Motivation and Factors Affecting it… Tesfaye, D et al 231

ORIGINAL ARTICLE

Motivation and Factors Affecting It among Health Professionals in

the Public Hospitals, Central Ethiopia
Tesfaye Dagne1, Waju Beyene2, Negalign Berhanu2
ABSTRACT
BACKGROUND: Motivation is an individual’s degree of willingness to exert and maintain an
effort towards organizational goals. This study assessed motivational status and factors affecting
it among health professionals in public hospitals of West Shoa Zone, Oromia Region.
METHOD: Facility based cross-sectional survey was employed. All health professionals who served
at least for 6 months in Ambo, Gedo and Gindeberet hospitals were included. Self-administered
Likert scale type questionnaire was used. Data were analyzed using SPSS version 20. Mean
motivation calculated as percentage of maximum scale score was used. Bivariate and multiple linear
regression analyses were done to see the independent effects of explanatory variables.
RESULTS: The overall motivation level of health professionals was 63.63%. Motivation level of
health professionals varied among the hospitals. Gindeberet Hospital had lower motivation score
as compared to Ambo Hospital (B = -0.54 and 95% CI; -0.08,-0.27). The mean motivation score of
health professionals who got monthly financial benefit was significantly higher than those who did
not (B = 0.71 and 95% CI; 0.32, 1.10). Environmental factors had higher impact on doctors’ motivation
compared to nurses’ (B = 0.51 and 95% CI; 0.10, 0.92). Supervisor-related factors highly varied in
motivation relative to other variables.
CONCLUSIONS: Motivation of health professionals was affected by factors related to supervisor,
financial benefits, job content and hospital location. Efforts should be made to provide financial
benefits to health professionals as appropriate especially, to those who did not get any such
benefits. Officially recognizing best performance is also suggested.
KEYWORDS: Motivation, Health Professionals, West Shoa, Hospital, Oromia, Ethiopia
DOI: http://dx.doi.org/10.4314/ejhs.v25i3.6
INTRODUCTION system requires high labor and delivery of service
quality, efficiency and equity, which are
Motivation in the work context can be defined dependent on health workers’ motivation to exert
as an individual’s degree of willingness to exert their effort on their tasks. Although availability of
and maintain an effort towards organizational resources and skills of health workers are
goals. Work motivation is an internal process in important, health managers and decision
which an individual receives certain stimulus makers should know that these factors are not
from the environment (rewards, feedback,
enough by themselves to make health workers
directives and consequences of previous
work to the expected level of performance that is
efforts) which combine with certain internal
influenced by their willingness to come to work
features (self-concept and needs) (1).
regularly, work diligently and be flexible and
Policy makers are becoming aware of health
willing to carry out the necessary tasks (2).
workers’ motivation and its importance in
performances of healthcare system. Healthcare

1
Department of Health Service Management, Jimma University, Ethiopia
2
Shashemene Town Health Office, Oromiya, Ethiopia
Corresponding Author: Negaligh Berhanu, Email: negenu@gmail.com
232 Ethiop J Health Sci. Vol. 25, No. 3 July 2015

