No abstract

The Health Extension Program is one of the most innovative community-based health programs in Ethiopia. It is based on the assumption that access to and quality of primary health care in rural communities can be improved through transfer of health knowledge and skills to households. Since it became operational in 2004-2005, the Program has had a tangible effect on the thinking and practices of rural people regarding disease prevention, family health, hygiene and environmental sanitation. It has enabled Ethiopia to increase primary health care coverage from 76.9% in 2005 to 90% in 2010.

BackgroundAlthough human resources for health have received increased attention by health systems decision-makers and researchers in recent years, insufficient attention has been paid to understanding the factors that influence the performance of health workers. This empirical study investigates the factors that are associated with health worker motivation over time among public sector primary health care workers in Ethiopia.MethodsThe study is based on data from public sector health worker surveys collected through a convenience sample of 43 primary health care facilities in four regions (Addis Ababa, Oromia, Amhara, and Somali) at three points in time: 2003/04, 2006, and 2009. Using a Likert scale, respondents were asked to respond to statements regarding job satisfaction, pride in work, satisfaction with financial rewards, self-efficacy, satisfaction with facility resources, and self-perceived conscientiousness. Inter-reliability of each construct was assessed using Cronbach’s alpha, and indices of motivational determinants and outcomes were calculated for each survey round. To explore the associations between motivational determinants and outcomes, bivariate and multivariate regression analyses were carried out based on a pooled dataset.ResultsAmong the sample public sector health workers, several dimensions of health worker motivation significantly increased over the study period, including two indicators of motivational outcomes—overall job satisfaction and self-perceived conscientiousness—and two indicators of motivational determinants—pride and self-efficacy. However, two other dimensions of motivation—satisfaction with financial rewards and satisfaction with facility resources—significantly decreased. The multivariate analyses found that the constructs of pride, self-efficacy, satisfaction with financial rewards, and satisfaction with facility resources were significantly associated with the motivational outcomes, after controlling for other factors.ConclusionsOverall, the findings support the premise that both financial and non-financial factors are important determinants of health worker motivation in the Ethiopian context. Although the findings do not point to specific interventions that should be introduced, they do suggest possible areas that interventions should target to help improve health worker motivation.Electronic supplementary materialThe online version of this article (doi:10.1186/s12960-015-0083-6) contains supplementary material, which is available to authorized users.

IntroductionNeglected tropical diseases (NTDs) causing lower limb lymphoedema such as podoconiosis, lymphatic filariasis (LF) and leprosy are common in Ethiopia. Routine health services for morbidity management and disability prevention (MMDP) of lymphoedema caused by these conditions are still lacking, even though it imposes a huge burden on affected individuals and their communities in terms of physical and mental health, and psychosocial and economic outcomes. This calls for an integrated, holistic approach to MMDP across these three diseases.Methods and analysisThe ‘Excellence in Disability Prevention Integrated across NTDs’ (EnDPoINT) implementation research study aims to assess the integration and scale-up of a holistic package of care—including physical health, mental health and psychosocial care—into routine health services for people with lymphoedema caused by podoconiosis, LF and leprosy in selected districts in Awi zone in the North–West of Ethiopia. The study is being carried out over three phases using a wide range of mixed methodologies. Phase 1 involves the development of a comprehensive holistic care package and strategies for its integration into the routine health services across the three diseases, and to examine the factors that influence integration and the roles of key health system actors. Phase 2 involves a pilot study conducted in one subdistrict in Awi zone, to establish the care package’s adoption, feasibility, acceptability, fidelity, potential effectiveness, its readiness for scale-up, costs of the interventions and the suitability of the training and training materials. Phase 3 involves scale-up of the care package in three whole districts, as well as its evaluation in regard to coverage, implementation, clinical (physical health, mental health and psychosocial) and economic outcomes.Ethics and disseminationEthics approval for the study has been obtained in the UK and Ethiopia. The results will be disseminated through publications in scientific journals, conference presentations, policy briefs and workshops.