Employee retention initiatives_study_report-rev

i

Report on assessment of the health workforce retention initiatives

in Ethiopia

A Collaborative Work

2011

December, 2011

i

Consultant:

Fikru Tessema (DSc, BSc. MSc)

Public Health Professional

M&E Specialist

ii

Acknowledgments

This study was done with the support and contributions of the various experts of the HR directorate of FMoH, experts from the HR regional health bureaus, respective health facility HR managers. We are grateful for sharing their ideas; discuss their own views and experiences. We thank the World Health Organization, Ethiopia, country Office for having supported this initiative as part of its biennium activity, both technically and financially. Mr Fikru Tessema, consultant, also provided a technical expertise in data collection and analysis for report writing of this document. Lastly, we would like to state that while every attempt has been made to ensure that the information provided is accurate, some of the facts and figures may not be updated.

iii

Acronyms

AA : Addis Ababa

BoH : Bureau of Health

CEOs : Chief Executive Officers

ETB : Ethiopian Birr

FMoH : Federal Ministry of Health

GPs : General Practitioners

HCHs : Health Centre Heads

HR : Human Resources

HRH : Human Resources for Health

HSDP : Health Sector Development Programme

HRD : Human Resources Department

MDs : Medical Directors

MoCS : Ministry of Civil Servant

MoE : Ministry of Education

MoFED : Ministry of Finance and Economic Development

SNNPR : Southern Nations and Nationalities Peoples Region

iv

Contents Page

Acknowledgments .................................................................................................................................. i

Acronyms .............................................................................................................................................. iii

1. Introduction .................................................................................................................................... 1

2. Methodology .................................................................................................................................. 3

3. Findings .......................................................................................................................................... 4

3.1 Study sites and participants .................................................................................................... 4

3.2 Presence and implementation of policies and regulations on retention by level of the health

care systems ....................................................................................................................................... 4

3.3 Presence and implementation of plans for retention by level of the health care systems ..... 4

3.4 Typology of Motivation and retention schemes for employees ............................................. 5

3.4.1 Financial incentives ............................................................................................................. 5

3.4.2 Non-financial incentives ...................................................................................................... 9

4. Discussion and Conclusion ............................................................................................................ 10

5. Recommendations ....................................................................................................................... 11

References ........................................................................................................................................... 12

Annexes ................................................................................................................................................ 13

1

1. Introduction

An effective Employee Retention Program is a systematic effort to create and foster an

environment that encourages employees to remain employed by having policies and practices

in place that address their diverse needs. “Retention” is defined as an increase of numbers of

health workers staying in rural and urban areas as a consequence of specific policy

interventions [1, 2].

In the Health Sector Development Programme Four (HSDP IV), improving human capital and

leadership is one of the strategic objectives that entail human resource planning, development

and management including recruitment, retention and performance management. The

expected outcome of this strategic objective is adequate, availability of skilled and motivated

health staff and committed to work and stay in a well managed sector [3].

HSDP-IV will use a mix of strategies to achieve these outcomes, including:

Ensuring demand driven production of human resources;

Maximizing use of available resources in producing key categories of health workers for

which there is scarce supply;

Improving inter-sectoral collaboration in HRD;

Enhancing private sector involvement in HRH development;

Enhancing quality assurance in the training of health professionals;

Using appropriate ICT to enhance quality & efficiency of medical education;

Improving geographic distribution of HRH;

Strengthening the regulatory system;&

Enhancing cost-effectiveness in staff retention & motivation schemes.

The way staff retention & motivation schemes were in the past: National and sub-national state

jobs in the health sector were considered desirable and sufficient candidates could be found to

fill most critical jobs. Moreover, once employed, workers would often spend their entire

careers in public service. In areas where there was turnover, new employees could be recruited

easily [4].

2

The way staff retention & motivation scheme is today: there is a high demand in the public and

private health sectors for workers in critical areas such as clinical services and high level

professionals in public health. The supply of qualified health workers is limited and good

workforce planning requires an aggressive recruitment and innovative retention strategies.

Retention policies need to focus on elimination of unwanted turnover [5, 6].

Unwanted turnover is expensive: Costs to the employer can include separation benefits, lost

productivity, recruitment costs and training costs. When a valuable employee leaves it costs the

employer money and diminished services as new employees get up to speed [5, 6].

Ethiopia works to achieve health equity and to meet the health needs of its populations,

especially vulnerable and disadvantaged groups. The key challenge however has been ensuring

people living in rural and remote locations have access to trained health workers. Skilled and

motivated health workers in sufficient numbers at the right place and at the right time are keys

to attain the Millennium Development Goals. More than 85% of the Ethiopian population

currently lives in rural and remote areas. The problem is that most health workers live and work

in cities. This imbalance is caused by the overall shortage and high level of attrition of the

health workforce from the public sector. This therefore poses a major challenge to the

nationwide provision of health services [7].

Cognizance to the health workforce crisis, the Ethiopian government has been working across

all dimensions of the health workforce development that include scaling up of production while

addressing mal-distribution across the various population with focus to the key workers and in

line with its health sector policy and strategy, strengthening health systems and aiming for

universal coverage in the context of primary health care [7]. To this end the Federal Ministry of

Health in collaboration with the regional states has developed and endorsed initiatives on

health workforce attraction and retention schemes as part of the comprehensive sector-wide

reform implementation. This has been to improve workforce distribution and enhance health

services across the country. The belief has been that doing so will address a long-standing

problem, contribute to more equitable access to health care, and boost prospects for

3

improving maternal and child health and combating diseases such as AIDS, tuberculosis and

malaria [7].

This study explored the existing national and sub national level policies and strategies to

increase the availability of health workers through improved motivation and retention

schemes, but recognizing the fact that what may work in one setting may not work in another.