Poor health systems, with lack of equipment, they simply “sit around” while patients are waiting,
supplies and poor management structures, lead to and these complaints are acknowledged by health
poor productivity, limited competences and poor workers. However, the real causes are inadequate
responsiveness. The root causes that result in facilities and lack of material, which are seen as
suboptimal performance in these areas consist being beyond the control of health professionals.
of a complex set of factors, which are This is a source of frustration for many health
interrelated. These include the complexity and workers and affects their motivation, which in
challenges involved in providing and managing turn affects their performance. Many feel that a
competing demands in patient care, which can career in the health sector has become less
contribute to job dissatisfaction and low attractive. These frustrations are rooted in a number
motivation among health care professionals (3, 4). of more specific complaints. Thus, this study was
In developing countries, low staff conducted to identify the level of motivation and
motivation and shortage of human resources for factors affecting it among health professionals in
health (HRH) are factors that are crippling the study area to provide evidences for responsible
health systems and health care. Despite this, bodies for making improvement decisions.
the development of human resources has been
given little attention at global and national levels METHODS AND MATERIALS
until recently. Effective health service delivery The study was conducted in West Shoa Zone,
requires efficient use of the skills of a well- one of the 18 zones in Oromia Regional State,
motivated health workforce. The delivery of care Central Ethiopia, from February 15, 2013 to
by its nature involves personal interaction and March 30, 2013. West Shoa Zone has 19
effective teamwork. Improving staff motivation Woredas (18 rural and one urban) and three
and performance through effective use of pay public hospitals: Ambo, Gedo and Gindeberet
and non-pay incentives such as the provision of hospitals with a total of 103, 51 and 72 health
education and career development opportunities, professionals, respectively. Both Gindeberet and
flexibility in working schedules, safe working Gedo hospitals are district hospitals and
environments and other factors is an important Ambo hospital is a General hospital by type.
issue in health services provision (5, 6). Facility based cross-sectional study
In Ethiopia, manpower in the health design was employed using both quantitative
service is small, unevenly distribution, and qualitative methods. Since the number of
underutilized in some cases, and does not have health professionals working in the three
the appropriate level and mix of skills. An public hospitals was manageable for the study,
appropriate system of supervision and monitoring all permanently employed health professionals
is also lacking. Performance and standards have who served for more than 6 months in their
been insufficient, particularly due to lack of respective hospitals were included in the
appropriate career structure and incentive study. Health professionals with work
schemes. Management at all levels of the health experiences of less than six months were
care delivery system appears to be headed by excluded because these health professionals had
health professionals who neither have the not faced the true situation of the hospital
training nor the motivation. The attrition, under environment, and the first six month for newly
current conditions, is expected to be particularly employed health professionals were considered
high for physicians, health officers and as a trial period.
pharmacists. This indicates the urgency to Quantitative data were collected using a
develop human resource management system and self-administered questionnaire adapted from
policy in order to retain a motivated health different literatures (10-14). The questionnaire
workforce (7, 8). contained items categorized in to three, that is,
Results from a qualitative study on socio-demographic characteristics of the
performance of health workers in Ethiopia (9) respondents, their motivational status and factors
revealed poor treatment or inadequate service in affecting their motivation, with responses in five
health institutions. Health workers in public label Likert scale (Strongly disagree = 1;
facilities are often absent during working hours, or Disagree = 2; Neutral = 3; Agree = 4 and
 Motivation and Factors Affecting it… Tesfaye, D et al 233
Cerebral Vein Thrombosis Feridoun S. et al
strongly agree = 5). The questionnaire was assumptions, to show whether the difference in
prepared in English. It was distributed and mean motivation level between different
collected back by three data collectors. group was statistically significant or not.
Qualitative data were collected through Then, multiple linear regression analysis was
in-depth interviews. A total of six key employed to identify the predictors of
informants were involved that included motivation of health professionals. Variables
clinical directors and chief executive officers that were found to be significant at 0.20 or less
of the respective hospitals. Notes were taken level of significance by bivariate analysis were
and each interview was tape-recorded. The entered into the multivariate analysis to rule out
interview guide focused on systems and confounders. Mean score of the respondents
strategies each hospital was implementing to calculated as percentage of maximum scale
motivate its employees, general perception of score was used for measuring level of
motivational status of health professionals, and motivation of health professionals. This
what the interviewees recommend for the health calculation was made with the Likert scales
system to motivate health professionals. The before factors were generated. The findings were
data obtained through qualitative method presented in tables and figures.
were triangulated with the quantitative ones. Efforts were made to ensure quality of the
while motivation, which is a composite data. Training was given to data collectors for
variable consisting of 12 items, measured on one day on the contents of the questionnaire and
five likert scale, was the dependent variable. process of data collection. The questionnaire was
The independent variables included socio- pretested at Bishoftu Hospital by taking 10%
demographic characteristics of the of sample size a week prior to the actual
respondents (age, sex, marital status, study and slight modification was made. Close
ethnicity, education, work experience, supervision was carried out on daily basis by the
profession, qualification and salary); work principal investigator, and the questionnaires
environment (physical conditions, supplies, were checked for missing values and
chance for creativity, hospital location and inconsistencies.
policy); benefit-related factors (additional Ethical clearance was obtained from the
income and employment benefits); job-related Ethical Review Committee of the College of Public
factors (training opportunities, job security, Health and Medical Sciences, Jimma University. A
working relationships and nature of work); and letter of cooperation was written to West Shoa
supervisor-related factors (relation with Zonal Health Department and to the respective
supervisor and Supervisor’s recognition and study hospitals. Informed oral consent was
appreciation). obtained from each respondent during data
Quantitative data were entered into collection.
computer and analyzed using SPSS for window
version 20.0. Factor analysis was employed for RESULTS
all Likert scale instruments to extract factors
representing each of the scales and had factor Socio-demographic characteristics: In total,
scores. Kaiser-Meyer-Olkin (KMO> 0.5) Measure 217 health professionals participated in this study
of Sampling Adequacy and Bartlett’s Test of from the three hospitals making the response rate
Significance (0.000) were used to test 96.02%. The median age of the respondents was
suitability of the data to factor analysis. 26 years with a range of 20-57 years. Oromo
Principal axis factoring with Eigen value greater ethnicity accounted for more than 83% of the
than or equal to one extraction and varimax study participants. More than 55% of the health
rotation methods were employed. This facilitated professionals were protestant religion followers.
treatment of the variables as continuous in further More than half (5 1.6%) of the respondents were
analyses. Bivariate (correlation) analyses were single and about 53% of them were diploma
used to assess the relationships between holders. The median monthly salary of the
independent and dependent variables, and respondents was 1881.00 ETB with a range of
ANOVA was used, after checking for 1000.00-4,343.00 ETB. Seventy-two percent of the
234 Ethiop J Health Sci. Vol. 25, No. 3 July 2015

