The relationship between EFL teachers’ professional identity, professional self-esteem, and job satisfaction

This study investigated the relationship between secondary school English as a foreign language (EFL) teachers’ professional identity, professional self-esteem, and job satisfaction in the Sidama National Regional State, Ethiopia. For this purpose, ninety-four (N=94) EFL teachers were selected from 10 government secondary schools. Schools and participants were selected using cluster and availability sampling techniques respectively. Adapted professional identity, professional self-esteem, and job satisfaction questionnaires were used. The relationship between the variables was examined via the Pearson correlation coefficients. In addition, structural equation modelling (SEM) was applied to test the direct and indirect effects of professional self-esteem and job satisfaction on professional identity. The analysis of the goodness of fit indices yielded a good model fit. The results of correlational analysis indicated that professional self-esteem (r= 0.81, P= 0.000) and job satisfaction (r= 0.70, P= 0.000) are positively and significantly correlated with professional identity. SEM analysis also indicated that professional self-esteem positively predicted professional identity (β= 0.66, P ≤ 0.001). Congruently, job satisfaction positively predicted professional identity (β= 0.27, P≤ 0.001). Moreover, professional self-esteem indirectly mediated the relationship between job satisfaction and professional identity. Thus, it is recommended to pay a close attention to EFL teachers’ professional identity and some of the interplaying variables

Disentangling HIV and AIDS Stigma in Ethiopia,Tanzania and Zambia

The International Center for Research on Women (ICRW), in partnership with organizations in Ethiopia, Tanzania, and Zambia, led a study of HIV and AIDS-related stigma and discrimination in these three countries. This project, conducted from April 2001 to September 2003, unraveled the complexities around stigma by investigating the causes, manifestations and consequences of HIV and AIDS-related stigma and discrimination in sub-Saharan Africa. It then uses this analysis to suggest program interventions. Structured text analysis of 730 qualitative transcripts (650 interviews and 80 focus group discussions) and quantitative analysis of 400 survey respondents from rural and urban areas in these countries revealed the following main insights about the causes, context, experience and consequences of stigma: The main causes of stigma relate to incomplete knowledge, fears of death and disease, sexual norms and a lack of recognition of stigma. Insufficient and inaccurate knowledge combines with fears of death and disease to perpetuate beliefs in casual transmission and, thereby, avoidance of those with HIV. The knowledge that HIV can be transmitted sexually combines with an association of HIV with socially “improper” sex, such that people with HIV are stigmatized for their perceived immoral behavior. Finally, people often do not recognize that their words or actions are stigmatizing. Socio-economic status, age and gender all influence the experience of stigma. The poor are blamed less for their infection than the rich, yet they face greater stigma because they have fewer resources to hide an HIV-positive status. Youth are blamed in all three countries for spreading HIV through what is perceived as their highly risky sexual behavior. While both men and women are stigmatized for breaking sexual norms, gender-based power results in women being blamed more easily. At the same time, the consequences of HIV infection, disclosure, stigma and the burden of care are higher for women than for men. People living with HIV and AIDS face physical and social isolation from family, friends, and community; gossip, name-calling and voyeurism; and a loss of rights, decision-making power and access to resources and livelihoods. People with HIV internalize these experiences and consequently feel guilty, ashamed and inferior. They may, as a result, isolate themselves and lose hope. Those associated with people with HIV and AIDS, especially family members, friends and caregivers, face many of these same experiences in the form of secondary stigma. People living with HIV and AIDS and their families develop various strategies to cope with stigma. Decisions around disclosure depend on whether or not disclosing would help to cope (through care) or make the situation worse (through added stigma). Some cope by participating in networks of people with HIV and actively working in the field of HIV or by confronting stigma in their communities. Others look for alternative explanations for HIV besides sexual transmission and seek comfort, often turning to religion to do so. Stigma impedes various programmatic efforts. Testing, disclosure, prevention and care and support for people with HIV are advocated, but are impeded by stigma. Testing and disclosure are recognized as difficult because of stigma, and prevention is hampered because preventive methods such as condom use or discussing safe sex are considered indications of HIV infection or immoral behaviors and are thus stigmatized. Available care and support are accompanied by judgmental attitudes and isolating behavior, which can result in people with HIV delaying care until absolutely necessary. There are also many positive aspects of the way people deal with HIV and stigma. People express good intentions to not stigmatize those with HIV. Many recognize that their limited knowledge has a role in perpetuating stigma and are keen to learn more. Families, religious organizations and communities provide care, empathy and support for people with HIV and AIDS. Finally, people with HIV themselves overcome the stigma they face to challenge stigmatizing social norms. Our study points to five critical elements that programs aiming to tackle stigma need to address: Create greater recognition of stigma and discrimination. Foster in-depth, applied knowledge about all aspects of HIV and AIDS through a participatory and interactive process. Provide safe spaces to discuss the values and beliefs about sex, morality and death that underlie stigma. Find common language to talk about stigma. Ensure a central, contextually-appropriate and ethically-responsible role for people with HIV and AIDS While all individuals and groups have a role in reducing stigma, policymakers and programmers can start with certain key groups that our study suggests are a priority: Families caring for people living with HIV and AIDS: programs can help families both to cope with the burden of care and also to recognize and modify their own stigmatizing behavior. NGOs and other community-based organizations: NGOs can train their own staff to recognize and deal with stigma, incorporate ways to reduce stigma in all activities, and critically examine their communication methods and materials. Religious and faith-based organizations: these can be supportive of people living with HIV and AIDS in their role as religious leaders and can incorporate ways to reduce stigma in their community service activitie