This review aimed to detail the various retention and motivation schemes nationally and in six

selected regional states and one city administration. The review encompasses all HR

departments/units that handle HRH matters (e.g. policy, planning, management, training,

payroll, human resource information systems etc.) at national level, and a sample of

departments at regional and health facility levels to describe to what extent the contextual

conditions of employee retention schemes, which would be needed to implement the

programme, are present and to provide essential information for strengthening stewardship

and leadership of HRH in the MoH in order to improve strategic function of employee retention

schemes;

2. Methodology

Desk Review: this involved collection of existing data and information to describe the current

contextual conditions (policies, strategies, guides, distributions of these materials by level,

status of actions) [8].

Interviews: Two targets. First, with key stakeholders who would have an important role as

future providers of administrative and operational support to the programme (e.g. heads at

federal level, RHBs and facility managers); second, health workers of various categories

(medical doctors, midwives, nurses, anesthetists, lab and pharmacy) [8].

Geographical coverage: This study took place in six regions including AA and the FMOH: these

included, the FMOH/HRD and seven regional states (AA, Oromiya, Amhara, Southern nations,

Tigray, BG and Somale) and respective hospital and health center that have been selected for

the study).

4

3. Findings

3.1 Study sites and participants

National: Federal Ministry of Health and one federal hospital were included in this study. Of

the total respondents who participated in the study were Human resource (HR) director,

CEO, Medical director, and senior HR staff (see annex 1).

Sub-national: A total of six regions including Addis Ababa were included in this study. Of the

total respondents, about 16.2% were managers and senior staff from regions and 81.3% was

from health facilities (42.5% from hospitals and 38.8% from health centers). About 59% of the

participants were male and 41% were also female respondents to the study (see annex 1).

3.2 Presence and implementation of policies and regulations on retention by level

of the health care systems

National: The Human resource (HR) director, CEO, Medical director, and senior HR staff

responding to this study reported that there exists a policy or equivalent (guideline) that

addresses employee retention schemes in human resources for health (HRH) system (see

annex 2).

Sub-national: About 48% health facility health workers and managers responding to this

study reported that there exists a policy or equivalent (guideline) for human resources for

health (HRH). More than half (54%) of the health facility health workers and managers also

acknowledged the presence of HRH regulation that addresses the issue of employee

retention schemes (see annex 2).

Oromiya and Addis Ababa City Bureau of Health have developed their own regulation for

employee retention schemes in addition to the regulation of Ministry of Civil Servant. Tigray

and Somale Bureau of Health are on the process of drafting a regulation for employee

retention schemes. The federal hospitals and the remaining regions use the guideline of the

federal government. All health workers and managers responding to this study also

mentioned that the legal instruments for employee retention schemes are not regularly

updated to fit to current living conditions (see annex 2).

3.3 Presence and implementation of plans for retention by level of the health care

systems

National: The managers and senior HR staff responding to this study reported that there

exists a strategic plan that addresses employee retention schemes in human resources for

5

health (HRH) development schemes (see annex 3). The health sector has also a

strategy/plan for HRH as part of Health Sector Development Programme, i.e., HSDP-IV.

Sub-national: Fifty percent of the total health workers and managers responding to this

study also reported that there is a strategy or plan for HRH. The regional health bureaus

visited during this study period mentioned that they do have HRH plan as part of regional

HSDP-IV for five years (see annex 3). Health facilities have HRH plans cascaded from the

regional bureau of health on annual bases.

3.4 Typology of Motivation and retention schemes for employees

National: The managers and senior HR staff responding to this study reported presence of

different forms of employee motivation and retention schemes at National and Federal

hospitals level (see annex 5).

Sub-national: The majority (96%) of the health workers and managers responding to this

study knew the presence of any form of employee motivation and retention schemes at

regional and health facilities level (see annex 5).

The employee incentive packages included financial and nonfinancial incentives in different

forms. The incentive packages vary from region to region and health facilities to health

facilities in the same region at the same level.

3.4.1 Financial incentives

3.4.1.1 Professional allowance

National: Eligible for professional allowance at federal MoH hospitals level are anesthetist,

midwifery and psychiatrist with the rate of ETB 125, 50 and 75 per month respectively (see

annex 6).

Sub-national: In Oromiya, anesthetists are eligible and paid at the rate ranging from ETB 300-

625 per month. The rate for midwifery and psychiatrist is the same as the federal hospitals.

Beside these professions, only specialists and general practitioners (GPs) also are eligible for

professional allowance with the rate of ranging ETB 1000-1200 and 500-700 per month

respectively. Still it varies from facilities to facilities in Oromiya Region for specialists. In

health centre, only professional allowance for midwifery is in practice (see annex 6).

Health workers and managers responding to this study from Addis Ababa Bureau of Health

and HFs reported that specialists, general practitioners and midwifery are eligible for

professional allowance and paid at the rate ranging from ETB 1000-1200, ETB 800 and ETB 50

per month respectively, which is also the same only for GPs and midwifery working at health

6

centre level. Still there is variation from facilities to facilities in Addis Ababa City for

specialists (see annex 6).

Health workers and managers responding to this study from SNNPR Bureau of Health and

HFs reported that only midwifery are eligible for professional allowance at the rate of ETB

50 per month for both hospitals and health centers. This is also true for Somale Region; even

professional allowance for midwifery is not in practice (see annex 6).

Participants in the study from Amhara Bureau of Health and HFs reported that only

specialists, general practitioners, anesthetist and midwifery are eligible for professional

allowance with the rate ETB 1000 with 800 top-up, ETB 800 with 600 top-up, ETB 75 and ETB

50 per month respectively, which is also the same only for midwifery working at health

centre level (see annex 6).