participants were not getting any type of monthly allowances other than their salaries (Table 1).

Table 1: Socio-demographic characteristics of respondents, West Shoa Zone, Oromia Region, Central Ethiopia, March
2013
Variables (N=217) Categories Frequency Percent
Age 20-24 56 25.8
25-29 112 51.6
30 - 34 28 12.9
>=35 21 9.7
Sex Male 113 52.1
Female 104 47.9
Ethnicity Oromo 182 83.9
Amhara 21 9.7
Tigre 5 2.3
Others 9 4.1
Religion Orthodox 76 35.0
Protestant 120 55.3
Muslim 17 7.8
Others 4 1.8
Marital status Single 112 51.6
Married 105 48.4
Healthcare work <=4.9 116 53.5
experiences 5-9.9 68 31.3
10-14.9 18 8.3
>=15 15 6.9
Qualification Diploma 113 52.1
BSc degree 99 45.6
Masters degree 5 2.3
Monthly salary <= 1233 32 14.7
1234-2249 87 40.1
2250-3413 78 35.9
>= 3414 20 9.2
Monthly financial 0 156 71.9
allowance 1-499 28 12.9
500-999 18 8.3
>=1000 15 6.9

The majority (44%) of the study participants were

nurses followed by medical doctors (11%) and
laboratory professionals (9%), among others. Work
experience varied from 4 years to more than 15
years. Most experienced health professionals (15
years or more) were more present at Ambo
Hospital, and less experienced health professionals
(less than 5) were more present at Gindeberet
Hospital (Figure 1).
 Motivation and Factors Affecting it… Tesfaye, D et al 235
Cerebral Vein Thrombosis Feridoun S. et al
frequently; they do not obtain transportation
services when they need it, there is absolutely no
recreation center which disappoints them" (39
years old, CEO). Male health professionals had
relatively higher mean motivation score (67.10%)
than their female counterparts (59.86%). Health
professionals who worked for less than five
years and those who were Protestant had the
least mean motivation scores, (60.56%) and
(61.91%), respectively. Health professionals
with Master’s degree and doctors (Medical
doctors and Dental doctors) had the highest mean
motivation scores, (95.00%) and 93.50%),
respectively. As we move from the lowest to
the highest monthly allowance scale of the
health professionals, their mean motivation scores
increase sharply with increment in amount of any
type of monthly allowances (Table 2).
Fifty-seven point three percent of the health
professionals showed a mean motivation score of
greater than 50%, while a significant proportion
Figure 1: Work experience of health professionals by
(21.2%) had a mean motivation score of less
hospital, West Shoa Zone, Oromia Region, Central
Ethiopia, March 2013
than 25% as calculated by percentage of
maximum possible scale. The overall mean
Motivational status: The mean motivation motivation score of health professionals was
score was highest in Ambo Hospital found to be 63.63% (Figure 2). On the other hand,
(72.52%) and lowest in Gindebert Hospital all the in-depth interview participants rated the
(49.46%). An in-depth interview participant also motivation status of their respective health
supported this idea saying: "But this people professionals as “medium”.
according to our district, for example, water
supply and electricity services will be interrupted
236 Ethiop J Health Sci. Vol. 25, No. 3 July 2015

Table 2: Mean motivation score of health professionals versus socio-demographic characterstics in West Shoa zone,
Oromia region, central Ethiopia, March 2013

Variables (N=217) N % Mean (Total mean Std. Deviation (total std.

