Factors Affecting Health Extension Workers motivation in selected rural districts of Ethiopia

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Addis Abeba Universty


Background: The Health Extension Program (HEP) in Ethiopia is a core component of the broader health system and is one of the strategies implemented with a view to achieving universal coverage of primary health care to the rural population within the context of limited resources. There is scanty evidence on factors influencing motivation of health extension workers (HEWs) in Ethiopia. This study aimed to explore factors affecting motivation of rural HEWs. Methods: A qualitative case study design was used. In depth interview data collection methods carried out for comprehensive understanding of factors affecting motivation among rural HEWs. HEWs working in rural areas are the primary study population. Two districts were selected from Oromia and SNNPR based on accessibility to carry out the research. Sixteen study respondents (no refusal) were sampled considering a wide range of variation in multiple aspects of HEWs like service year, marital status and career level (level III and level IV). The principal investigator collected all data. All interviews were recorded, transcribed, translated, coded and thematically analyzed based on similarities, differences, and associations. Atlas.ti (v 7.5.7) was used to analyze the data. Quality assurance of the study was considered from selection of study design to data analysis and report writing. Result: Factors affecting motivation HEWs were identified at the individual, family, community, and organizational/system levels. Love of work and pride to serve community is personal level motivators. However, workload and burnout were among de-motivating factors at individual level. Moral and domestic work supports are main family level source of HEWs’ motivation. At community level, increased respect, acceptance and task sharing motivated HEWs. On the contrary, less acceptability of health service by the community de-motivated HEWs. Slow progress in career advancement; poor supervision, support and governance from leaders, inadequate material availability, no transfer policy, insufficient financial earning were labeled as de-motivating factor at health system/organizational level. Among the motivating factors at organizational level, regular supportive supervision by health center, availability of supplies and on the job trainings were identified. Conclusions: Workload, remuneration, career advancement, transfer policy and leadership support require more attention. Functional linkage with health center, regular training and community engagement are essential to maintain level of motivation.



Factors Affecting Health Extension Workers motivation