Health workers and managers responding to this study from Tigray Bureau of Health and

HFs reported eligible professions for professional allowance, such as specialists who paid at

a rate of ETB 1078 per month, general practitioners ETB 875, anesthetist ETB 125, midwifery

ETB 50, psychiatrist ETB 75, emergency surgeon ETB 875and field surgeon ETB 356 (see

annex 6).

Participants in the study from Benshangul Gumz Bureau of Health and HFs reported that

only specialists at the rate of ETB 3500 plus ETB 4200 top up, general practitioners ETB

1700, anesthetist ETB 1000 and midwifery ETB 50 have professional allowance per month,

which is also the same only for midwifery working at health centre level. The specialists

working at hospitals are also eligible for additional allowance, ETB 4200 per month in the

form of top up (see annex 6).

3.4.1.2 Positional allowance

National: Positional allowance is not in practice at federal level for Ministry of Health and its

referral Hospitals (see annex u7).

Sub-national: In Oromiya region only chief executive officers (CEO), medical directors

(MDs), health center heads (HCHs), process owners and matrons working at HFs level are

eligible for positional allowance and paid at a rate of ETB 500, ETB 300, ETB 150-200, ETB 150

and ETB 250 per month respective. For HCHs, it ranges from ETB 150-200 per month in HFs at

the same level, fore stance, Dukem and Hmbisso Health Centers. The process owners are

heads of work processes at health facility level. But process owners at Health Bureau level

have no positional allowances (see annex 7).

Positional allowance is in practice in Addis Ababa City HFs only for CEO who paid at rate of

ETB 400, for MDs ETB 450, for HCHs ETB 400 and for Case team leaders ETB 100 per month.

7

The case team leaders are coordinators of work processes at health facility level. The

positional allowance in practice in SNNPR is only for CEOs at a rate of ETB 350 per month.

But in Smale Region only both CEOs and MDs have positional allowance with the same rate

of ETB 400 per month. In Amhara region only MDs, HCHs and process owners have

positional allowance with ETB 200, ETB150 and ETB 90 per month respectively. The process

owners are heads of work processes at Health Bureau level (see annex 7).

Both medical directors and case team leaders/unit heads of Tigray Region are the only

eligible for positional allowances and paid at the rate of ETB 420 and ETB 182 per month. But

in Benshangul Gumz Region, MDs and HMIS Committees have positional allowance at a rate

of ETB 100 and ETB 70 per month (see annex 7).

3.4.1.3 Transport allowance

National: Transport allowance is not in practice at National level. At Sub national level, it is in

practice only in Addis Ababa City HFs. Only CEO, MDs, HCHs, Process owners and GPs are

eligible for transport allowances with the rate of ETB 200, ETB 200, ETB 100, ETB 243 and

ETB 100 per month respectively (see annex 8).

3.4.1.4 Telephone allowance

National: Telephone allowance is also one of the incentive packages at national level. Only

Director Generals, Directors, CEOs, MDs and Unit heads at federal level are eligible for

telephone allowance with the rate of ETB 200, ETB 125, ETB 200, ETB 100 and ETB 100 per

month respectively (see annex 9).

Sub national: Addis Ababa City is one of the city administrations that also practicing

telephone allowance at HFs level, in which only CEOs, MDs and GPs are eligible with the rate

of ETB 200, ETB 150 and ETB 100 per month respectively. Amhara region is also one of the

regions that practicing telephone allowance with the rate ranging from ETB 200-500 for

CEOs and ETB 300 for MDs. In Benshangul Gumz, CEOs and HCHs are eligible for telephone

allowance with the rate ETB 150 and ETB 100 respectively per month. The rest four regions

participated in the study like Oromiya, SNNPR, Somale and Tigray were not practicing

telephone allowance (see annex 9).

3.4.1.5 Duty allowance

National and Sub national practice: Duty allowance varies across the level from federal to

region, region to region and health facility to health facility, even within a region. Federal

hospitals (FH) have a rate of ETB 27 per duty for health assistance; ETB 62 per duty for BSc

professionals (see annex 10).

8

Hospitals in Addis Ababa (AA) City also have a rate of ETB 41 per duty for health assistance.

For health workers with advance diploma, federal hospitals have ETB 53 per duty and

hospitals in AA City have ETB 80 per duty. The rest health facilities (HFs) of other regions

participated in the study have no health assistance and health workers with advance

diploma.

The SNNPR and Beneshangu Gumz (BG) HFs have the same rate ETB 62 per duty for BSc

professionals. Oromiya HFs has a rate of ETB 50 per duty, AA City HFs ETB 98 per duty,

Somale and Tigray HFs ETB 81 per duty, and Amhara HFs ETB 45 per duty, which is the least

rate for duty for BSc professionals (Nurses, Lab, Pharma, etc).

The federal HFs and AA City, Somale, and Amhara HFs have no duty allowances for

midwifery but compensate with duty off. Oromiya HFs have a rate of ETB 50 per duty.

SNNPR and Beneshangul Gumz HFs paid ETB 62 and Tigray ETB 81 per duty for midwifery.

The federal HFs and Oromiya, Somale, Amhara and Beneshangul Gumz HFs have also no

duty allowance for anesthetists but they will be on duty off. Addis Ababa City HFs have a

rate of ETB 114, SNNPR HFs ETB 62 and Tgray HFs ETB 67 per duty.

Duty allowance for health officers (HOs) is in practice at all level. Federal HFs have a rate of

ETB 62 per duty and Regional HFs of Bureaus of Health, Oromiya ETB 50, AA City ETB 126,

SNNPR and Beneshangul Gumz have the same rate to Federal ETB 62, Smale and Tigray ETB

81, and Amhara ETB 45 per duty. Duty allowance rate for GPs at federal HFs level is ETB 86

per duty. It is also ETB 100 in Oromiya HFs, ETB 185 in AA City HFs, SNNPR have the same rate

to Federal ETB 86, Somale and Amhara HFs have also the same rate ETB 120, and Tigray HFs

ETB 118 per duty.

