Key factors influencing motivation among health extension workers and health care professionals in four regions of Ethiopia: A cross-sectional study

• Published in: PloS one Vol. 17; no. 9; p. e0272551
• Main Authors: Abate, Mehiret, Mulissa, Zewdie, Magge, Hema, Bitewulign, Befikadu, Kiflie, Abiyou, Biadgo, Abera, Alemu, Haregeweyni, Seman, Yakob, Woldesenbet, Dorka, Estifanos, Abiy Seifu, Parry, Gareth, Quaife, Matthew
• Format: Journal Article
• Language: English
• Published: San Francisco Public Library of Science 30.09.2022; Public Library of Science (PLoS)
• Subjects: Biology and Life Sciences; Cross-sectional studies; Data collection; Evaluation; Factor analysis; Health aspects; Health care; Health facilities; Interviews; Job satisfaction; Likert scale; Maternal & child health; Medical personnel; Medicine and Health Sciences; Motivation; People and Places; Physical Sciences; Primary care; Professionals; Psychological aspects; Quality improvement; Research and Analysis Methods; Sample size; Social Sciences; Team leaders; Workers; Working conditions; Ethiopia; Tanzania
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0272551

Although Ethiopia has improved access to health care in recent years, quality of care remains low. Health worker motivation is an important determinant of performance and affects quality of care. Low health care workers motivation can be associated with poor health care quality and client experience, non-attendance, and poor clinical outcome. Objective this study sought to determine the extent and variation of health professionals' motivation alongside factors associated with motivation. We conducted a facility based cross-sectional study among health extension workers (HEWs) and health care professionals in four regions: Amhara, Oromia, South nations, and nationalities people's region (SNNPR) and Tigray from April 15 to May 10, 2018. We sampled 401 health system workers: skilled providers including nurses and midwives (n = 110), HEWs (n = 210); and non-patient facing health system staff representing case team leaders, facility and district heads, directors, and officers (n = 81). Participants completed a 30-item Likert scale ranking tool which asked questions across 17 domains. We used exploratory factor analysis to explore latent motivation constructs. Of the 397 responses with complete data, 61% (95% CI 56%-66%) self-reported motivation as "very good" or "excellent". Significant variation in motivation was seen across regions with SNNPR scoring significantly lower on a five-point Likert scale by 0.35 points (P = 0.003). The exploratory factor analysis identified a three-factors: personal and altruistic goals; pride and personal satisfaction; and recognition and support. The personal and altruistic goals factor varied across regions with Oromia and SNNPR being significantly lower by 0.13 (P = 0.018) and 0.12 (P = 0.039) Likert points respectively. The pride and personal satisfaction factor were higher among those aged > = 30 years by 0.14 Likert scale points (P = 0.045) relative to those aged between 19-24years. Overall, motivation was high among participants but varied across region, cadre, and age. Workload, leave, and job satisfaction were associated with motivation.