63.63%) dev 34.99)
Name of hospitals Ambo 99 72.52 27.94
Gedo 49 65.64 33.68
Gindeberet 69 49.46 40.52
Age (in years) 20-24 56 59.44 32.32
25-29 112 61.38 37.56
30-34 28 77.23 26.65
>= 35 21 68.65 34.63
Sex male 113 67.10 33.64
female 104 59.86 36.18
Ethnicity Oromo 182 62.34 35.51
Amhara 21 67.66 35.91
Tigre 5 65.83 37.08
Others* 9 79.17 16.00
Religion Orthodox 76 65.57 36.75
Protestant 120 61.91 34.83
Muslim 17 63.48 32.06
Others** 4 79.17 16.32
Marital status Single 112 61.42 33.98
Married 105 65.99 36.05
healthcare work <= 4.9 116 60.56 35.37
experiences (in 5-9.9 68 64.03 34.67
years) 10-14.9 18 77.54 29.91
>= 15 15 68.89 37.66
qualification Diploma 113 60.17 34.01
BSc degree 99 65.99 36.08
Masters degree 5 95.00 11.18
profession Nurse 95 59.08 35.07
Laboratory 19 68.20 28.64
MD/DDM 25 93.50 11.54
Pharmacy 15 69.72 35.96
Others*** 63 55.82 36.74
monthly salary <= 1233 32 63.67 30.06
(ETB) 1234-2249 87 60.30 34.33
2250-3413 78 59.72 38.20
>= 3414 20 93.33 12.41
monthly allowances 0.00 156 55.87 34.30
(ETB) 150-499 28 70.69 36.87
500-999 18 93.28 10.99
>= 1000 15 95.56 10.26
monthly financial 0.00 196 60.31 35.12
benefits(ETB)
>= 200.00 21 94.64 8.85

N= number (frequencies) Others* = Gurage, Kambata, Wolaita. Others** = Wakefata, Catholic, Adventist
Others*** = Radiology, Physiotherapy, Environmental health, Anesthesia, Health officer
 Motivation and Factors Affecting it… Tesfaye, D et al 237
Cerebral Vein Thrombosis Feridoun S. et al
factors) were correlated at the significance level
of <0.01 (Table 3). The importance of financial
incentives as a motivator was also stressed by
in-depth interview participants. For instance, a
27 years old clinical director said, "Our hospital
provides 700.00 Ethiopian birr incentives per
month for each medical doctor on top of the
allowance given to them from the regional
government." “We emphasize on financial
incentives because it is important for retaining
higher health professionals" (A 50 years old
CEO).
Bivariate analysis (correlation) of socio-
demographic variables and motivation of health
professionals showed that qualification,
Figure 2: Mean motivation score level of health profession and hospital location were associated
professionals in West Shoa Zone, Oromoa Region, with motivation at significance level of <0.20. Since
central Ethiopia, March 2013 monthly salary and qualification of health
professionals were found to have multi-co linearity,
For the determination of factors affecting monthly salary was excluded from the analysis.
motivation of health professionals, the data were According to the stepwise regression analysis, job
subjected to factor analysis to identify the content related motivation was affected by
fewest number of factors that can represent the qualification, hospital location and monthly
areas covered by the items. After factor analysis, allowances. Job content was 0.43 units more
one factor consisting of six items (out of 12) important in motivating BSC degree holders when
explaining 81.50% of the variability was compared with its effect on diploma holders (B =
extracted for motivation questions. Similarly, job 0.43 and 95% CI; 0.17, 0.69). On the other hand,
content, work environment, benefit and health professionals working at Gedo Hospital
supervisor related factors had undergone factor responded that the gepgraphical location of their
analysis. The job content factor included 5 items hospital is 0.44 units less important in motivating
and one factor consisting of 4 items and them when compared with their counterparts
explaining 65.32% of variability was extracted. working at Ambo Hospital (B = -0.44 and 95%
For work environment, all the items (four of CI; -0.74, -0.13). Similarly, health professionals
them) were included in one factor explaining for who had been earning monthly financial
67.8 5% of the variability. Four from the five allowances of 500-999 ETB responded that
items were extracted as one factor from the benefit- the allowance is 0.63 units more important in
related factors explaining 69.51% of the variability. motivating them when compared to those
The supervisor related factor included all the earning below 500 or above 999 ETB (B = 0.63
items in one factor explaining for 75.02% of the and 95% CI; 0.17, 1.09). In-depth interview
variability. Since all of these factors contain only participants supported this idea as: “Health
one factor identified for each category based on professionals who obtain incentives are more
their Eigen value, communality, factor loading motivated than those who do not obtain
and the total variance explained, their names were incentives." (27 years old, clinical director) "But
retained as original name. there is something that these health professionals
Bivariate analysis of the factors that affect need, meaning additional things that motivate
motivation revealed that age, work experiences them. For example nurses are obtaining 35.00
and monthly allowances were correlated with Ethiopian birr duties. They need this duty to be
motivation of health professionals at increased. There is also a question for salary
significance level of 0.20. All other factors increase." (26 years old, clinical director)
affecting motivation (job content, work
Motivational value of work environment varied
environment, benefits and supervisor related
from profession to profession. Accordingly,
 238 Ethiop J Health Sci. Vol. 25, No. 3 July 2015