The duty allowance rate for all type of specialists at federal HFs level is ETB 114 per duty. ETB

150 in Oromiya and Amhara HFs, ETB 248 in AA City HFs, SNNPR HFs have the same rate with

federal HFs ETB 114. Somale HFs have different schemes by type of professionals, ETB 240

for Surgeon and Gynecologists, and ETB 150 for Internist and Pediatrician, ETB 171 in Tigray

HFs and ETB 240 in Beneshangul Gumz HFs.

Operation Room (OR) Nurses have no duty allowance at federal HFs level. But they do have

duty off. AA City HFs and Regions HFs (SNPPR, Somale and Beneshangul Gumz) reported

that they have no special rate for OR Nurses. But Oromiya, Amhara and Tigray HFs have a

rate of ETB 50, ETB 45 and RTB 67 per duty respectively.

For cleaners, cashiers and card registrar of HFs of Somale and Amhara have ETB 35 and ETB

15 per duty. In the rest regions including the federal HFs, there is no duty allowance but they

do have duty off per duty.

9

3.4.1.6 House allowance

National: House allowance is also one of the incentive packages for employees in the health

sector. Federal MoH and hospitals have no such incentive packages (see annex 11).

Sub national: In some regions only MDs, CEOs and HCHs are eligible for house allowance.

SNNPR arranged only for MDs (referral hospital) at the rate of ETB 500 per month. Amhara

HFs only for CEOs and paid at the rate of ETB 300 and Beneshangul Gumz HFs only for CEOs

and HCHs with the rate of ETB 200 and ETB 100 per month respectively. Addis Ababa City

has special arrangements for Specialists, GPs, Health officers, Medical directors and CEOs of

HFs. They will arrange condominium houses with ETB 350 subsidy per month (see annex 11).

3.4.1.7 Staff working part-time in the private wing

Health professionals and support staff were also working in private wing in their hospital.

Rate of income share from par-time for staff working part-time in the private wing is 70% for

Professionals, 15% for Support staff and 15% for Organization (HFs).

3.4.2 Non-financial incentives

3.4.2.1 Residential House

National: Non financial incentives are also included in the employees’ incentive packages at

federal, regional and health facilities level. At federal level general directors, directors and

CEOs of hospitals are eligible for the provision of residential houses (see annex 12).

Sub national: Addis Ababa City also has an arrangement for condominium house only for

specialists, GPs and health officers. Beneshangul Gumz also have the same experiences with

federal level and provides houses only for specialists, GPs, medical directors, health officers,

unit heads and senior staffs, which may not uniformly practiced in the region. The rest

regions did not have a practice of providing a house for employees (see annex 12).

3.4.2.2 Car for Transport

National: Federal MoH and its Hospitals are the one who provided car for general directors,

directors and CEOs (see annex 13).

Sub national: Addis Ababa City Hospitals also provide car only for CEOs and medical

directors. The rest regions have no provision of individual level cars (see annex 13).

3.4.2.3 Continuous education

About 43% of the health workers and managers responding to the study mentioned that

there exists a strategy/plan for continuous education. Nearly 33% of health workers and

10

managers also reported that continuous education programmes match human resource for

health needs and staff in the main human resource for health categories benefit from

continuous education (see annex 20).

4. Discussion and Conclusion

There exists a policy (guidelines of Ministers’ of Council) and regulation (civil servant

regulation of MoCS) that addresses employee retention schemes at national and sub

national level.

Regions, Oromiya and Addis Ababa City Bureau of Health in placed their own regulation; and

the remaining regions did not have their own tools but use the guideline of the federal

government. Regularly updating the guidelines and regulation was missing at all level to fit

to current living conditions.

There exists a plan/strategy that addresses employee retention schemes as part of Health

Sector Development Programme, i.e., HSDP-IV. Health facilities have also HRH plans

cascaded from the regional bureau of health on annual bases.

About 15% respondents are also mentioned that a planned continuous education has to be

provided for employees’ educational career. About 25% also reported transport services

have to be accessible for employees.

The policies and regulations for employees’ incentive packages in place are guidelines of the

Councils of Ministers and regulation of Ministry of Civil Servant at National level. Oromiya

and Addis Ababa City have Regional regulations. Both national and regional tools lack

regular updating.

The existence of different forms of employee motivation and retention schemes is reported

by the majority (96%) of the health workers and managers responding to this study.

The most commonly practiced financial incentives are professional, positional, duty and

telephone allowances at all level. Non-financial incentives mainly included provision house,

car, short and long term trainings and certificate of recognition at all level [9].

Lack of comprehensiveness of retention schemes in including main HRH professionals and

variation for the same level HFs from region to region and from facility to facility is observed

for both financial and non-financial incentive schemes.

11

Income sharing for staff working at part-time in the private wing was reported with 70% of

the total income goes to professionals; 15% for support staff and 15% for the hospital income

supplementations.

Continuous education programmes are low (33%) in matching human resource for health

needs and benefiting staff in the main human resource for health categories.

5. Recommendations

The existence of policies, regulations and plans/strategies at all level is a good practice, but

they have to regularly update and especially the FMoH has to have lead role and take

initiative in updating the tools.

A comprehensiveness incentive packages have to be in placed to benefit all staff and

minimize the gap of the rate especially in professional, positional and duty allowances at all

level, and the federal MoH has to take the lead role and initiative.

Motivational and retention schemes for nurses and physicians need further study to identify what satisfy them at all level, and the federal MoH has to take the lead role and initiatives.

