Motivation and job satisfaction of community health workers in Ethiopia: a mixed-methods approach.

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 ß = - 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.

Disparities in Long-Acting Reversible Contraceptive Utilization among Married Women in Ethiopia: Findings of the Ethiopian Demographic and Health Survey.

BACKGROUND: Long-acting contraceptive methods, subdermal implants, and intrauterine devices are reliable, safe, and cost-effective family planning methods. However, these methods are not widely used in Ethiopia despite government effort to increase access. The study is aimed at assessing the rate of utilization of long-acting contraceptive methods among married women and associated factors. METHOD: We analyzed the 2016 Ethiopian Demographic and Health Survey dataset. A total of 2045 married women of reproductive age group, who were using any modern contraceptive method at the time of the survey, were included in the study. Descriptive statistics were computed to characterize the study participants. Bivariate and multivariable logistic regression analyses were performed to identify associated factors, reporting odds ratios (ORs) and 95% confidence intervals (95% CIs). RESULT: The multivariable analyses showed that women educational status, parity, religion, previous history of abortion, desire for more child, and region where the respondents reside were significantly the factors that determine the utilization of long-acting contraceptive. There is a significant regional disparity in long-acting contraceptive utilization. Compared to women residing in Tigray region, those who live in other regions (Afar-Somali, Oromia, Amhara, Benishangul Gumz-Gambela, and Southern Nations Nationalities and People) have low likelihood of using long-acting contraceptive methods. CONCLUSION: Utilization of long-acting family planning method is low in Ethiopia. There is a significant regional disparity in utilizing these methods. Policy makers should promote culture-sensitive and tailored interventions to improve the utilization of long-acting family planning methods.

Factors associated with sanitary conditions of food and drinking establishments in Addis Ababa, Ethiopia: cross-sectional study.

INTRODUCTION: Food borne illness has been a global challenge and it persisted as a major public health problem, which consumes significant amounts of health care resources, particularly in the developing world. Poor sanitary conditions of food and drinking establishments are the major cause for the occurrence of food borne illness. This study assessed sanitary conditions of food and drinking establishments in Arada sub-city, Addis Ababa, Ethiopia. METHODS: A cross-sectional study design with stratified simple random sampling technique was used. Data were collected from 587 licensed food and drinking establishments and their managers, using interviewer administered questionnaire and observation checklist. The data were entered using Epi info version 3.5.3 and analyzed using SPSS version 20. Binary and Multi-variable logistic regression analyses were conducted. RESULTS: The study showed 58.8% of food and drinking establishments were under poor sanitary conditions; only 16.5% of the establishments had a proper liquid waste disposal facility, and only 7.2% had a suitable dish washing facility. Availability of trained managers on hygiene and sanitation (AOR = 2.56, 95% CI: 1.66-3.94); inspection from the respective body (AOR = 4.41, 95% CI: 2.9-6.8) and the distance between kitchen and toilet (AOR = 1.8, 95% CI: 1.1-3.0) were associated factors which affected sanitary conditions. CONCLUSION: A majority of the establishments had poor sanitary conditions; where an absence of sanitary facilities for waste management was major cause. Regulatory bodies should conduct regular inspection on the establishments to promote and ensure proper hygiene and sanitation practices.