medical doctor and doctor of dental medicine health professionals working at Ambo Hospital
assumed work environment as 0.51 units more (B = -0.96 and 95% CI; -1.23, -0.69). In
important in motivating them when compared addition, it was about 0.30 units more important
with nurses (B = 0.51 and 95% CI; 0.10, 0.92). for Orthodox Christianity followers as
And, health professionals working at Gindeberet compared to followers of the protestant religion
Hospital responded that work environment is (B = 030 and 95% CI; 0.06, 055).
about 0.38 units less important in motivating them Hospital location, qualification and
when compared with health professionals working at profession were factors that were found to affect
Ambo Hospital (B = -0.38 and 95% CI; -0.66, - benefit factors of motivation. For health
0.11). Similarly, Orthodox Christianity professionals working at Gedo and Gindeberet
followers (0.30 units and BSc degree holders hospitals benefit-related factors were 0.54 and
(0.29 units) responded that work environment is 0.76 units less important in motivating them
more important in motivating them: (B = 0.30 when compared with health professionals
and 95% CI; 0.03, 0.57) and (B = 0.29 and 95% working at Ambo Hospital, (B = -0.54 and 95%
CI; 0.03, 0.55), respectively. CI; -0.85, -0.22) and (B = -76 and 95% CI; -1.05,
The role of supervision in motivating health -0.48), respectively. For laboratory professionals
professionals varied across level of qualification, and doctor of dental medicine and medical doctor
religion and location of a hospital. In this health professionals, benefit related factors were
regard, medical doctors and doctors of dental about 0.51 and 0.85 units more important in
medicine rated supervisor related factors as motivating them when compared with nursing
0.62 units more important when compared with health professionals (B = 0.51 and 95% CI;
nurses (B = 0.62 and 95% CI; 0.22, 1.03). It was 0.07, 0.94) and (B = 0.85 and 95% CI; 0.43,
also about 0.96 units less important at 1.27), respectively.
Gindeberet Hospital when compared with
Table 3: Bivariate analysis of factors affecting motivation among health professionals in West Shoa Zone, Oromia
Region, Central Ethiopia, 2013

