Health professionals’ licensing: the practice and its predictors among health professional hiring bodies in Ethiopia

Abstract

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. Objective To assess the practice of health professionals’ licensing and its predictors among hiring bodies in Ethiopia, March 24/2021–May 23/2021. Methods A cross-sectional study was conducted in privately and publicly funded health facilities throughout Ethiopia. For each region, a stratified sampling strategy was utilized, followed by a simple random sampling method. Documents from the recruiting bodies for health professionals were reviewed. A pretested structured questionnaire and document review tool were used to extract data confidentially. A descriptive analysis of the basic hiring body characteristics was conducted. Hiring body characteristics were analyzed in bivariate and multivariate logistic regression to identify factors associated with best health professionals licensing practice. Data management and analysis were conducted with Epi-Data version 4.4.3.1 and SPSS version 23, respectively. Results The analysis included 365 hiring bodies and 4991 files of health professionals (1581 from private and 3410 from public health organizations). Out of 365 hiring bodies studied, 66.3% practiced health professional licensing. A total of 1645 (33%) of the 4991 professionals whose files were reviewed were found to be working without any professional license at all. Furthermore, about 2733 (55%) have an active professional license, and about 603 (12%) were found to work with an expired license. Being a private facility (adjustedOR = 21.6; 95% CI = 8.85–52.55), obtaining supervision from a higher organ (adjustedOR = 19.7; 95%CI: 2.3–169.1), and conducting an internal audit (adjustedOR = 2.7; 95% CI: 1.15–6.34) were predictors of good licensing practice. Conclusions The licensing of health practitioners was poorly practiced in Ethiopia as compared to the expected proclamation of the country. A system for detecting fake licenses and controlling revoked licenses does not exist in all regions of the country.

Dimensions of Health Care Management Professionalization: A Scoping Review

“…To achieve professionalism, these certifications should be required for all health leaders and managers( 23 , 25 , 28 ).The study conducted by Alemne et al, which focused on hiring health specialists based on licenses, indicates that there are weaknesses in license issuance, and there is no system to detect fraudulent claims and control expired licenses in all regions of the country. In this study, voluntary professional certifications are perceived as a signal of applicants' competencies and potential future performance ( 39 ).…”

Health care managers’ perspectives on workforce licensing practice in Ethiopia: A qualitative study

“…The health workforce regulators in low- and middle-income countries (LMICs) lack the capacity to effectively implement and maintain the system [ 2 , 3 ]. Regulatory agencies in Ethiopia were not effectively discharging their responsibilities due to poor follow-up and inadequate professional registration and licensure practices [ 4 ]. Registration and licensing practices in regions are not supported by an automated human resource management information system.…”

Introducing a National Licensing Examination: the case of Ethiopian Associate Clinician Anesthetists

“…A licensing examination is a standardized examination administered by a state or federal official body at the end of a predefined training program or following graduation to determine whether those new graduates are capable of providing safe and effective independent service and are licensed to practice healthcare in their respective fields of study [44,55,56]. By setting up a system for isolating incompetent practitioners who are not fit for safe clinical practice, licensing exams are believed to improve healthcare quality and maintain patient safety [57,58]. A long-known and frequently quoted example of a licensing examination is the United States Medical Licensing Examination (USMLE), which requires all medical doctors to pass a three-step examination to practice medicine in the United States (US) [59].…”

“…In Chapter Three, the enforcement of the NLE pass or fail decision was reportedly irregular, with occasions of untested or failed graduates joining the practicing workforce, including in universities. A recent national study also revealed that regulation enforcement needed to be improved, with a less reliable system for detecting fake licenses and controlling revoked licenses across regions [58]. Without a mature enforcement system, NLEs will have little impact in driving education quality and, most importantly, preventing less-competent graduates from harming the public with unsafe practices.…”

“…In this regard, education quality assurance, licensing, and accreditation systems are worth considering to standardize the quality of training nationally and regionally. Task-sharing shouldn't be only seen as a short-term solution to fix specialist shortages, but rather a sustainable and longterm approach that focuses on producing a workforce resilient to burnout and other professional challenges (36,(56)(57)(58). Furthermore, it shouldn't be too late to pause and reflect on the different NPAs training models and establish an agreed-upon standardization framework.…”