Attracting, training and retaining high-quality health workers are critical for a health system to function well, and it is important to know what health workers value in their roles. Many studies eliciting the labour market preferences of health workers have interviewed doctors or medical students, and there has been little research on the job preferences of lower-skilled cadres such as community health workers, mid-skilled clinical care staff such as nurses and midwives, or non-patient facing staff who manage health facilities. This study estimated the job preferences of public health sector community health extension workers (HEWs), care providers including nurses and midwives, and non-patient-facing administrative and managerial staff in Ethiopia. We used a discrete choice experiment to estimate which aspects of a job are most influential to health worker choices. A multinomial logistic regression model estimated the importance of six attributes to respondents: salary, training, workload, facility quality, management and opportunities to improve patient outcomes. We found that non-financial factors were important to respondents from all three cadres: e.g., supportive management [odds ratio (OR) = 2.96, P-value = 0.001] was the only attribute that influenced the job choices of non-patient-facing administrative and managerial staff. Training opportunities (OR = 3.45, P-value < 0.001), supportive management (OR = 3.26, P-value < 0.001) and good facility quality (OR = 2.42, P-value < 0.001) were valued the most amongst HEWs. Similarly, supportive management (OR = 3.22, P-value < 0.001), good facility quality (OR = 2.69, P-value < 0.001) and training opportunities (OR = 2.67, P-value < 0.001) influenced the job choices of care providers the most. Earning an average salary also influenced the jobs choices of HEWs (OR = 1.43, P-value = 0.02) and care providers (OR = 2.00, P-value < 0.001), which shows that a combination of financial and non-financial incentives should be considered to motivate health workers in Ethiopia.

Background: Mistreatment of women during facility-based childbirth is a major violation of human rights and often deters women from accessing skilled delivery in health facilities. In Ethiopia, mistreatment has been documented to occur in up to 49.4% of mothers delivering in health facilities. This study describes the development, implementation and results of a novel intervention to improve respectful maternity care in Ethiopia. Methods: As part of a national initiative to reduce maternal and perinatal mortality in Ethiopia, we developed a novel respectful maternity care training module with three core components: testimonial videos, a skills-building session on communication, and onsite coaching. The respectful maternity care training was conducted in February 2017 in three districts within three regions of Ethiopia. Facility level solutions applied to enhance the experience of care for mothers as a result of the training module were documented. Safe Childbirth Checklist data measuring privacy maintained and birth companion offered during labor and delivery were collected over 27 months from 17 health centers and three hospitals in the three districts. Interrupted time series and a regression analysis were conducted to assess the significance of improvement. Results: Data analysis showed significant improvement in the percentage of births with two elements of respectful maternal care—privacy maintained and birth companionship offered—following the respectful maternity care training, which was sustained beyond the project intervention (regression coefficients ranging from 18% to 77% for births with privacy and with birth companion offered). About 23 local solutions were devised and implemented in the health facilities that improved the experience of care for mothers. Conclusion: This study suggests that integrating the respectful maternity care training into a district-wide quality improvement collaborative is effective in improving respectful maternity care. Use of a multi-pronged approach is especially helpful in enhancing respectful maternity care comprehensively. Testimonial videos helped providers to see their services from their clients’ perspective, while quality improvement training and coaching helped them reflect on potential root causes for this type of treatment and develop effective solutions.

BackgroundDisrespect and abuse (D&A) during childbirth are major violations of human rights and often deter women from accessing skilled delivery in health facilities. In Ethiopia, D&A has been documented to occur in up to 49.4% of mothers delivering in health facilities. This study describes the development, implementation and results of a novel intervention to improve respectful maternity care (RMC) and decrease D&A in three districts in Ethiopia.MethodsAs part of a national initiative to reduce maternal and perinatal mortality in Ethiopia, we developed a novel RMC training module with three core components: testimonial videos, didactic sessions on communication, and onsite coaching. As of February 2017, we implemented the RMC training in three districts within the regions of Oromia; Southern Nations, Nationalities, and People’s; and Tigray. Measures of births with privacy and a birth companion from a 27-month data from 17 health centers and three hospitals were analyzed using STATA version 13 for interrupted time series and a regression analysis was conducted to assess the significance of improvement. Facilitated discussions were conducted among health care providers to gauge the effectiveness of the videos. Facility level solutions applied to enhance RMC were documented. ResultsAn analysis of the effectiveness of integrating RMC using available programmatic data showed significant improvement following the RMC training, which was sustained beyond the project intervention (regression coefficients ranging from 0.18 to 0.77). Several local solutions were devised and implemented in the health facilities to improve the experience of care for mothers. Facilitated discussions with health care providers participating in the RMC training showed improved understanding of patients’ perspectives and the psychosocial needs of their clients. ConclusionThis study suggests that integrating the RMC training into the district-wide quality improvement (QI) collaborative is effective in improving RMC. Use of testimonial videos are especially helpful as they remind providers of the need to treat mothers with dignity and helps them reflect on potential root causes for this type of treatment and develop effective solutions.

Background: Mistreatment during childbirth are major violations of human rights and often deter women from accessing skilled delivery in health facilities. In Ethiopia, mistreatment has been documented to occur in up to 49.4% of mothers delivering in health facilities. This study describes the development, implementation and results of a novel intervention to improve respectful maternity care and decrease mistreatment in three districts in Ethiopia. Methods: As part of a national initiative to reduce maternal and perinatal mortality in Ethiopia, we developed a novel respectful maternity care training module with three core components: testimonial videos, didactic sessions on communication, and onsite coaching. As of February 2017, we implemented the respectful maternity care training in three districts within the regions of Oromia; Southern Nations, Nationalities, and People’s; and Tigray. Measures of births with privacy and a birth companion from a 27-month data from 17 health centers and three hospitals were analyzed using interrupted time series and a regression analysis was conducted to assess the significance of improvement. Facility level solutions applied to enhance privacy and birth companion were documented. Results: Analysis of the effectiveness of integrating respectful maternity care using available programmatic data showed significant improvement following the respectful maternity care training, which was sustained beyond the project intervention (regression coefficients ranging from 0.18 to 0.77). Several local solutions were devised and implemented in the health facilities to improve the experience of care for mothers. Conclusion: This study suggests that integrating the respectful maternity care training into the district-wide quality improvement collaborative is effective in improving respectful maternity care. Multi-pronged approach is especially helpful in enhancing respectful maternity care comprehensively. Use of testimonial videos helped providers to see their services from their clients’ perspective, the quality improvement training and coaching helped them reflect on potential root causes for this type of treatment and develop effective solutions.

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