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Haramaya University School of Graduate Studies Health HARAMAYA UNIVERSITY SCHOOL OF GRADUATE STUDIES HEALTH PROFESSIONALS INTENTION TO LEAVE THE ORGANIZATION AND ASSOCIATED FACTORS IN PUBLIC HEALTH FCILITIES OF PASTORALIST AREA; FAFAN ZONE, EASTERN ETHIOPIA MPH THESIS BY: HIKMET ABDURAHMAN College: Health and Medical Science School/department: Public Health Program: Health Service Management (HSM) Major advisor: Melkamu Merid (MPH, Assistant professor) Co-advisor: Lemessa Oljira (PHD, Associate professor) JANUARY 2021 HARAMAYA UNIVERSITY, ETHIOPIA HARAMAYA UNIVERSITY SCHOOL OF GRADUATE STUDIES Health Professionals Intention to Leave The Organization and Associated Factors in Public Health Facilities in pastoralist Area; Fafan Zone, Eastern Ethiopia A Thesis Submitted to the Collage of Health Science, School Of Graduate Studies, Haramaya University In Partial Fulfilment of the Requirements for the Degree of Master of Public Health in Health Service Management By: Hikmet Abdurahman Major Advisor: Melkamu Merid (Mph, Assistant Professor) Co-Advisor: Lemessa Oljira (Phd, Associate Professor) January, 2021 Haramaya University, Ethiopia i APPROVAL SHEET HARAMAYA UNIVERSITY SCHOOL OF GRADUATE STUDIES I hereby certify that I have read and evaluated this thesis entitled " Health Professionals Intention to Leave and Associated Factors in Public Health Facilities in Fafan Zone, Eastern Ethiopia” prepared under my guidance by Hikmet Abdurahman. I recommend that it should be submitted as fulfilling the thesis requirement. _______________________ _______________ _______________ Major Advisor Signature Date _______________________ _______________ _______________ Co-Advisor Signature Date As a member of the Board of Examiners of the MPH Thesis-Open Defence Examination, I certify that I have read and evaluated the thesis prepared by Hikmet Abdurahman and examined the candidate. I recommend that the thesis be accepted as fulfilling the thesis requirements for the degree of Master of Public Health in Health Service Management. _________________________ _______________ ________________ Chair Person Signature Date ____________________________ _______________ ________________ Internal Examiner Signature Date ____________________________ _______________ ________________ External Examiner Signature Date Final approval and acceptance of the thesis are contingent upon submitting its final copy to the Council of Graduate Studies (CGS) through the Candidate's Department or School Graduate Committee (DGC or SGC). ii STATEMENT OF THE AUTHOR By my signature below, I declare and affirm that this thesis is my work. I have followed all ethical and technical principles of scholarship in the preparation, data collection, data analysis, and compilation of this thesis. Any scholarly matter that is included in the thesis has been given recognition through citation. This thesis is submitted in partial fulfillment of the requirements for an MPH degree at Haramaya University. The thesis is kept in the Haramaya University Library and is made available to borrowers under the Library rules. I solemnly declare that this thesis has not been submitted to any institution anywhere for the award of academic degree, diploma, or certificate. Brief quotations from this may be made without special permission provided that accurate and complete acknowledgment of the source is made. Requests for permission for extended quotations from or reproduction of this thesis in whole or in part may be granted by the Head of the School when in his or her judgments, the proposed use of the material is in the interest of scholarship. In all other instances, however, permission must be obtained from the author of the thesis. Name:- Hikmet Abdurahman Signature: ___________________ Date: ________________________ School/Department:-Public Health/Health Service Management iii BIOGRAPHICAL SKETCH The auther was born in 1992 in Haramaya Woreda, East Hararge Zone, Oromia region, Eastern Ethiopia. She has completed elementary school in Haramaya University Model School. She had attended Secondary school in Medhana Alem Comprehensive Secondary School and Preparatory School in Harar Senior Secondary School, Harar. Upon completion of preparatory School, she joined Haramaya University by the year 2008 and she got her first degee in Bachelor of Science (BSc) in Public Health from Haramaya University in 2011. Then, she employed at the Finkile Health center and Adelle Health Center, Haramaya Woreda, for about four years. In 2015 she joined Jigjiga University CHMS, public health department and was working as assistant lecturer until she started post graduate study in Haramaya University for a Masters of Public Health in health service management in 2019. iv ACKNOWLEDGMENT I would like to thank Haramaya University, College of