monthly allowances
Work environment

Supervisor related

healthcare work
Benefit related

experiences
Job content
Motivation

Age

Pearson Correlation 1
Motivation
Sig. (2-tailed)
Pearson Correlation .294** 1
Job content factors
Sig. (2-tailed) .000
Work environment Pearson Correlation .357** .595** 1
factors Sig. (2-tailed) .000 .000
Pearson Correlation .373** .390** .699** 1
Benefit related
Sig. (2-tailed) .000 .000 .000
Pearson Correlation .469** .239** .467** .551** 1
Supervisor related
Sig. (2-tailed) .000 .000 .000 .000
Pearson Correlation .102 .111 .106 .152* .197** 1
Age
Sig. (2-tailed) .135 .104 .120 .025 .004
Healthcare work Pearson Correlation .102 .102 .100 .157* .221** .897** 1
experiences Sig. (2-tailed) .133 .135 .144 .021 .001 .000
Pearson Correlation .352** .199** .229** .243** .246** .070 -.007 1
Monthly allowances
Sig. (2-tailed) .000 .003 .001 .000 .000 .303 .923
 Motivation and Factors Affecting it… Tesfaye, D et al 239
Cerebral Vein Thrombosis Feridoun S. et al
Variables that had association by bivariate motivation score when compared with health
analysis at significance level of 0.20 or less were professionals who did not obtain any financial
entered into the multivariate analysis. The benefits (B = 0.83 and 95% CI; 0.39, 1.27)
multiple regression analysis showed that (Table 4 & 5).
motivation of health professionals was This is supported by in-depth interviews.
associated with supervision, type of profession, For instance, a 26 years old clinical director
job content, location of the hospital, and financial said, “... but health professionals want
benefits. Accordingly, health professionals additional money to their salaries in order to
working at Gindeberet Hospital had about 0.54 be motivated. For example nurses are getting
units lower motivation score when compared 35.00 Ethiopian Birr per day for duty
with health professionals working at Ambo compensation, but they want this to be improved.
Hospital (B = -0.54 and 95% CI; -0.80, -0.27) Another group has no such benefits and thus are
and professionals earning monthly benefits of 499 requesting for it. So everybody has his/her own
ETB and above had about 0.83 unit higher question."
Table 4: Stepwise multiple regression analysis showing the final model of factors affecting motivation of health
professionals in West Shoa Zone, Oromia region, Central Ethiopia, 2013

Model Unstandardized Standardized Sig. 95% CI

Coefficients Coefficients
B Std. Error Beta
(Constant) .010 .073 .887 -.133, .153
Supervisor related factor .287 .064 .287 .000 .162, .412
Medical doctor & doctor of dental medicine .596 .182 .191 .001 .237, .955
Job content factor .213 .059 .213 .000 .097, .330
Gindeberet hospital -.424 .132 -.198 .002 -.684, -.164
Benefits less than 499 1.012 .338 .166 .003 .345, 1.679
Benefits of 500-999 .670 .285 .134 .020 .108, 1.231
Dependent variable: work motivation
Table 5: Stepwise multiple regression analysis of results of factors affecting motivation of health
professionals, West Shoa zone, Oromia region, central Ethiopia, March 2013
Model F (%) Unstandardized Standardized Sig.
Coefficients Coefficients 95.0% Confidence Interval for B

B Std. Error Beta Lower Bound Upper Bound

Benefits
No benefit* 196(90.3) - - - - - -
>= 200ETB 21(9.7) .71 .20 .21 .000 .32 1.10
Hospital location
Ambo* 99(45.6) - - - - - -
Gindeberet 69(31.8) -.54 .13 -.25 .000 -.80 -.27
Allowances
No allowances * 156(71.9) - - - - - -
>=1000ETB 15(6.9) .83 .22 .21 .000 .39 1.27
500-999ETB 18(8.3) .49 .21 .14 .023 .07 .91
150-499ETB 28(12.9) .33 .16 .11 .044 .01 .65
Dependent Variable: work motivation *Reference categories (category with highest frequencies). F=frequencies
240 Ethiop J Health Sci. Vol. 25, No. 3 July 2015

