Healthcare workers’ readiness to provide immunization services at primary health care units in pastoral and semipastoral regions in Ethiopia: Core Group Polio Project implementation areas

Abstract

Background: Ethiopia has been implementing immunization programs for the past four decades. However, coverage remains low, especially in pastoral and semi-pastoral regions. Among the obstacles to achieving immunization targets is the level of health workers’ readiness to provide immunization services, measured in terms of levels of motivation, capacity and involvement.

Objective: To assess the extent of healthcare providers’ readiness to provide immunization services at primary healthcare units in pastoral and semi-pastoral areas of Ethiopia.  Methods: A cross-sectional survey was conducted on a sample of 1,283 healthcare providers involved in immunization services in 233 health centers, and 699 health posts in the health center catchment areas. From five CORE Group Polio Project intervention regions in Ethiopia, interviews were held with personnel in each health center – an Extended Program on Immunization focal person, a midwife, and the medical director or head. From each health post, interviews were held with one health extension worker. Data were collected using a selfadministered questionnaire facilitated by woreda and zonal health and CORE Group staff. The outcome variable of interest, readiness, was measured using three indicator variables – high to very high levels of self-reported motivation and involvement in immunization service provision, and having received at least one immunizationrelated training in the last two years. In addition to health care workers’ background characteristics, where workers were based – in pastoral or semi-pastoral areas – were included as factors for readiness. Data were entered into EpiData and exported to STATA version 12 for analysis. Binary logistic regression was used to identify independent factors associated with readiness, and p<0.05 was used to declare statistical significance.

Results: Among health center respondents, those with a diploma were 2.3 times more likely to be ready compared to those with a first degree. Similarly, nurses and those who claimed higher satisfaction with supportive supervision were 2.1 and 6.2 times more likely to be ready to provide immunization services compared to midwives and those with a medium level of satisfaction, respectively. Among health post staff, being female (AOR=2.2), having more than five years of work experience (AOR=2.2) and having a high level of satisfaction with supportive supervision (AOR=4.5) showed higher readiness levels compared to males, those with less than or equal to two years of service, and those with a medium level of satisfaction, respectively.

Conclusions: To ensure health care workers’ readiness to provide immunization services, providing ongoing inservice training and improving supportive supervision, particularly for men in health posts, should be prioritized. [Ethiop .J. Health Dev. 2019; 33(Special issue):37-45] 

Key words: Primary healthcare unit, readiness, immunization, health workers, pastoral and semi-pastoral, Ethiopia