BackgroundDespite the large-scale investment in access to contraceptives, high population growth and unintended pregnancies are posing pressures in Ethiopia where the economy is incapable of holding overpopulation. The aim of this study was to assess and explore socioeconomic and religious differentials in contraceptive uptake.MethodsA mixed-methods phenomenological study was conducted in western Ethiopia, Oromia region. Data were collected through survey with 1352 mothers of reproductive age, interviews with 37 key informants, and 13 focus group discussions with family planning service providers, college instructors and mothers of reproductive age. Multivariate logistic regression model was used to identify factors associated with contraceptives uptake and thematic analysis was used to interpret the qualitative data.ResultsOf mothers included, 68% lived in rural settings and 50% were unable to read and write. Religiously, 42% were Protestant Christian, 30% Orthodox Christian and 25% Muslim. Modern-contraceptives were available at healthcare facilities; however, all mothers have been influenced by religion not to use contraceptives. Muslims were 65% less likely to utilize modern-contraceptives as compared to Orthodox (aOR, .35, 95% CI, .21–.60). All mothers were well informed of any one of modern-contraceptive methods and knew a place to get the service, while their knowledge about contraceptive was limited and their contraceptive uptake was low.ConclusionThough the Ethiopian government has so far improved access to contraceptives, utilization is lagging, mainly due to religious influences, limited contraceptives knowledge in the community, and low home-based contraceptive coverage. Societal attitudes and norms of the community towards modern-contraceptives need to be modified through innovative and culturally appropriate interventions. In countries like Ethiopia, where people’s religious devotion remains reasonably high, knowledge on natural-contraceptive methods is equally important to help religious people make an informed decision about family planning in accordance with their faith.Electronic supplementary materialThe online version of this article (10.1186/s12905-018-0580-6) contains supplementary material, which is available to authorized users.

BackgroundStrong scientific evidence is needed to support low-income countries in building effective and sustainable immunization programs and proactively engaging in global vaccine development and implementation initiatives. This study aimed to implement and evaluate the effectiveness of system-wide continuous quality improvement (CQI) interventions to improve national immunization programme performance in Ethiopia.MethodsThe study used a prospective, quasi-experimental design with an interrupted time-series analysis to collect data from 781 government health sectors (556 healthcare facilities, 196 district health offices, and 29 zonal health departments) selected from developing and emerging regions in Ethiopia. Procedures included baseline quality assessment of immunization programme and services using structured checklists; immunization systems strengthening using onsite technical support, training, and supportive supervision interventions in a Plan-Do-Check-Act cycle over 12 months; and collection and analysis of data at baseline and at the 6th and 12th month of interventions using statistical process control and the t-test. Outcome measures were the coverage of the vaccines pentavalent 3, measles, Bacillus Calmette–Guérin vaccine (BCG), Pneumococcal Conjugate Vaccine (PCV), as well as full vaccination status; while process measures were changes in human resources, planning, service delivery, logistics and supply, documentation, coordination and collaboration, and monitoring and evaluation. Analysis and interpretation of data adhered to SQUIRE 2.0 guidelines.ResultsPrior to the interventions, vaccination coverage was low and all seven process indicators had an aggregate score of below 50%, with significant differences in performance at healthcare facility level between developing and emerging regions (P = 0.0001). Following the interventions, vaccination coverage improved significantly from 63.6% at baseline to 79.3% for pentavalent (P = 0.0001), 62.5 to 72.8% for measles (P = 0.009), 62.4 to 73.5% for BCG (P = 0.0001), 65.3 to 81.0% for PCV (P = 0.02), and insignificantly from 56.2 to 74.2% for full vaccination. All seven process indicators scored above 75% in all regions, with no significant differences found in performance between developing and emerging regions.ConclusionsThe CQI interventions improved immunization capacity and vaccination coverage in Ethiopia, where the unstable transmission patterns and intensity of infectious diseases necessitate for a state of readiness of the health system at all times. The approach was found to empower zone, district, and facility-level health sectors to exercise accountability and share ownership of immunization outcomes. While universal approaches can improve routine immunization, local innovative interventions that target local problems and dynamics are also necessary to achieve optimal coverage.

