School of Public Health, Haramaya University, Harar, Ethiopia.
Federal Ministry of Health, Addis Ababa, Ethiopia.
Hum Resour Health. 2022 Feb 19;20(1):20. doi: 10.1186/s12960-022-00716-1.
The Health Extension Program (HEP) is Ethiopia's flagship community health program, launched in 2003. Health Extension Workers (HEWs) are key vehicles for the delivery of the HEP. While it is believed that there is high attrition among HEWs, the magnitude of or reasons for attrition is unknown. Their intention to leave their jobs in the next 5 years has also never been investigated on a national scale. This study aimed to assess the magnitude of, and factors affecting HEWs' attrition and intention to leave in Ethiopia.
The study used mixed methods to address the research objectives. Using stratified random sampling and regions as strata, 85 districts from nine regions were randomly selected in Ethiopia. Within each study district, six kebeles (village clusters) were randomly selected, and all HEWs working in these kebeles were interviewed to capture their 5-year intention to leave. The study team developed a data-extraction tool for a rapid review of district-level documents covering the period June 30, 2004 through June 30, 2019 to gather their attrition figures. We used survival analysis to model attrition data and checked model goodness-of-fit using the Cox-Snell residual test. We additionally collected qualitative data from HEWs who had left their positions.
The attrition of HEWS over the lifespan of the HEP was 21.1% (95% CI 17.5-25.3%), and the median time to exit from HEWs workforce was 5.8 years. The incidence rate was 3.1% [95% CI 2.8-3.4]. The risk of attrition was lower amongst HEWs with level four certifications, with children, and among those working in urban settings. By contrast, HEWs who were not certified with a certificate of competency (COC), who were deployed after 2008, and those who were diploma/degree holders were more likely to exit the HEWs workforce. The magnitude of intention to leave was 39.5% (95% CI 32.5-47%) and the primary reasons to leave were low incentives, dearth of career development opportunities (50.8%), high workload (24.2%), and other psychosocial factors (25%).
Although the magnitude of attrition is not worryingly high, we see high magnitude in HEWs' intention to leave, indicating a dissatisfied workforce. Multiple factors have contributed to attrition and intention to leave, the prevalence of many of which can be reduced to fit the needs of this workforce and to retain them for the sustained delivery of primary healthcare in the country. Ensuring HEWs' job satisfaction is important and linked with their career development and potentially higher rates of retention.
健康拓展计划（HEP）是埃塞俄比亚的旗舰社区卫生计划，于 2003 年启动。健康拓展工作人员（HEWs）是提供 HEP 的主要手段。虽然人们认为 HEWs 的离职率很高，但离职的规模或原因尚不清楚。他们在未来 5 年内离开工作岗位的意愿也从未在全国范围内进行过调查。本研究旨在评估埃塞俄比亚 HEWs 离职和离职意愿的规模以及影响因素。
该研究使用混合方法来实现研究目标。使用分层随机抽样和地区作为分层，从 9 个地区中随机选择了 85 个区。在每个研究区，随机选择 6 个 kebeles（村庄集群），对在这些 kebeles 工作的所有 HEWs 进行采访，以了解他们在未来 5 年内离职的意愿。研究团队为快速审查 2004 年 6 月 30 日至 2019 年 6 月 30 日期间的地区一级文件制定了一个数据提取工具，以收集离职人数。我们使用生存分析来对离职数据进行建模，并使用 Cox-Snell 残差检验检查模型拟合度。我们还从已经离职的 HEWs 那里收集了定性数据。
HEP 生命周期内 HEWs 的离职率为 21.1%（95%CI 17.5-25.3%），HEWs 离开劳动力的中位时间为 5.8 年。发病率为 3.1%[95%CI 2.8-3.4]。拥有四级证书、有子女和在城市工作的 HEWs 的离职风险较低。相比之下，没有获得能力证书（COC）的 HEWs、2008 年后部署的 HEWs 和持有文凭/学位的 HEWs 更有可能离开 HEWs 劳动力队伍。离职意愿的幅度为 39.5%（95%CI 32.5-47%），离职的主要原因是激励措施低、缺乏职业发展机会（50.8%）、工作量大（24.2%）和其他社会心理因素（25%）。
尽管离职率的幅度并不令人担忧，但我们看到 HEWs 离职意愿的幅度很高，表明员工不满意。多种因素导致了离职和离职意愿，其中许多因素的流行程度可以降低，以适应这一劳动力队伍的需求，并留住他们，以持续提供国家初级保健。确保 HEWs 的工作满意度很重要，这与他们的职业发展以及潜在的更高留任率有关。