other two hospitals. Even, there was DSTV

DISCUSSION service in the hospital compound of Gindeberet
Hospital, which was not available in the other
This study showed that there is no statistically two hospitals for health professionals. An in-
significant relationship between socio- depth interview participant also supported this
demographic variables (age, sex, ethnicity, marital idea saying, "But this people according to our
status, religion) and their motivation. This finding district, for example, water supply and
is different from a study conducted on motivation electricity services will be interrupted
and job satisfaction among medical and nursing frequently; they do not obtain transportation
staff in a Cyprus, public Nicosia General Hospital services when they need it, there is absolutely
which revealed the female doctors reported being no recreation center which disappoints them"
motivated significantly by remuneration (salary, (39 years old, CEO). In Ethiopia, motivation is
benefits, pension and vacation schemes) than their affected by non-conducive working
male counterparts (15). This difference may be environment, shortage of staff housing and
due to the difference in socio-political system transport facilities for health professionals to stay
between the study areas. It is also different from a in remote areas (17).
study conducted in Addis Ababa hospitals which Health professionals earning monthly
revealed that nurses’ motivation depended on age financial benefits had higher motivation score
(16). The difference may be related to when compared with health professionals who
inclusion of only nursing health professionals did not obtain any financial benefits. In-depth
in the study carried out in Addis Ababa. interview participants supported this idea as:
Motivation level of hospital health “Health professionals who obtain incentives are
professionals differs from hospital to hospital. more motivated than those who do not obtain
Health professionals from Ambo Hospital incentives." (27 years old, clinical director);
scored higher mean motivation score than "But there is something that these health
Gindeberet Hospital health professionals. This professionals need, meaning additional things that
may be because of the difference in distance motivate them. For example nurses are obtaining
from the central and zonal capital town. These 35.00 ETB duties. They need this duty to be
hospitals also differ in the infrastructures they increased. There is also a question for salary
have like road, water supply, electricity, access to increase."(26 years old, clinical director). A
transportation services, etc. For example, Ambo finding from health worker (internal customer)
Hospital is found in the zonal town and at a satisfaction and motivation in the public sector in
distance of only 114kms from Addis Ababa, the Ghana shows low salary was the most frequently
capital city of Ethiopia, with full access to mentioned de-motivator for over 94% of staff in
transportation. However, Gindeberet Hospital all districts (18).
is found at a distance of 195kms from Addis Qualification of health professionals was
Ababa, and there is sever difficulty in access to associated with their motivation. A report from a
transportation services. Gindeberet Hospital study conducted on employee motivation and
being in the district town, health professionals performance in the healthcare industry in the
do not almost have access to cafes, restaurants, Middle East supports this finding in which
recreation centers, centers for further education motivation had positive and significant
for health professionals, etc. At the same time, relationships with education (qualification)
monthly allowances and monthly top-ups (12). The study conducted in Addis Ababa
given to health professionals at Gindeberet hospitals on the relationship between rewards
Hospital were relatively higher than the other two and nurses’ motivation reported that there was a
hospitals. Educational opportunities were also significant relationship between motivation and
more available for health professionals educational qualification of nurses (16).
working in Gindeberet Hospital than for those On the other hand, job content related
working in Ambo or Gedo hospitals. The factors affect motivation and include knowledge
availability of different materials like lap-tops of what is expected to be achieved,
was more in Gindeberet Hospitals than in the relationship of colleagues, doing challenging
 Motivation and Factors Affecting it… Tesfaye, D et al 241
Cerebral Vein Thrombosis Feridoun S. et al
work and training opportunities. This finding those health professionals who do not get any
was also consistent with findings from Peter financial benefits based on their performance.
et al in a study conducted on public and private Gindeberet Hospital should collaborate with
sector health workers in Andhra Pradesh and relevant sectors like road and transportation
Uttar Pradesh, India, which found that the three of authority to improve health professionals’ access
the top five job characteristics for motivation with to transportation services. The works achieved by
the highest important rating overall were “good health professionals should be properly
working relationships with colleagues”, communicated, and relationship among them needs
“training opportunities” and “challenging to be enhanced. Training opportunities should be
work” all of which were included in the ‘job created to facilitate health professionals’ career
content’ component (11). developments. The main limitation of the study
West Shoa hospital health professionals was that the questionnaire was administered to
overall motivation score was 63.63% the participants while they were on their routine
calculated as percentage of maximum scale duty that they may have responded to the items
score. All the in-depth interview participants without deep understanding them. All types of
rated their respective health professionals’ Health professionals’ category was also not
motivation as “medium.” A study from public equally represented in the study.
health facilities in Malawi shows that mean level
scores of intrinsic motivation of health workers range REFERENCES
from motivated to highly motivated to fulfill their 1. Bennett S, and Franco LM, Public Sector
jobs (13). A report from assessment of the role Health Worker Motivation and Health Sector
of non-financial incentives for motivation in Reform: A Conceptual Framework. Major
Kenya shows that more than 55% of health Applied Research 5, Technical Paper 1.
workers do not place their own level of Bethesda, MD: Partnerships for Health
motivation in the category “rather good,” “high” Reform Project, Abt Associates Inc. January
or “very high.” Only around a quarter (26.83%) 1999.
of health professionals assessed their level of 2. Bennett S, and Franco LM, Health Worker
motivation as “very high,” “high” or “rather Motivation and Health Sector. Reform Primer
good” from public services in Benin (19). for policy makers. Partnership for health
In conclusion, motivation of health reform. 2000.
professionals was affected by different factors: 3. Dieleman M, and Harnmeijer JW, Improving
supervisor related factors, financial benefits, job health worker performance: in search of
content, professional qualification and location promising practices. World Health
of the hospital. A significant proportion of Organization. KIT – Royal Tropical institute
participants believed that the current supervision The Netherlands. September 2006.
positively impacted their motivation. Health 4. Global Health Workforce Alliance.
professionals working in Ambo Hospital, Guidelines: Incentives for Health
which is geographically favored with better Professionals. Prepublication Copy. 2008
social infrastructures, were more motivated than 5. World Health Organization: Workshop on
their counterparts working in Gindeberet Hospital. global health workforce strategy Annecy,
The mean motivation score of health professionals France. Geneva 2001
who did not get any monthly financial benefit was 6. Human Resources for Health Country
significantly lower than those who did. Doctors Profile Ethiopia. Africa Health Workforce
responded that their job content had higher impact Observatory. June 2010 p: 10
in their motivation while nurse responded it had a 7. Dejene T, Health Situation in Ethiopia,
lesser impact in their motivation. It is therefore German Ethiopian Association. Ausgabe,
recommended that achievements and good work November 2003
by health professionals should be recognized by 8. Girma S, et al, Human Resource Development
their respective hospitals through creating reward for Health in Ethiopia: Challenges of
and recognition systems. The hospitals need to Achieving the Millennium development
devise ways of accessing financial benefits to Goals. Ethiop.J.Health Dev. 2007; 21
242 Ethiop J Health Sci. Vol. 25, No. 3 July 2015

