To meet the needs of its people, the government of Ethiopia is working to build up its health workforce. As a result, the nurse-to-population ratio rose from 1 per 5,000 in 2009 to 1 per 2,132 in 2014.1
Despite efforts to retain these workers, however, a recent study of nurses working in public health facilities reported that 50 percent intended to leave their jobs in the next year. One of the nurses who took part in the study reported, “My salary is low… [there is] no housing allowance and [there are] limited opportunities for in-service training and continuing education.”
These findings underscore the pressing need to find new ways to retain frontline health workers. The study, “Factors Affecting Turnover Intentions among Nurses in Ethiopia,” which was co-authored by Jhpiego’s program staff in Ethiopia and partners, recommends targeting incentives to those most at risk of leaving the system: young nurses completing their compulsory service obligations and university-educated nurses. Further, the authors propose that retention efforts should include not only financial incentives, such as higher salaries, but also career-enhancing incentives including opportunities for professional development.
Ethiopia’s health care worker crisis—a reflection of a more profound global health worker shortage—is the focus of the Jhpiego-led Strengthening Human Resources for Health (HRH) project, which is funded by the U.S. Agency for International Development. With the Government of Ethiopia leading the way, Jhpiego has worked to train and place 8,301 midwives and 10,626 health extension workers through the HRH project to date. The focus is on ensuring that the factors that influence the midwives and health extension workers to remain in or leave their posts are addressed through policy, management interventions and other measures to improve their motivation to stay on the job, especially in rural settings. The project also helped develop a nursing-specialty curriculum to meet the needs and demands of incoming student nurses.
The nurse retention study, undertaken through the HRH project, is published in a special maternal and child health issue of the journal World Health & Population. The issue contains a series of articles authored by Jhpiego experts, including Jhpiego President and CEO Leslie Mancuso, and program partners. The articles reflect Jhpiego’s work in strengthening health systems in many of the more than 40 countries where the organization works and the various forms that improvement takes.
The lead article is a summary of lessons learned about program implementation from eight of Jhpiego’s leaders—all with years of field experience. They emphasize the importance of recruiting local talent to address local health system problems—problems best understood by those who live and work nearby—and forming partnerships with governments and international agencies for long-term program impact and value. According to one Jhpiego program manager, “We are seen as a good partner because we are more open to sharing what we are doing and how we are doing [it].”
The issue also contains six short case studies, which cover peer-to-peer clinical governance mentoring in Indonesia, a rapid rollout of new antiretroviral therapy guidelines in Kenya, a review of the Standards-Based Management and Recognition® approach in four African countries, lessons from an unsuccessful media campaign to influence breastfeeding in Pakistan, two studies on pre-service education—primary health clinic placements in Lesotho and e-learning in Ghana—and the use of a task analysis to address gaps in education and the practice of associate medical clinicians in Zambia.
Although these articles explore specific program experiences, their lessons can be applied in other contexts. As one respondent in the lead article said, “Global work allows countries to not have to reinvent the wheel.”
1 Ayalew et al. 2016. Factors affecting turnover intentions among nurses in Ethiopia. World Health & Population. 16(2).