory service component in rural areas for newly recruited government servants, and (6) the introduction of a requirement to obtain a professional health care certificate to work in a private hospital. The Lao Ministry of Health (MOH) has endorsed a specific strategy for licensing to realize this system. Conclusion: The need for licensing systems has increased in recent years due to regional economic integration and a shift in policy toward achieving universal health coverage. A national licensing system would be a significant milestone in health system development, helping to ensure the competency of health care professionals by means of a national examination, continuing professional development, and the revoking of licenses when appropriate.
2020
Background: In addition to disastrous shortage of health professionals in developing countries, turnover is very detrimental and costly for the country as well as to different organizations. Intention to leave is an immediate sign of employee’s turnover. It is among the most pressing problems of health system of developing countries. However, intention to leave and its determinants were not well known in Ethiopia especially in peripheral areas. Objective: The aim of this study was to assess the magnitude of intention to leave their current job and associated factors among health professionals working in Guji zone public health centers. Methods: Facility based cross-sectional study was conducted among 262 health professional working in Guji zone, Southeast Ethiopia from August 13, to September 02ְ 2018. Intention to leave was measured with intention to leave scale tools with five-point Likert scales items. Data were analyzed using SPSS version 20 software. Both simple and multiple lo...
Developing core competencies for the public health workforce in Ethiopia: The way forward
Ethiopian Journal of Health Development, 2020
Background: Preparing the public health workforce for the 21 st century is a formidable task as public health professionals are expected to address the myriad of political and economic development challenges in the context of limited resources. In spite of achieving most MDGs, the Ethiopian 'health system' continues to face complex and daunting tasks. Method: Available studies that outlined requirements for competent, motivated and empowered workforce in a rapidly evolving global order were reviewed and synthesized without following a formal review procedure. Result: Although it is not easy, in view of available evidences, this synthesis provided the Way Forward to ascertain competencies of public workforce in Ethiopia. Specific details on adopting and sharing competencies; promoting the development of a philosophy and definition of public health; promoting the development of a public health workforce taxonomy; promoting research to inform the design and implementation of reforms; curriculum development; learning materials development; strengthening continuing professional development (CPD); monitoring and evaluation; and setting up a follow-up mechanism for the long-term were defined. Conclusion: This synthesis has suggested clear guidance on how and who may have to track, adopt, share and updates public health core competencies in Ethiopia.
BACKGROUND: Skill mix of health professionals, staff acquisition and turnover rate are among the major challenges for the delivery of quality health care. This study assessed the health workforce acquisition, retention, turnover rate and their intention to leave. METHODS: A cross-sectional survey with quantitative and qualitative data collection methods was conducted in Jimma Zone health institutions. Five years records (September 2009-August 2014) were reviewed to determine the turnover rate. A total of 367 health professionals were included for the quantitative study. For the qualitaive study, all available and relevant health managers and administrative records in the selected health institutions were included. Descriptive and inferential analyses were done for the quantitative study. Thematic analysis was used for the qualitative component. RESULTS: A total of 367 health workers were incorporated for the quantitative study making a response rate of 87%. The overall health workers' satisfaction was neutral (mean 3.3). In five years period, 45.9% staffs had left for a cause; 59.4% health professionals intended to leave. Being male (AOR =1.6, 95%CI: 1.001-2.5), not knowing their overall satisfaction (AOR=0.5, 95%CI: 0.2-0.8), below mean score of institutional satisfaction (AOR =1.7, 95%CI: 1.06-2.7) and below mean score of organizational satisfaction (AOR=1.8, 95%CI: 1.08-2.8) were independent predictors for intention to leave. CONCLUSIONS: The overall health workers' satisfaction was marginally neutral. A considerable number of staffs had left, and more than half of the current staffs had an intention to leave. Thus, it is recommended that the responsible authorities should design strategies to improve the situation.
Global Health Research and Policy
Background: A high performing physician workforce is critical to attain nationally set health sector goals. Ethiopia has expanded training of medical doctors. However, little is known about junior doctors' performance. Understanding medical practice is essential to inform medical education and practice, establish licensure examination and guide workforce management decisions. We conducted a practice analysis study to identify gaps in Ethiopian medical education and practice, and to determine composition of subjects in national licensing examination. Methods: We conducted a cross-sectional study with national representative sample of junior doctors. After calculating a sample size of 198, we used a two-stage stratified cluster sampling method to select study participants. We collected data using a structured questionnaire comprising 222 tasks. Study participants reported in interviews on frequency of, competence at, and importance of doing each task for improved health outcome. We developed proportions, averages, graphs and tables. Using the results of practice analysis and experts' ratings, relative weights of subjects in the national licensing examination for medical undergraduates were determined. Results: A total of 191 junior doctors participated. Most were males (74.6%) and had less than 2 years of experience (69.8%). Junior doctors frequently performed tasks of internal medicine and pediatrics. Their participation in obstetrics and gynecology, ophthalmology, psychiatry and dentistry services was infrequent. Junior doctors had competency gaps to conduct clinical procedures, research and health programming tasks. Practice analysis results and expert ratings generated comparable recommendations for composition of a national licensing examination, with more than threequarters of the items focusing on internal medicine, pediatrics, surgery, obstetrics and gynecology, and public health. Conclusion: Junior doctors in Ethiopia rarely managed psychiatry, ophthalmology and dental patients. They had competence gaps in clinical procedures, research and health programming skills. The findings have implications for establishing licensing examination, and reviewing curriculum, continuing professional development, placement and rotation policy, and distribution of responsibilities.
The Health Workforce in Ethiopia
2012
H ealth indicators in Ethiopia, particularly on child health and malaria, have improved signifi cantly in recent years, with the next challenge now focused on improving maternal health indicators. Improvements in child health and malaria in particular can be a ributed to strong government commitment towards health results, refl ected in a number of notable policies and programs related to Human Resources for Health (HRH), in particular the health extension worker program. However, indicators related to maternal health remain problematic. Ethiopia has one of the lowest levels of assisted deliveries in the region. Although increases in the number of health workers particularly in rural areas may have contributed to improving access to some health services, it is in the government's interest to further improve the stock, distribution, and performance of relevant health workers in Ethiopia, particularly to bring about improvement in access to maternal health services for the poor. This document reviews the current HRH situation in Ethiopia, summarizes the evidence on population use of select health services, and off ers relevant policy options to assist the government fi nalize its new Human Resources Strategy and address remaining health challenges.
Amsalu Asnake, 2019
The purpose of this qualitative study was to explore how health extension workers’ (HEWs’) experience with local governance influences their perceptions and healthcare practices in Ethiopia. The researcher used a qualitative case study, conducting semi-structured interviews with 14 participants who worked as HEWs in Gondar, in the Amhara region. The open-ended questions explored different perceptions of how health extension workers’ (HEWs’) experience with local governance influences their perceptions and healthcare practices. Five themes emerged from the analysis of interview data: (a) the government’s lack of prioritization and significance of HEW’s work; (b) a lack of clarity in lines of accountability, supervision, and responsibility; (c) unmet expectations in working conditions and career advancement; (d) the HEWs’ relationship with Kebele cabinets at times failed to meet objectives due to challenges found in the different work environments, and (e) assignments from the woreda and other government officials can affect the treatment of Tuberculosis patients. The study contributed to an understanding of how and why HEWs in Ethiopia are impacted by the government they serve while implementing healthcare prevention programs. The discussion section focuses on recommendations for future research and the limitations of the study.