The impact of polio eradication on routine immunization and primary health care: A mixed-methods study

Background: After 2 decades of focused efforts to eradicate polio, the impact of eradication activities on health systems continues to be controversial. This study evaluated the impact of polio eradication activities on routine immunization (RI) and primary healthcare (PHC).Methods: Quantitative analysis assessed the effects of polio eradication campaigns on RI and maternal healthcare coverage. A systematic qualitative analysis in 7 countries in South Asia and sub-Saharan Africa assessed impacts of polio eradication activities on key health system functions, using data from interviews, participant observation, and document review.Results: Our quantitative analysis did not find compelling evidence of widespread and significant effects of polio eradication campaigns, either positive or negative, on measures of RI and maternal healthcare. Our qualitative analysis revealed context-specific positive impacts of polio eradication activities in many of our case studies, particularly disease surveillance and cold chain strengthening. These impacts were dependent on the initiative of policy makers. Negative impacts, including service interruption and public dissatisfaction, were observed primarily in districts with many campaigns per year.Conclusions: Polio eradication activities can provide support for RI and PHC, but many opportunities to do so remain missed. Increased commitment to scaling up best practices could lead to significant positive impacts

Good Health at Low Cost 25 years on: lessons for the future of health systems strengthening.

In 1985, the Rockefeller Foundation published Good health at low cost to discuss why some countries or regions achieve better health and social outcomes than do others at a similar level of income and to show the role of political will and socially progressive policies. 25 years on, the Good Health at Low Cost project revisited these places but looked anew at Bangladesh, Ethiopia, Kyrgyzstan, Thailand, and the Indian state of Tamil Nadu, which have all either achieved substantial improvements in health or access to services or implemented innovative health policies relative to their neighbours. A series of comparative case studies (2009-11) looked at how and why each region accomplished these changes. Attributes of success included good governance and political commitment, effective bureaucracies that preserve institutional memory and can learn from experience, and the ability to innovate and adapt to resource limitations. Furthermore, the capacity to respond to population needs and build resilience into health systems in the face of political unrest, economic crises, and natural disasters was important. Transport infrastructure, female empowerment, and education also played a part. Health systems are complex and no simple recipe exists for success. Yet in the countries and regions studied, progress has been assisted by institutional stability, with continuity of reforms despite political and economic turmoil, learning lessons from experience, seizing windows of opportunity, and ensuring sensitivity to context. These experiences show that improvements in health can still be achieved in countries with relatively few resources, though strategic investment is necessary to address new challenges such as complex chronic diseases and growing population expectations

The impact of polio eradication on routine immunization and primary health care: a mixed-methods study.