(3):216-231 Healthcare employee satisfaction survey.

9. Lindelow M, Serneels P and Lemma T, The Republic of Turkey, Ministry of Health.
Performance of Health Workers in Ethiopia Ankara 2010
Results from Qualitative Research. World 15. Lambrou P., Kontodimopoulos N. and
Bank Policy Research Working Paper 3558, Niakas Dimitris: Motivation and job
April 2005 satisfaction among medical and nursing staff
10. Malik AA, et al. Motivational determinants in a Cyprus public general hospital. Human
among physicians in Lahore, Pakistan. Resources for Health. 2010 8:26
BMCHealthServices Research 2010, 10:201 16. Negussie N, Relationship between Rewards
11. Peters DH, et al, Job satisfaction and and Nurses’ Work Motivation in Addis
motivation of health workers in public and Ababa Hospitals. Ethiop JHealth Sci. July
private sectors: cross-sectional analysis from 2012, 22:2
two Indian states. Human Resources for 17. Ethiopian Federal Ministry of Health: Health
Health 2010, 8:27 Sector Strategic Plan (HSDP-III) 2005/6-
12. Suliman AM, and Al-Sabri N, Surviving Through 2009/10. Planning and Programming
the Global Downturn: Employee motivation and Department. 2005
Performance in Healthcare Industry. The 18. Agyepong IA, et al, Health worker (internal
Open Business Journal, 2009, 2, 86-94 customer) satisfaction and motivation in the
13. Goldberg, Allison B, and Levey IR, public sector in Ghana. Int JHealth Plann
Understanding the Complex Drivers of Mgmt 2004; 19: 319–336
Intrinsic Motivationfor Health Workers in 19. Mathauer I, Imhoff I, Health worker motivation
Malawi. Bethesda, MD: Health Systems in Africa: the role of non-financial incentives and
20/20 project, Abt Associates Inc. May 2012. human resource management tools. Hum.
14. Mollahalġloğlu S, Kosdak M and Taġkaya S, Resour. Health. Aug 2006 29;4:24.