Background Ethiopia has been providing health care to its rural population since 2004 using female Community Health Workers called Health Extension Workers (HEWs). The HEWs are credited with several achievements in improving the country's health indicators. However, information about the HEWs' motivation and job satisfaction is limited. The aim of this study was to assess the HEWs' motivation and job satisfaction, as well as the factors that influence them. Methods A mixed-methods study was nested within a national health extension program assessment conducted from March 01 to May 31, 2019. A structured questionnaire which looked at motivation and satisfaction with Likert type single-question and multiple-item measures was used to collect quantitative data from 584 HEWs. Focus group discussion and in-depth interviews were used to gather qualitative data. Means and percentages were used to descriptively summarize important variables. Linear regression was used to identify factors associated with job satisfaction. The qualitative data was analysed thematically. Results Overall, 48.6% of HEWs were satisfied with their job, with a mean score of 2.5 out of 4.0. The result showed a high level of satisfaction with autonomy (72%), relationships with co-workers (67%), and recognition (56%). Low level of satisfaction was linked to pay and benefits (13%), opportunities for promotion (29%), and education (34%). Regression analysis showed that HEWs in the age category of 30 years and older had lower satisfaction scores as compared to HEWs in the age category of 18–24 years (adjusted β = − 7.71, 95% CI: − 14.42, − 0.99). The qualitative result revealed that desire to help their community, recognition or respect gained from the community, and achievement were the major motivating factors. In contrast, inadequate pay and benefit, limited education and career advancement opportunities, workload, work environment, limited supportive supervision, and absence of opportunity to change workplace were the demotivating factors. Conclusions The overall job satisfaction of HEWs was low; extrinsic factors, such as inadequate pay, limited education and career advancement opportunities were the major sources of demotivation. Policy makers and human resource managers should revise their human resource policies and guidelines to address the main sources of low level of job satisfaction and demotivation.

Background The existing evidence on households’ ability and willingness to join the community-based health insurance (CBHI) scheme in Ethiopia is inadequate and lacks representativeness and disaggregation. Thus, the aim of this study was to assess the ability to pay (ATP) and willingness to pay (WTP) for CBHI membership and to identify factors that WTP Methods A nationwide cross-sectional household survey, involving both CBHI member and nonmember households, was conducted from February to May 2020. Two-stage stratified cluster sampling was used to select enumeration areas (EAs) and households from within EAs. ATP was measured using the spending net of the poverty line approach. The maximum monetary value that obtained a “yes” response in the bidding game exercise was used as a measure of WTP. Linear regression analysis was used to identify the factors associated with WTP. Results Among the study participants, 30.9% were active members of the scheme. The mean ATP was Ethiopian Birr (ETB) 3,992.45 (USD 139.4) at 10% and ETB 15,969.82 (USD 557.6) at 40% cutoff. The mean WTP was ETB 244 (SD = ETB 175.4) in rural areas and ETB 361.6 (SD = ETB 210.8) in urban areas per household per year. The average WTP was higher if the family size was increased by one person both in rural (AMD = 9.3; 95% CI [6.8, 11.9]) and urban (AMD = 7.2; 95% CI [1.0, 13.4]) settings and positively associated with ATP for CBHI (AMD = 64.1; 95% CI [6.3, 121.8]) in urban settings. The male and literate respondents in urban areas had higher mean WTP values (AMD = 39.8; 95% CI [13.1, 66.4] and AMD = 56.8; 95% CI [26.1, 87.4], respectively) compared to their counterparts. Being a leader in the Health Development Army (HDA), Women’s Development Army (WDA), or a 1:5 network (in urban settings) positively affected WTP (AMD = 23.4; 95% CI [3.4, 43.5]). Conclusions Most households could afford the CBHI premiums at a 10% threshold. Premium revisions based on ATP, while addressing challenges in WTP through an in-depth understanding of modifiable factors and by adopting effective strategies to modify these factors, is crucial.

Background: Ethiopia has been providing health care to its rural population since 2004 using female Community Health Workers called Health Extension Workers (HEWs). The HEWs are credited with several achievements in improving the country's health indicators. However, information about the HEWs' motivation and job satisfaction is limited. The aim of this study was to assess the HEWs' motivation and job satisfaction, as well as the factors that influence them. Methods: A mixed-methods study was nested within a national health extension program assessment conducted from March 01 to May 31, 2019. A structured questionnaire which looked at motivation and satisfaction with Likert type single-question and multiple-item measures was used to collect quantitative data from 584 HEWs. Focus group discussion and in-depth interviews were used to gather qualitative data. Means and percentages were used to descriptively summarize important variables. Linear regression was used to identify factors associated with job satisfaction. The qualitative data was analysed thematically. Result: Overall, 48.6% of HEWs were satisfied with their jobs, with a mean score of 2.5 out of 4.0. The result showed a high level of satisfaction with autonomy (72%), relationships with co-workers (67%), and recognition (56%). Low level of satisfaction was linked to pay, and benefits (13%); opportunities for promotion (29%); and education (34%). Regression analysis showed that HEWs in the age category of 30 years and older had lower satisfaction scores as compared to HEWs in the age category of 18 to 24 years (adjusted β = -7.71, 95% CI: -14.42, -0.99). The qualitative result revealed that desire to help the community, recognition or respect gained from the community, and achievement were the major motivating factors. In contrast, inadequate pay and benefit packages, limited education and career advancement opportunities, workload, work environment, limited supportive supervision, and absence of opportunity to change workplace were the demotivating factors.Conclusion: The overall job satisfaction of HEWs was low; extrinsic factors, such as inadequate pay and benefits, limited education, and career advancement opportunities were the major sources of demotivation. Policy makers and human resource managers should revise their human resource policies and guidelines to address the main sources of low level of job satisfaction and demotivation.