Private wing for part time work of staff at facility level has to be encouraged in all hospitals at regions level and regional bureaus of health have to take a lead role in encouraging practicing private wing in all hospitals.

Continuous education programmes have to match the needs of HRH and benefit staff in the main HRH categories.

12

References

1. Peru med exp. Addressing the HRH crisis in countries: How far have we gone? What

can we expect to achieve by 2015?, Salud Publica, 2011

2. World Health Organization. International migration of health personnel: a challenge

for health systems in developing countries. Resolution WHA57.19. Geneva,

Switzerland: WHO; 2004.

3. FMoH. A five year health sector development programme, HSDP-IV (2010/11-

2014/15), 2011

4. World Health Organization. Global Code of Practice on the International

Recruitment of Health Personnel. Resolution WHA63.16. Geneva, Switzerland:

WHO; 2010.

5. Harvard University. Human Resources for health: overcoming the crisis. Joint

Learning Initiative. Cambridge, Massachusetts: Press Global Equity Initiative; 2004.

6. Prince Mahidol Award Conference. Proceedings of Second Global HRH Forum.

January 27-29, 2011. Bangkok, Thailand; PMAC/GHWA/WHO/JICA; 2011.

7. FMoH. Human resource development redesign study report, 2008

8. Salary.com. Employee Job Satisfaction & Retention Survey 2007/2008

9. World Health Organization. Rapid scaling up of health workforce production.

WHA59.23. Geneva, Switzerland: WHO; 2006.

10. George C. Sinnott, George H. Madison, etal. EMPLOYEE RETENTION: Report of the

Employee Retention Workgroup, September 2002

13

Annexes

Annex 1: No of participants responding to this study, 2011

Level Frequency Percent Male Female

Federal

(MoH) 2 2.5% 2 0

Regional 13 16.2% 10 3

Hospital

(Federal +

Regional)

34 42.5% 21 13

Health

center 31 38.8% 14 17

Total 80 100.0% 47 33

Total 59% 41%

14

Annex 2: Financial and non-financial incentives

Level Policy Regulation Type of Incentive

packages

Incentive packages by type and level

Eligible

Health

office

Health facility by level and

eligibility criteria*

Health workers

satisfaction level

- MoH/RHB

(ETB/ m)

A

(ETB/m)

B

(ETB/m)

C

(ETB/m)

Good Poor

Federal

MoH/Hospital

Guideline of

Councils of

Ministers

Regulation of

the MoCS

Professional

allowance

Anesthetist NA** 125 NA NA

40% 60%

Psychiatrist No 75 NA NA

Midwifery No 50 NA NA

Telephone

allowance

General directors 200 NA NA NA

Directors 125 NA NA NA

CEO NA 200

MD NA 100

Duty allowance HA NA 27 NA NA

Diploma NA 41 NA NA

Diploma (Advance) NA 53 NA NA

BSc Professionals No 62 NA NA

MW No Duty off NA NA

Anesthetist NA Duty off NA Na

Health Officer No 62 NA NA

GP No 86 NA NA

Specialist No 114 NA NA

OR nurse NA Duty of f NA NA

Cleaners/ Cashier/

Card Registrar

No Duty of f NA NA

Residential house General directors - Provided - NA NA

Directors Provided NA NA

CEO Provided NA NA

Car for transport General directors - Provided - NA NA

Directors - Provided - NA NA

CEO - - Provided NA NA

MD - - Provided NA NA

15


packages


Eligible

Health

office



Health workers

satisfaction level

- MoH/RHB

(ETB/ m)

A

(ETB/m)

B

(ETB/m)

C

(ETB/m)

Good Poor

Oromiya BoH No regional Regional

Regulation

Professional

allowance

Specialist No 1000-1200 2000 3000

54% 46%

GP No 500-700 1000 2000

Anesthetist NA 300 625 1000

Psychiatrist No 75 75 75

Midwifery

No 50 50 50

Positional

allowance

Process owners - No 150 150 150

CEO NA 500 500 500

Medical director NA 300 300 300

Health center head NA NA NA 150-200

Matron NA 250 250 250

Duty allowance Diploma NA 41 41 41

BSc Professionals NA 50 50 50

MW NA 50 50 50

Anesthetist NA Duty of Duty of Duty of

Health Officer NA 50 50 50

GP NA 100 100 100

Specialist NA 150 150 150

OR nurse NA 50 50 50

Cleaners/ Cashier/

Card Registrar

NA Duty of Duty of Duty of

Addis Ababa City

BoH

No regional Regional

Regulation

Professional

allowance

Specialist No

1000-

1200

NA NA

100% 0%

GP No 800 NA NA

Anesthetist NA 125 NA NA

Midwifery No 50 NA NA

Positional

allowance

Process owners - No 243 NA NA

CEO NA 400 NA NA

16


packages


Eligible

Health

office



Health workers

satisfaction level

- MoH/RHB

(ETB/ m)

A

(ETB/m)

B

(ETB/m)

C

(ETB/m)

Good Poor

Medical director NA 450 NA NA

Health center head NA NA NA

Transport

allowance

CEO NA 200 NA NA


Health center head NA 100 NA

Process Owner No 243 NA NA

GP No 200 NA 200

Team leaders No 200 NA NA

Telephone

allowance

CEO No 200 NA NA

Medical director No 150 NA NA

GP No 100 NA NA

Health center head No NA NA NA

CEO No 200 NA NA

Duty allowance HA NA 41 NA NA

Diploma NA 62 NA NA

Diploma (Advance) NA 8 NA NA

BSc Professionals NA 98 NA NA

MW NA Duty of NA NA

Anesthetist NA 114 NA NA

Health Officer NA 126 NA NA

GP NA 185 NA NA

Specialist NA 248 NA NA

Cleaners/ Cashier/

Card Registrar

NA 41 NA NA

House allowance Specialist No 350 NA NA

GP No 350 NA NA

Health officer No 350 NA NA


17


packages


Eligible

Health

office



Health workers

satisfaction level

- MoH/RHB

(ETB/ m)

