Exploring health workforce regulation practices and gaps in Ethiopia:a national cross-sectional study

Background:Health workforce regulation plays key roles in ensuring the availability of competent health workers and improving performance of the health system.In 2010,Ethiopia established a national authority aiming to ensure competence and ethics of health professionals.Subsequently,subnational regulators were established and regulatory frameworks were developed.Although there were anecdotal reports of implementation gaps,there was lack of empirical evidence to corroborate the reports.We conducted a national study to explore health professional regulation practices and gaps focusing on registration,licensing,ethics,scope of practice,and continuing professional development.Methods:We conducted a mixed methods cross-sectional survey using structured interview with a national representative sample of health professionals and key informant interviews with health regulators and managers.We used two stage stratified cluster sampling to select health professionals.The quantitative data were subjected to descriptive and multivariable logistic regression analysis.We conducted thematic analysis of the qualitative data.Results:We interviewed 554 health professionals in the quantitative survey.And 31 key informants participated in the qualitative part.Nearly one third of the respondents(32.5%)were not registered.Many of them(72.8%)did not renew their licenses.About one fifth of them(19.7%)did nothing against ethical breaches encountered during their clinical practices.Significant of them ever practiced beyond their scope limits(22.0%);and didn’t engage in CPD in the past 1 year(40.8%).Majority of them(97.8%)never identified their own CPD needs.Health regulators and managers stressed that regulatory bodies had shortage of skilled staff,budget and infrastructure to enforce regulation.Regulatory frameworks were not fully implemented.Conclusions:Health professionals were not regulated well due to limited capacity of regulators.This might have affected quality of patient care.To ensure effective implementation of health professional regulation,legislations should be translated into actions.Draft guidelines,directives and tools should be finalized and endorsed.Capacity of the regulators and health facilities needs to be built.Reinstituting health professionals’council and regulation enforcement strategies require attention.Future studies are recommended for assessing effects and costs of weak regulation.

Practice analysis of junior doctors in Ethiopia:implications for strengthening medical education,practice and regulation

Background:A high performing physician workforce is critical to attain nationally set health sector goals.Ethiopia has expanded training of medical doctors.However,little is known about junior doctors’performance.Understanding medical practice is essential to inform medical education and practice,establish licensure examination and guide workforce management decisions.We conducted a practice analysis study to identify gaps in Ethiopian medical education and practice,and to determine composition of subjects in national licensing examination.Methods:We conducted a cross-sectional study with national representative sample of junior doctors.After calculating a sample size of 198,we used a two-stage stratified cluster sampling method to select study participants.We collected data using a structured questionnaire comprising 222 tasks.Study participants reported in interviews on frequency of,competence at,and importance of doing each task for improved health outcome.We developed proportions,averages,graphs and tables.Using the results of practice analysis and experts’ratings,relative weights of subjects in the national licensing examination for medical undergraduates were determined.Results:A total of 191 junior doctors participated.Most were males(74.6%)and had less than 2 years of experience(69.8%).Junior doctors frequently performed tasks of internal medicine and pediatrics.Their participation in obstetrics and gynecology,ophthalmology,psychiatry and dentistry services was infrequent.Junior doctors had competency gaps to conduct clinical procedures,research and health programming tasks.Practice analysis results and expert ratings generated comparable recommendations for composition of a national licensing examination,with more than threequarters of the items focusing on internal medicine,pediatrics,surgery,obstetrics and gynecology,and public health.Conclusion:Junior doctors in Ethiopia rarely managed psychiatry,ophthalmology and dental patients.They had competence gaps in clinical procedures,research and health programming skills.The findings have implications for establishing licensing examination,and reviewing curriculum,continuing professional development,placement and rotation policy,and distribution of responsibilities.