Health and Medical Science for giving me this chance and support to perform this study. My sincerely appreciation goes to my advisors, Melkamu Merid (MPH, Assistant Professor) and Dr. Lemessa Oljira (PHD, Associate Professor) for their valuable comments and suggestions throughout the study. I would like to give thanks to managers from each health center, hospital and Zonal health department of Fafan zone for giving me the necessary information and support throughout the data collection period. Finally, I would like to show appreciation for data collectors and supervisors who were participated during data collection and those health professionals who gave responses for the study questioner. v TABLE OF CONTENTS APPROVAL SHEET ii STATEMENT OF THE AUTHOR iii BIOGRAPHICAL SKETCH iv ACKNOWLEDGMENT v TABLE OF CONTENTS vi LIST OF TABLES ix LIST OF FIGURES x ABBREVIATIONS xi ABSTRACT xii 1. INTRODUCTION 1 1.1. Background 1 1.2. Statement of the problem 3 1.3. Significance of the study 5 1.4 Objectives of study 5 1.4.1. General Objective 5 1.4.2. Specific Objective 5 2. LITRATURE REVIEW 6 2.1 Intention to leave the organization 6 2.2 The magnitude of intention to leave 6 2.3 Associated factors with intention to leave the organization 7 2.3.1. Socio demographic factors 7 2.3.2. Organizational related factors 9 2.3.3. Work - related factors 12 2.3 Conceptual framework 15 3. METHODS AND MATERIALS 16 3.1 Study area/ setting and study period 16 3.2. Study design 16 3.3. Source population 16 3.4. Study population 16 3.5. Inclusion and exclusion criteria 16 vi 3.5.1. Inclusion criteria 16 3.5.2 Exclusion criteria 17 3.6. Sample size determination 17 3.7. Sampling procedure/ technique 18 3.8. Data collection tool and methods 20 3.9. Variables 22 3.9.1 Dependent variable 22 3.9.2 Independent variables 22 3.10. Operational definition(s) 22 3.11. Data quality control 23 3.12. Method of data process and analysis 24 3.13. Ethical considerations 25 3.14. Dissemination of results 25 4. Results 26 4.1 Socio‑demographic characteristics of respondents 26 4.2 Organizational related factors 27 4.3 Work-related factors 28 4.4 Magnitude of Intention to leave 28 4.5 Factors associated with intention to leave of health porfessionals 29 5. Discussion 32 6. Limitation and strength of the study 35 6.1. Strength of the study 35 6.2. Limitation of the study 35 7. Conclusion and Recommendation 36 7.1. Conclusion 36 7.2. Recommendation 36 8. REFERENCE 37 9. ANNEXES 41 9.1 Annex A: Information sheet and informed voluntary consent form for health professionals 41 9.2 Annex B: Information sheet and informed voluntary consent form for head of the hospital/ health center 43 9.3 Annex C: Questionnaire 45 9.4 Annex D: Curriculum vitae 52 vii 9.5 Annex E: Approval sheet 55 viii LIST OF TABLES Table Page Table 1 Socio‑demographic characteristics of health professionals in public health facilities in Fafan Zone, Eastern Ethiopia, 2020 26 Table 2 Organizational related factors of health professionals in public health facilities in Fafan Zone, Eastern Ethiopia, 2020 27 Table 3 Work related factors of health professionals in public health facilities in Fafan Zone, Eastern Ethiopia, 2020 28 Table 4 Magnitude of Intention to leave of health professionals in public health institutions in Fafan Zone, Eastern Ethiopia, 2020. 29 Table 5 Bivariate binary logistic regression analyses of health professionals intention to leave and associated factors in public health fcilities in Fafan zone, Eastern Ethiopia, 2020. 30 Table 6 Multivariate logistic regression analyses for intention to leave and associated factors among health professionals in public health institutions in Fafan Zone, Eastern Ethiopia, 2020 31 ix LIST OF FIGURES Figures Page Figure 1 Conceptual framework of health professionals intention to leave and associated factors in public health fcilities in Fafan zone, Eastern Ethiopia, 2020 15 Figure 2 Sampling Procedure of health professionals intention to leave and associated factors in public health fcilities in Fafan zone, Eastern Ethiopia, 2020 19 x ABBREVIATIONS AOR: Adjusted Odds Ratio CI: Confidence Interval EHSTP: Ethiopian Health Sector Transformation Plan FDREMOH: Federal Democratic Republic of Ethiopia Minister of Health HRM: Human Resource Management IHRERC: Institutional Health Research Ethics Review Committee OR: Odd Ratio RHWs: Rural Health Workers USAID: United States Agency for International Development USD: United State Dollar VIF: Variance inflation factor WHO: World Health Organization xi ABSTRACT Background: Health professionals‟ intention to leave significantly affects the functioning of the health care sector worldwide, especially in developing countries, and it impedes progress towards different health-related goals by reducing innovation, affecting the quality of services
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