A

(ETB/m)

B

(ETB/m)

C

(ETB/m)

Good Poor

Specialist No 350 NA NA

Residential house Specialist N0 Provided N0 N0

GP N0 Provided N0 N0

Health officer N0 Provided N0 N0

General directors - Provided NA NA NA

Directors - Provided NA NA NA

CEO - - Provided NA NA

Car for transport CEO NA NA - Provided NA

Medical director NA NA - Provided NA

SNNPR BoH MoH Guidelines Regulation of

the MoCS

Professional

allowance

Anesthetist NA 125 No

0% 100%

Midwifery No 50 50

Positional

allowance

Medical director No 350 No



MW NA 62 62 62



GP NA 8 8 8


Cleaners/ Cashier/

Card Registrar


House allowance Medical director No 500 No No

Somale BoH MoH Guidelines Regulation of

the MoCS

Positional

allowance

CEO NA NA 400 400 0% 100%

Medical director NA - NA 400 400

18


packages


Eligible

Health

office



Health workers

satisfaction level

- MoH/RHB

(ETB/ m)

A

(ETB/m)

B

(ETB/m)

C

(ETB/m)

Good Poor



MW NA Duty of Duty of Duty of



GP NA 120 120 120

Specialist NA NA NA NA

Surgeon &

Gynecologist

NA 240 240 240

Internist&

Pediatrician

NA 150 150 150

Cleaners/ Cashier/

Card Registrar

NA 35 35 35

Amhara BoH Regional

Guidelines

Regulation of

the MoCS

Professional

allowance

Specialist No 1000 1200 1500

0% 100%

GP No 800 1000 1200


Midwifery No 50 50 50

Positional

allowance

Process owners 90 No No No

Medical director NA 200 200 200

Health center head NA 150 150 150

Duty allowance CEO 500 200 200

Medical director 300 300 300

Diploma NA 35 35 35


MW NA Duty of Duty of Duty of



GP NA 120 120 120

19


packages


Eligible

Health

office



Health workers

satisfaction level

- MoH/RHB

(ETB/ m)

A

(ETB/m)

B

(ETB/m)

C

(ETB/m)

Good Poor



Cleaners/ Cashier/

Card Registrar

NA 15 15 15

House allowance CEO NA 300 No No

Tigray BoH Regional

Guidelines

Regulation of

the MoCS

Professional

allowance

Specialist No 1078 1078 1078

8% 92%

GP No 875 875 875


Midwifery No 50 50 50

Psychiatrist No 75 75 75

Emergency Surgeon 875 875 875

Field Surgeon 356 356 356

Positional

allowance

Medical director NA MoE 420 420

Case Team Leaders - No - MoE 182 182

Duty allowance Diploma NA Duty of Duty of Duty of


MW NA 81 81 81



GP NA 118 118 118



Cleaners/ Cashier/

Card Registrar


Benshangul

Gumz

Regional

Guidelines

Regulation of

the MoCS

Professional

allowance

Specialist No No 3500 3500

38% 62% GP No No 1700 1700

Anesthetist NA No 1000 1000

20


packages


Eligible

Health

office



Health workers

satisfaction level

- MoH/RHB

(ETB/ m)

A

(ETB/m)

B

(ETB/m)

C

(ETB/m)

Good Poor

Midwifery No No 50 50

Positional

allowance

Medical director NA No 100 100

HMIS Committee NA No No No

Duty allowance Medical director No No 150 150

Health center head NA NA NA NA

Diploma NA 41 41 41


MW NA 62 62 62



GP NA 100 100 100


Cleaners/ Cashier/

Card Registrar


House allowance CEO NA NA 200 No

Health center head NA NA NA 100

Residential house Specialist NA No Provided No

GP No No Provided No

Health officer No No Provided No

Unit head/ Senior

staff

No No Provided No

Medical director NA No Provided No

CEO NA No Provided No

* Eligibility criteria: health facilities located in areas classified as A, B and C based on the availability of infrastructure.

** NA: Not Applicable

*** ETB/m: Ethiopian Birr per month

21

Annex 3: No of respondents acknowledge the existence of HRH policy, regulation and plan

for employee retention by region, 2011

Annex 4: Expenditure rate for HRH in the total recurrent expenditure of health by level, 2011

National/Sub-

national

Have HRH policy (or equivalent)

Have HRH regulation (or

equivalent)

Have strategy or plan for HRH

Y N % Y N % Y N %

MoH 5 0 100% 5 0 5 0

Oromiya 7 0 7 7 0 11 0

Addis Ababa City 9 0 5 7 0 9 2

SNNPR 6 0 5 6 0 2 9

Somale 3 3 6 6 0 3 3

Amhara 1 6 4 5 2 5 2

Tigray 4 0 4 4 0 3 0

Benishangu Gumz 3 1 1 3 1 2 1

Total 38 10 32 43 3 40 17

Total 48% 13% 40% 54% 4% 50% 21%

National/Sub-

national

Rate of expenditure for HRH in the total health expenditure

Have <70% of recurrent budget for HR Salary

Have >70% of recurrent budget for HR salary

I do not know

MoH 1 3 1

Oromiya 1 5 8

Addis Ababa City 3 3 8

SNNPR 0 5 6

Somale 2 4 6

Amhara 0 3 8

Tigray 0 4 4

Benishangu Gumz 0 3 2

Total 7 30 43

% 9% 37% 54%

22

Annex 5: Number of health workers and managers approved the existence of HRH policy,