BACKGROUND: After 2 decades of focused efforts to eradicate polio, the impact of eradication activities on health systems continues to be controversial. This study evaluated the impact of polio eradication activities on routine immunization (RI) and primary healthcare (PHC). METHODS: Quantitative analysis assessed the effects of polio eradication campaigns on RI and maternal healthcare coverage. A systematic qualitative analysis in 7 countries in South Asia and sub-Saharan Africa assessed impacts of polio eradication activities on key health system functions, using data from interviews, participant observation, and document review. RESULTS: Our quantitative analysis did not find compelling evidence of widespread and significant effects of polio eradication campaigns, either positive or negative, on measures of RI and maternal healthcare. Our qualitative analysis revealed context-specific positive impacts of polio eradication activities in many of our case studies, particularly disease surveillance and cold chain strengthening. These impacts were dependent on the initiative of policy makers. Negative impacts, including service interruption and public dissatisfaction, were observed primarily in districts with many campaigns per year. CONCLUSIONS: Polio eradication activities can provide support for RI and PHC, but many opportunities to do so remain missed. Increased commitment to scaling up best practices could lead to significant positive impacts

EnDPoINT: protocol for an implementation research study to integrate a holistic package of physical health, mental health and psychosocial care for podoconiosis, lymphatic filariasis and leprosy into routine health services in Ethiopia

Introduction Neglected tropical diseases (NTDs) causing lower limb lymphoedema such as podoconiosis, lymphatic filariasis (LF) and leprosy are common in Ethiopia. Routine health services for morbidity management and disability prevention (MMDP) of lymphoedema caused by these conditions are still lacking, even though it imposes a huge burden on affected individuals and their communities in terms of physical and mental health, and psychosocial and economic outcomes. This calls for an integrated, holistic approach to MMDP across these three diseases. Methods and analysis The ‘Excellence in Disability Prevention Integrated across NTDs’ (EnDPoINT) implementation research study aims to assess the integration and scale-up of a holistic package of care—including physical health, mental health and psychosocial care—into routine health services for people with lymphoedema caused by podoconiosis, LF and leprosy in selected districts in Awi zone in the North–West of Ethiopia. The study is being carried out over three phases using a wide range of mixed methodologies. Phase 1 involves the development of a comprehensive holistic care package and strategies for its integration into the routine health services across the three diseases, and to examine the factors that influence integration and the roles of key health system actors. Phase 2 involves a pilot study conducted in one subdistrict in Awi zone, to establish the care package’s adoption, feasibility, acceptability, fidelity, potential effectiveness, its readiness for scale-up, costs of the interventions and the suitability of the training and training materials. Phase 3 involves scale-up of the care package in three whole districts, as well as its evaluation in regard to coverage, implementation, clinical (physical health, mental health and psychosocial) and economic outcomes. Ethics and dissemination Ethics approval for the study has been obtained in the UK and Ethiopia. The results will be disseminated through publications in scientific journals, conference presentations, policy briefs and workshops. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made

The Impact of Polio Eradication on Routine Immunization and Primary Health Care: A Mixed-Methods Study

BACKGROUND: After 2 decades of focused efforts to eradicate polio, the impact of eradication activities on health systems continues to be controversial. This study evaluated the impact of polio eradication activities on routine immunization (RI) and primary healthcare (PHC). METHODS: Quantitative analysis assessed the effects of polio eradication campaigns on RI and maternal healthcare coverage. A systematic qualitative analysis in 7 countries in South Asia and sub-Saharan Africa assessed impacts of polio eradication activities on key health system functions, using data from interviews, participant observation, and document review. RESULTS: Our quantitative analysis did not find compelling evidence of widespread and significant effects of polio eradication campaigns, either positive or negative, on measures of RI and maternal healthcare. Our qualitative analysis revealed context-specific positive impacts of polio eradication activities in many of our case studies, particularly disease surveillance and cold chain strengthening. These impacts were dependent on the initiative of policy makers. Negative impacts, including service interruption and public dissatisfaction, were observed primarily in districts with many campaigns per year. CONCLUSIONS: Polio eradication activities can provide support for RI and PHC, but many opportunities to do so remain missed. Increased commitment to scaling up best practices could lead to significant positive impacts.This is the publisher’s final pdf. The published article is copyrighted by the author(s) and published by Oxford University Press on behalf of the Infectious Diseases Society of America. The published article can be found at: http://jid.oxfordjournals.org/.Keywords: health systems, eradication, poliomyelitis, routine immunizatio

