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Background <p>High levels of health workers’ intention to leave and turnover continue to undermine health workforce availability and health system performance, particularly in low- and middle-income countries. Ethiopia has implemented a series of national Human Resources for Health (HRH) policy and programmatic interventions aimed at improving health worker motivation, retention and working conditions. This study compared intention to leave and turnover among selected health professionals between 2014 and 2022 and explored changes observed during the implementation period of these interventions.</p> Methods <p>A repeated cross-sectional mixed-methods study was conducted using nationally representative surveys in 2014 and 2022. Both surveys employed the same structured questionnaire and a two-stage cluster sampling design, with sample sizes calculated assuming a 95% confidence level, 5% margin of error and 10% non-response rate. The 2014 survey included 1,356 health workers from 224 health facilities, while the 2022 survey included 1,754 health workers from 176 facilities. In addition, qualitative key informant interviews were conducted in 2022 with health sector leaders, managers and health workers involved in implementing HRH motivation and retention interventions to provide contextual insights into the quantitative findings. Quantitative data were analysed using SPSS, while qualitative data were analysed using thematic analysis.</p> Results <p>Between 2014 and 2022, intention to leave declined from 49.0% to 17.5% (absolute reduction: 31.5% points; <i>p</i> &lt; 0.001), while the annual turnover rate decreased from 4.5% to 3.5% (absolute reduction: 1.0% point; <i>p</i> &lt; 0.001) among medical doctors, health officers, nurses, midwives and anaesthetists. Similar reductions were observed in both hospitals (47.3% to 17.9%) and health centres (51.4% to 16.1%). Annual turnover also declined among medical doctors, nurses and anaesthetists. Key informants perceived improvements in selected financial and non-financial incentive packages, training opportunities, supportive supervision and workplace allowances. However, inadequate housing, unfair supervisory practices, low salaries, increasing costs of living and workplace safety concerns remained important challenges affecting workforce retention.</p> Conclusions <p>Substantial reductions in health workers’ intention to leave and turnover were observed during the implementation period of Ethiopia’s national HRH policy and programmatic interventions. Although qualitative findings suggest perceived improvements in several workforce retention strategies, the repeated cross-sectional design does not permit causal attribution of the observed changes to the interventions. Persistent concerns regarding remuneration, housing, supervision and rising living costs indicate that continued investment in both financial and non-financial retention strategies remains essential for strengthening Ethiopia’s health workforce.</p>

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The role of program and policy level interventions in addressing intention to leave and turnover among health workers in Ethiopia – a repeated cross-sectional study

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  • 出版模式：

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  • 发表日期：

    2026年7月29日

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  • Jemal Mohammed Ali,
  • Zeine Abosse,
  • Tegbar Yigzaw Sendekie,
  • Jelle Stekelenburg,
  • Shelemo Shawula,
  • Asfaw Demissie,
  • Mesfin Goji,
  • Miruts Goshu,
  • Gizachew Yismaw,
  • Firew Ayalew

摘要

Background

High levels of health workers’ intention to leave and turnover continue to undermine health workforce availability and health system performance, particularly in low- and middle-income countries. Ethiopia has implemented a series of national Human Resources for Health (HRH) policy and programmatic interventions aimed at improving health worker motivation, retention and working conditions. This study compared intention to leave and turnover among selected health professionals between 2014 and 2022 and explored changes observed during the implementation period of these interventions.

Methods

A repeated cross-sectional mixed-methods study was conducted using nationally representative surveys in 2014 and 2022. Both surveys employed the same structured questionnaire and a two-stage cluster sampling design, with sample sizes calculated assuming a 95% confidence level, 5% margin of error and 10% non-response rate. The 2014 survey included 1,356 health workers from 224 health facilities, while the 2022 survey included 1,754 health workers from 176 facilities. In addition, qualitative key informant interviews were conducted in 2022 with health sector leaders, managers and health workers involved in implementing HRH motivation and retention interventions to provide contextual insights into the quantitative findings. Quantitative data were analysed using SPSS, while qualitative data were analysed using thematic analysis.

Results

Between 2014 and 2022, intention to leave declined from 49.0% to 17.5% (absolute reduction: 31.5% points; p < 0.001), while the annual turnover rate decreased from 4.5% to 3.5% (absolute reduction: 1.0% point; p < 0.001) among medical doctors, health officers, nurses, midwives and anaesthetists. Similar reductions were observed in both hospitals (47.3% to 17.9%) and health centres (51.4% to 16.1%). Annual turnover also declined among medical doctors, nurses and anaesthetists. Key informants perceived improvements in selected financial and non-financial incentive packages, training opportunities, supportive supervision and workplace allowances. However, inadequate housing, unfair supervisory practices, low salaries, increasing costs of living and workplace safety concerns remained important challenges affecting workforce retention.

Conclusions

Substantial reductions in health workers’ intention to leave and turnover were observed during the implementation period of Ethiopia’s national HRH policy and programmatic interventions. Although qualitative findings suggest perceived improvements in several workforce retention strategies, the repeated cross-sectional design does not permit causal attribution of the observed changes to the interventions. Persistent concerns regarding remuneration, housing, supervision and rising living costs indicate that continued investment in both financial and non-financial retention strategies remains essential for strengthening Ethiopia’s health workforce.