regulation and plan for motivation and retention schemes for employees, 2011

By Level Y N MoH

Federal hospitals RBoH

RBoH Hospitals

WoHO HCs

Federal 5 0 2 3

Oromiya 14 0 3 3 8

Addis Ababa City 11 3 3 3 5

Amhara 11 0 3 3 5

Tigray 12 0 3 3 6

SNNPR 11 0 2 4 5

Benshangul G 8 0 2 2 4

Somale 5 0 2 1 2

Total 77 3 2 3 18 19 35

Percent approved 96% 4% 100% 100% 100% 95.0% 94.6%

Annex 6: Professional allowance for Health Facilities, 2011

National/Sub-

national

Professional allowance in Birr per month

For Specialist

For GP For Anesthetist

For Midwifery

For Psychiatrist

For Emergency

Surgeon

For Field

Surgeon

MoH

- Hospital No No 125 50 75 No No

- Health center

NA NA NA NA NA NA NA

Oromiya

- Hospital 1000-1200 500-700 300-625 50 75 No No

- Health center

NA No NA 50 No NA NA

Addis Ababa City

- Hospital 1000-1200 800 No 50 No No No

- Health center

NA 800 NA 50 No NA NA

SNNPR

- Hospital No No No 50 No No No

- Health center


Somale

- Hospital No No No No No No No

23

Note: NA (Not Applicable)

Annex 7: Positional allowance, 2011

- Health center

NA No NA No No NA NA

Amhara

- Hospital 1000 800 75 50 No No No

- Health center

None No NA 50 No NA NA

Tigray

- Hospital 1078 875 125 50 75 875 356

- Health center


Benishangu Gumz

- Hospital 3500 1700 1000 50 No No No

- Health center


National/Sub-

national

Positional allowance in Birr per month

For Process Owner

For CEO For Medical director

For Health center head

For HMIS Committee

For Matron

For Case Team

Leaders

MoH No No No NA No No No

Oromiya 150 500 300 150-200 No 250 No

Addis Ababa City 243 400 450 400 No No No

SNNPR No No 350 No No No No

Somale No 400 400 No No No No

Amhara 90 No 200 150 No No No

Tigray No No 420 No No No 182

Benishangu Gumz No No 100 No 70 No No

24

Annex 8: Transport allowance, 2011

Annex 9: Telephone allowance, 2011

National/Sub-

national

Transport allowance in Birr per month



For Process Owner

For GP

MoH No No No No No

Oromiya No No No No No

Addis Ababa City 200 200 100 243 200

SNNPR No No No No No

Somale No No No No No

Amhara No No No No No

Tigray No No No No No

Benishangu Gumz

No No No No No

Region

Telephone allowance in Birr per month

For D/General

For Director



For Unit

heads

For GP

MoH 200 125 200 100 NA No No

Oromiya NA NA No No No No No

Addis Ababa City NA NA 200 150 100 No 100

SNNPR NA NA No No No No No

Somale NA NA No No No No No

Amhara NA NA 200-500 300 No No No

Tigray NA NA No No No No No

Benishangu Gumz NA NA 150 No 100 No No

25

Annex 10: Duty allowance, 2011

Region

Duty allowance in Birr per duty

For HA For Diploma

For Diploma

(Advance)

For BSc Profe.

For MW For Anesthetist

For Health Officer

For GP For Specialist

For Surgeon

& Gyn

For Internist& Pedia

For OR nurse

For Cleaners/ Cashier/

Card Registn

MoH 27 41 53 62 Duty of Duty of 62 86 114 NA NA Duty of Duty of

Oromiya NA 41 NA 50 50 Duty of 50 100 150 NA NA 50 Duty of

Addis Ababa City

41 62 80 98 Duty of 114 126 185 248 NA NA NA Duty of

SNNPR NA 41 NA 62 62 62 62 86 114 NA NA NA Duty of

Somale NA 62 NA 81 Duty of Duty of 81 120 NA 240 150 NA 35

Amhara NA 35 NA 45 Duty of Duty of 45 120 150 NA NA 45 15

Tigray NA Duty of NA 81 81 67 81 118 171 NA NA 67 Duty of

Benishangu Gumz

NA 41 NA 62 62 Duty of 62 100 240 NA NA NA Duty of

Note: NA=+ Not Applicable

26

Annex 11: House allowance, 2011

Annex 12: Organizations providing residential house by type of position and profession, 2011

National/Sub-

national

House allowance

For D/General/ Director/ Process Owners

For Specialist

For GP

For Health officer

For unit head/ Senior staff

For Medical director

For CEO

For HC

head

MoH No No No No No No No No

Oromiya No No No No No No No No

Addis Ababa City

No 350 350 350 No 350 350 No

SNNPR No No No No No 500 No No

Somale No No No No No No No No

Amhara No No No No No No 300 No

Tigray No No No No No No No No

Benishangu Gumz

No No No No No No 200 100

National/Sub-

national

Residential


For Specialist

For GP

For Health officer

For unit head/ Senior staff

For Medical director

For CEO

MoH Yes No No No No No Yes

Oromiya No No No No No No No

Addis Ababa City

No Yes Yes Yes No No No

SNNPR No No No No No No No

Somale No No No No No No No

Amhara No No No No No No No

Tigray No No No No No No No

Benishangu Gumz

No Yes Yes Yes Yes Yes Yes

27

Annex 13: Organizations providing car for transport by type of position and profession, 2011