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ABSTRACT The Health Extension Program is one of the most innovative community-based health programs in Ethiopia. It is based on the assumption that access to and quality of primary health care in rural communities can be improved through transfer of health knowledge and skills to households. Since it became operational in 2004-2005, the Program has had a tangible effect on the thinking and practices of rural people regarding disease prevention, family health, hygiene and environmental sanitation. It has enabled Ethiopia to increase primary health care coverage from 76.9% in 2005 to 90% in 2010. KEYWORDS Family health, health education, health program, disease prevention, health policy, health priorities, environmental hygiene, sanitation, Millennium Development Goals, Ethiopia 47 MEDICC Review, July 2011, Vol 13, No 3 Peer Reviewed Perspective The fi rst families to be trained are selected by the local government (kebele) administration, HEWs, vCHWs and community leaders based on criteria related to their earlier participation in community health activities and readiness to enroll in the training. Women in the selected families take the lead role in the training, recognizing that women take more responsibility in family care. Other families are selected for training when the fi rst batch graduates. Each group receives 96 hours of training, involving face-toface teaching and household visits in four modules corresponding to the four HEP subprograms: prevention of communicable diseases, family health, environmental and household sanitation, and health education. Formal training continues until all households graduate. HEWs and vCHWs follow up with households regularly. The diffusion model assumes that change happens gradually. As model families change their health practices, they infl uence their neighbors and friends formally in venues such as community meetings, and informally when they get together for social activities such as coffee ceremonies and in idir and mahber, community associations formed for mutual practical support (the former for funeral services, the latter for activities such as harvesting and home-building). The social context gets modifi ed by facilitating discussion of the content of the four HEP modules. As HEP is implemented, household arrangement of rooms and utensils and the availability of pit latrines change the physical structure of the household. One vCHW supervises 10 to 20 households and 70% of HEWs' time is allocated to household visits. HEP is an expression of the government's political will regarding health. WHAT HAS HEP DONE SO FAR? Attribution of results to specifi c programs is always diffi cult because of the multiplicity of factors and actors in the social environment, but tangible improvements in key health indicators have been observed since HEP's implementation began,[2,13] supporting our conclusion that HEP is an effective approach to promoting good health in rural communities. It is now present in all rural agrarian areas and is being expanded to include pastoralist and urban areas. Credit for these improvements ( Analyzing qualitative data collected from the L10K study, HEP's main achievements (as expressed by those benefi ted) can be summarized as follows: [7] HEP has created greater awareness of how to prevent communicable diseases such as malaria, tuberculosis, HIV/AIDS and waterborne disease. Community members interviewed during the L10K study reported that malaria is no longer epidemic. They say that diarrhea and other waterborne diseases and eye infections are decreasing: Also, use of voluntary community health workers appears hard to sustain without some material compensation for extra services rendered to communities. With the government's policy of alignment of health activities, HEP is becoming the focal point of health programming, so increasingly, development partners are also executing their programs through HEP, creating heavier workloads for HEWs. Although the increased integration is positive, HEW burnout has been observed as a result. Career advancement is also a critical issue for HEWs and efforts are being made to address it. CONCLUSIONS Ethiopia's HEP has shown tangible positive impacts on community health, in disease prevention, family health, and environmental hygiene and sanitation. The government has made HEP the foundation of the country's emerging new health system. Local government and community participation is gaining momentum, and the roles and interests of development partners are crystallizing. In order to strengthen HEP, FMOH has embarked on training health offi cers and midwives. Cold storage for vaccines is also being addressed through making refrigerators available. Perspective Peer Reviewed 49 MEDICC Review, July 2011, Vol 13, No 3 Peer Reviewed HEP demonstrates that instead of sticking to traditional health provider and medication-oriented models, context-sensitive and affordable functional models and approaches could be developed to expand primary health care services. Development partners in health were skeptical of HEP at fi rst, but it has now proved to be a more effective approach to preventing disease and instilling skills and knowledge than the village clinic-based approach, which focused more on curative services with less attention to prevention. HEP is now at the center of global health initiatives directed to villages and districts in Ethiopia. Ethiopian health offi cials expect to meet MDGs 4 and 6 and to have made progress toward MDG 5 by 2015. What is more important is that HEP has shown that population behavior patterns can be changed to be more favorable to good health. With strong political will and a sense of purpose, lowincome countries can use innovative approaches to achieve universal coverage of primary health care. REFERENCE

Additional file 1: Table S1. of Job satisfaction and motivation among public sector health workers: evidence from Ethiopia

Cronbach’s Alpha of motivation indices by survey round. Cronbach’s alpha was used to examine the inter-reliability of the scales used and most of the scales had acceptable alpha levels