Rural health extension workers’ intention to leave their jobs and associated factors, North Wollo Zone, northeast Ethiopia

Background: The intention to leave primary jobs has risen in importance in the global dialogue on the health workforce. The related concept of staff turnover has also generated debate. This study was conducted to assess health extension workers’ intention to leave their jobs in North Wollo Zone, northeast Ethiopia. Methods: A cross-sectional study was conducted in North Wollo Zone from February to April 2016. Using a multi-stage stratified sampling technique, a total of 383 participants were selected. The data were entered into EpiData version 3.1 and exported to SPSS version 20 for analysis. Bivariable and multivariable logistic regression analyses were employed to identify significant factors. Odds ratios (ORs), 95% confidence intervals (CI), and p-values were used to measure the strength and presence of statistical associations. Results: The study showed that 64.1% (95% CI: 59.2, 69) of health extension workers had an intention to leave their jobs. Statistically significant factors were: low salary (AOR = 2.23; 95% CI: 1.98, 4.25); high workload (AOR = 2.78; 95% CI: 1.46, 5.31); dissatisfaction with educational opportunities (AOR = 3.74: 95% CI: 1.56, 8.27); dissatisfaction with payments and benefits (AOR = 3.32; 95% CI: 1.87, 6.68); dissatisfaction with the lack of recognition (AOR = 2.15; 95% CI: 1.18, 3.63); and dissatisfaction with working environments (AOR = 1.96; 95% CI: 1.18, 3.52). Conclusions: The proportion of participants who intended to leave their jobs was high. Hence, developing evidence-based retention strategies focusing on payments, educational opportunities, incentives, and work environment could help reduce the intention of health extension workers to leave their jobs. [Ethiop. J. Health Dev. 2020; 34(2):106-113] Keywords: Intention to leave, health extension workers, North Wollo Zone, Ethiopi

How to optimize health facilities and community linkage in order to enhance immunization service? The case of West Amhara Region, Ethiopia

AbstractBackground: Health facility-community linkages are important in designing community-level interventions, appropriate immunization service provision modalities, and changing unhealthy behaviors. However, there is limited evidence on the influence of community and facility linkage on vaccination services in Ethiopia.Aim: This study aimed to explore how the linkage between health facilitiesa and the community could be optimized in order to enhance immunization services.Methods: A Phenomenological study design, using an explanatory approach was applied in the two districts (Shebele Berenta & South Achefer district) of the Amhara region for the month of June , 2020. Forty-six key informants were interviewed using an interview guide and data was analyzed using open code version 4.02. The data was coded, and thematic analysis was applied.Results: The finding revealed that there were community platforms to facilitate community and health facility linkage. Respondents also perceived that the community to health facility linkage was an effective strategy for the Expanded Program on Immunization (EPI) service provision. The study revealed that perception of health care providers, health care providers attitude and practices, shortages of stock (medication and supplies), distance from main road and transportation, irregularity in the implementation of rules and regulations, lack of incentives, inadequate counseling and support, lack of awareness, shortages of human resources and lack of training support for health care workers were barriers for effective community-health facility linkage.Conclusion: The linkage of community and facilities were not approached in the same manner within districts and facilities. Therefore, strengthening a common system for community-health facility linkage and community engagement is critical during immunization services. Establishing a strong strategy of incentivizing mechanisms is vital for the effective implementation of immunization services. An advocacy strategy to mobilize engagement among policy and decision-makers, and other key stakeholders was an important strategy for improving the program. [Ethiop. J. Health Dev. 2021; 35(SI-3):75-85]Keywords: Community, Facility linkage, EPI, Amhara Region, Ethiopi

Willingness to pay for cataract surgery and associated factors among cataract patients in Outreach Site, North West Ethiopia.

IntroductionIn Ethiopia, cataract surgery is mainly provided by donors free of charge through outreach programs. Assessing willingness to pay for patients for cataract surgery will help explain how the service is valued by the beneficiaries and design a domestic source of finance to sustain a program. Although knowledge concerning willingness to pay for cataract surgery is substantive for developing a cost-recovery model, the existed knowledge is limited and not well-addressed. Therefore, the study aimed to assess willingness to pay for cataract surgery and associated factors among cataract patients in Outreach Site, North West Ethiopia.MethodsA cross-sectional outreach-based study was conducted on 827 cataract patients selected through a simple random sampling method in Tebebe Gion Specialized Hospital, North West Ethiopia, from 10/11/2018 to 14/11/2018. The data were collected using a contingent valuation elicitation approach to elicit the participants' maximum willingness to pay through face to face questionnaire interviews. The descriptive data were organized and presented using summary statistics, frequency distribution tables, and figures accordingly. Factors assumed to be associate with a willingness to pay were identified using a Tobit regression model with a p-value of ResultsThe study involved 827 cataract patients, and their median age was 65years. About 55% of the participants were willing to pay for the surgery. The average amount of money willing to pay was 17.5USD (95% CI; 10.5, 35.00) and It was significantly associated with being still worker (β = 26.66, 95% CI: 13.03, 40.29), being educated (β = 29.16, 95% CI: 2.35, 55.97), free from ocular morbidity (β = 28.48, 95% CI: 1.08, 55.90), duration with the condition, (β = -1.69, 95% CI: -3.32, -0.07), admission laterality (β = 21.21, 95% CI: 3.65, 38.77) and remained visual ability (β = -0.29, 95% CI (-0.55, -0.04).ConclusionsParticipants' willingness to pay for cataract surgery in outreach Sites is much lower than the surgery's actual cost. Early intervention and developing a cost-recovery model with multi-tiered packages attributed to the neediest people as in retired, less educated, severely disabled is strategic to increase the demand for service uptake and service accessibility

Willingness to pay for community-based health insurance and associated factors among rural households of Bugna District, Northeast Ethiopia

Abstract Objective Community based health insurance schemes are becoming recognized as powerful method to achieve universal health coverage and reducing the financial catastrophic shock of the community. Therefore, this study aimed to assess willingness to pay for community-based health insurance and associated factors among rural households of Bugna District, Ethiopia. Results A total of 532 study participants were included in the study. The finding indicated that 77.8% of the households were willing to pay for the community-based health insurance. The average amount of money the households were willing to pay per household per annum was 233 ETB ($11.12 USD). The result of the study also revealed that attending formal education[ß = 3.20; 95% CI = 1.87, 4.53], history of illness [ß = 2.52; 95% CI = 1.29, 3.75], household size [ß = 0.408; 95% CI = 0.092, 0.724], awareness about the scheme [ß = 2.96; 95% CI = 1.61, 4.30], and wealth status [ß = 5.55; 95% CI = 4.19, 6.90] were factors significantly associated with willingness to pay. Therefore, enhancing awareness of the community about the scheme, considering the amount of premium as per household family size and wealth status might increase household’s willingness to pay for community-based health insurance