Health care managers' perspectives on workforce licensing practice in Ethiopia: A qualitative study.

BACKGROUND: Professional licensing bodies are valuable sources for tracking the health workforce, as many skilled health-care providers require formal training, registration, and licensure. Regulatory activities in Ethiopia were not effectively implemented due to poor follow-up and gaps in skilled human resources, budget, and information technology infrastructure. OBJECTIVE: The aim of this study was to explore and describe the lived experiences and challenges faced by health care managers in health professionals' licensure practices in Ethiopia. METHODS: A cross-sectional study design with a phenomenological approach was employed between March 26 and April 30, 2021, to collect qualitative data. We conducted in-depth interviews with a total of 32 purposively selected health system managers. An interview guide was prepared in English, translated into Amharic, and then pretested. Audio recorded data was transcribed verbatim, translated, and analysed manually by themes and sub-themes. A member check was done to check the credibility of the result. RESULTS: The data revealed four major themes: awareness of licensing practices, enforcement of licensing practices, systems for assuring the quality of licensing practices, and challenges to licensing practices. Lack of awareness among managers about health workforce licensing was reported, especially at lower-level employers. Regulators were clear on the requirements to issue a licence to the health workforce if they are competent in the licensing exam, while human resource managers do not emphasise whether the employees have a licence or not during employment. As a result of this, non-licenced health workers were employed. Health care managers mentioned that they did not know any monitoring tools to solve the issue of working without a licence. Fraudulent academic credentials, shortage of resources (human resources, finance, equipment, and supplies), and weak follow-up and coordination systems were identified as main practice challenges. CONCLUSIONS: This study reported a suboptimal health professionals' licensing practice in Ethiopia, which is against the laws and proclamations of the country that state to employ all health workers only with professional licenses. Challenges for health professionals' licensing practice were identified as fraudulent academic credentials, a shortage of resources (HR, finance, equipment, and supplies), and a weak follow-up and coordination system. Further awareness of licensing practices should be created, especially for lower-level employers. Regulators shall establish a reliable digital system to consistently assure the quality of licensing practices. Health care managers must implement mechanisms to regularly monitor the licensing status of their employees and ensure that government requirements are met. Collaboration and regular communication between regulators and employers can improve quality practices.

Human resources for emergency care systems in Ethiopia: Challenges and triumphs.

Emergency care is in its nascency in most of the world and emergency health systems are developing throughout Africa, including Ethiopia. Ethiopia is a LMIC African nation that has committed to strengthening emergency care systems. A historical perspective provides the background of Ethiopian emergency care with the development of an emergency care taskforce to the first residency program and subsequent development of the Emergency and Critical Care Directorate. The goals of the directorate are discussed as well as their role in the development of the national integrated emergency medicine curriculum. Concurrently the development of multiple residencies as well as a nursing emergency and critical care training increased the human resources for emergency medicine. Recently, the WHO and Ministry of Health-Ethiopia have been working together to roll out an integrated emergency care system development agenda throughout the country bolstered by the recent passing of a world health assembly resolution to strengthen emergency care co-led by Ethiopia. With all the successes of Ethiopia in increasing human resources there have been both triumphs and challenges. The development of human resources for emergency care systems in Ethiopia provides insights and lessons learned to other nations on a similar pathway of strengthening emergency care systems.