The global crisis in the health workforce is often expressed in acute shortages and imbalanced distribution of health workers, geographically and professionally. To respond to this crisis at the country level, policies and actions are needed to address the dynamics of the health labor market as well as the production, management, and retention of the health workforce, and to strengthen the performance of existing health systems.

Most low and middle-income countries (LMICs), including Ethiopia, are urgently looking for strategies to not only train more health workers but also improve job satisfaction, motivation, and retention of the health workforce, especially in rural or hard-to-reach areas. While an overwhelming majority of ministries of health and health organizations view job satisfaction and retention as a key strategic imperative, it is not evident in the workforce planning or human resource (HR) management operational practice. In other words, although viewed in such a strong light, very few organizations have formal and effectively implemented job satisfaction and retention strategies. Therefore, the purpose of the study is to identify the factors and approaches to workforce job satisfaction and retention that will assist the Federal Ministry of Health and Regional Health Bureaus in Ethiopia to make evidence-based policy and management decisions regarding the successful recruitment, job satisfaction, and retention of workers in the public health sector.

A cross-sectional study employing both qualitative and quantitative data collection methods was conducted from May 28 to June 14, 2014, in the 9 Regional States and 2 City Administrations of Ethiopia. A total of 1,354 health professionals working in 227 health facilities (hospitals and health centers) were included in this study. The study population included: nurses (n = 424), medical doctors (n = 374), anesthetists (n = 252), midwives (n = 177) and health officers (n = 127); health managers (n = 217). The health professionals and health managers were interviewed using pre-tested, structured questionnaires. In-depth interviews of 63 health managers and senior health workers were also conducted using a separate open-ended interview guide to gather data on existing promising job satisfaction and retention practices. Quantitative data were analyzed using SPSS 20.0 (IBM Corporation) to generate frequencies, percentages, and other descriptive measures. Bivariate analysis was conducted to examine the relationship between the outcomes of interest and several explanatory variables. Recorded qualitative data were transcribed and coded in Atlas ti to generate query reports which were presented thematically.

In this study, overall motivation and job satisfaction among the target cadres of health workers was low. Fewer than half of respondents said that they were satisfied with their jobs and almost 50% said that they were planning to leave their jobs in the next year. Satisfaction with salary and benefits was particularly low amongst all the cadres. Furthermore, working and living conditions such as workload, work-related risks, and hazards, equipment and supplies, water and power supplies at work and home, access to children’s school, safe transport from home to work, and vice versa were deemed unsatisfactory. The workloads were judged to be unmanageable especially for doctors and anesthetists. Healthcare workers were not concerned about losing their jobs and felt relatively secure in their positions.

It is also evident from the results of the study that recognition and appreciation by co-workers and community are highly influential in health worker job satisfaction and that access to basic amenities, supportive supervision, training, safe work environment, adequate supplies and equipment, and appropriate infrastructure are key drivers of job satisfaction and intention to stay.

Lack of professional development was also a very important factor that affects healthcare workers' decision to leave their jobs. Access to professional development was measured using the ratings attached to the following survey items: limited opportunities for in-service training; limited opportunities for promotion; and poor supervision and feedback.

• Job satisfaction
• retention
• Public health sector
• Health profession
• Motivation
• Both qualitative and quantitative
• Human resources
• Region
• Federal Ministry of Health.

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