Annex 14: Number of organization awarding certificate of recognition for best performers

and providing shot and long term trainings, 2011

National/Sub-

national

Car




MoH Yes Yes No No

Oromiya No No No No

Addis Ababa City No Yes Yes No

SNNPR No No No No

Somale No No No No

Amhara No No No No

Tigray No No No No

Benishangu Gumz No No No No

National/Sub-national

Certificate of recognition for best

performer

Short and long term trainings

Yes No Yes No

Federal 2 3 5 0

Oromiya 4 10 8 6

Addis Ababa City 2 12 8 6

Amhara 0 11 5 6

Tigray 4 8 7 5

SNNPR 2 9 9 2

Benshangul G 0 8 8 0

Somale 0 5 2 2

Total 14 66 52 27

% 18% 65%

28

Annex 15: Health facilities employees’ motivation and satisfaction level grossly by region,

2011

Annex 16: No and category of staff leaving for the private health or non-health sector in the

last one year and organizations with <5% vacancy rate, 2011

Region Fair Good Very good

Poor I do not know (IDK)

Good % Poor %

Federal 3 0 0 2 0 3 60% 2 40%

Oromiya 5 1 1 6 0 7 54% 6 46%

Addis Ababa City

8 0 0 0 6 8 100% 0 0%

Amhara 0 0 0 11 0 0 0% 11 100%

Tigray 1 0 0 11 0 1 8% 11 92%

SNNPR 10 0 0 1 0

10 91% 1 9%

Benshangul G 3 0 0 5 0 3 38% 5 62%

Somale 2 0 0 2 1 2 50% 2 50%

Total 32 1 1 38 7

% 40%

48%

National/Sub-

national

Public health specialist/ professionals

Physician BSc Nurse

Health officer

Anesthetist BSc Pharmacist

BSc Lab

Mid wifery

Vacancy rate <5%

MoH 3 5 5 0 0 0 0 0 3

Oromiya 2 3 6 1 0 0 0 1 1

Addis Ababa City 0 4 13 0 0 3 1 0 1

Amhara 8 6 7 2 0 1 1 0 9

Tigray 4 6 8 0 0 0 6 0 5

SNNPR 3 3 3 1 1 0 1 0 5

Benshangul Gumz

0 3 0 1 0 0 0 0 3

Somale 0 1 3 0 0 1 0 0 1

Total 20 31 45 5 1 5 9 1 28

% 25% 39% 56% 6% 1% 6% 11% 1% 35%

29

Annex 17: Main reasons of employees for leaving the public sector for the private or non-

health sector, 2011

Se.

No. Reasons

Always Usuall

y

Sometim

es

Never

A Work environment (relationships, values and culture) 10 11 4 55

B Poor living conditions (shortage of basic needs, lack of

schooling for children and jobs for spouses

14 15 7 44

C Clear career advancement opportunities/structure 5 2 1 72

D Challenging work and

Work overload

12 2 4 62

E Flexibility in work schedule 2 3 4 71

F Salary 73 4 2 1

G Appropriate resources and equipment to perform the

job

9 6 4 61

H Employee benefits 32 5 2 41

I Less travel 1 1 4 74

J Supervision 1 2 4 73

K Leadership (management support) 2 3 6 69

30

Annex 18: Rate of income share from par-time for staff working part-time in the private wing

in their hospitals, 2011

Annex 19: Employees’ income supplementation schemes, 2011

Annex 20: A strategy/plan for continuous education at national and sub-nationals levels, 2011

National/Sub-

national

Rate of income share

For Professionals For Support staff

For Organization (HFs)

MoH 70% 15% 15%

Oromiya 70% 15% 15%

Addis Ababa City

70% 15% 15%

SNNPR 70% 15% 15%

Somale 70% 15% 15%

Amhara 70% 15% 15%

Tigray 70% 15% 15%

Benishangu Gumz

70% 15% 15%

Region Yes No

Have any form of income supplementation 80 0

Income supplementation of national government 80 0

Income supplementation increase earnings employees 0 80

National/Sub-

national

Continuous education (CE) strategy/plan

CE programmes match HRH needs

Staff in the main HRH categories benefit from

CE

Y N IDK Total Y N IDK Total Y N IDK Total

Federal 2 0 0 2 0 2 0 2 0 2 0 2

Region 13 0 0 13 8 5 0 13 11 2 0 13

Hospitals 14 16 4 34 14 16 4 34 12 17 5 34

Health centers

5 23 3 31 4 22 5 31 3 20 8 31

Total

34 39 7 80 26 45 9 80 26 41 13 80

31

Annex 21: Comments to make the organization a better place to work, 2011

General comments

Number of health workers and managers

Total % Federal Region Hospitals Health

centers

Update financial allowance regularly to fit to current living conditions

0 2 6 4 12 15%

Provide planned continuous education

0 2 6 4 12 15%

In place employee transfer schemes 0 2 2 4 8 10%

Avoid pool system for salary disbursement

0 2 1 4 7 9%

Make accessible transport services for employees

0 5 5 10 20 25%

Make accessible non-financial incentives like house for employees

0 3 3 3 9 11%

Private wing in all hospital 0 1 6 0 7 9%

Incentive for professionals at Bureau, Zone and Woreda level

0 3 2 0 5 6%

National and regional comprehensive incentive package

2 7 9 14 32 40%

Tax has to exempted for allowances 0 0 1 0 1 1%

32

Copies of policies and regulations

1. FMoH, Councils of Ministers’ Guidelines for Health Professionals Duty Allowance, April 2008

2. Amhara Regional Bureau of Health, Circular for Physicians Incentive Packages, 2007,

3. Benshangul Gumz Regional Bureau of Health, Circular for Professional Allowance, 2010

4. Addis Ababa City Health Bureau, Regulation of Health Professionals Incentive Packages, 2009

5. Tigray Regional Bureau of Health, Draft Guidelines for Health Professionals Incentive Packages, 2011

6. Oromiya Bureau of Health, Regulation of Health Professionals Incentive Packages, 2009

Date post:	18-Oct-2014
Category:	Healthcare
View:	56 times
Download:	0 times

Employee retention initiatives_study_report-rev

Healthcare