Table 3.
Summary of interview and FGD findings
| Factor | Relevance | Detailed workings | Mechanisms | |
|---|---|---|---|---|
| Pull | Learning opportunities | Dominant | -Founding Semera University reduces turnover to other regions because of learning opportunities | P-RE-M |
| -While most employees come from other regions, local employees/management are favoured for education programmes | Dis-Log | |||
| -Employees unlearn; lose skills because of poor facilities | SOP | |||
| Career opportunities | -Employees perceive big Ethiopian cities as better places for career opportunities | P-RE-M, SOP, Fin | ||
| -Non-local employees perceive promotion as unlikely for them in local public organisations | P-RE-M, Dis-Log, Fin | |||
| Recruitment | -New international companies arriving in region offer better paid positions | Fin | ||
| Push | Salary | Dominant | -Employees leave to earn up to four times higher salaries in private sector, or start their own business | Fin |
| -Low public sector salaries are even less attractive because of payment difficulties | Dis-Log, Fin | |||
| -Complementary salary (e.g. moonlighting) can prevent turnover, but opportunities are scarce in the Afar Region | P-RE-M | |||
| -Overtime work is perceived as excessively long and poorly paid in the Afar Region (potentially because of understaffing) | Dis-Log, Fin | |||
| Facilities | Dominant | -Employees leave because of low health service standards, which they perceive to be better at NGOs and private clinics | SOP | |
| -Employees feel frustrated and get emotionally drained by not being able to provide health services due to lack of equipment & medicine | SOP, Dis-Log | |||
| -Employees unlearn/lose skills because of lack of equipment. | SOP | |||
| -Exposure to chemicals, unhygienic conditions, for employees, technicians and patients (P-HS) | SOP | |||
| Location | Dominant | -Public sector workers seek locations with good moonlighting opportunities to supplement low base salary | P-RE-M, Fin | |
| -Employees and their families dislike the harsh climate and dull social infrastructure | P-RE-M | |||
| -Lack of good schools and health services for family | P-RE-M | |||
| -Professional and social life is complicated by language difficulties | P-RE-M | |||
| -Cultural differences and distances inhibit bonding with patients, colleagues, community | P-RE-M | |||
| -Perceived discrimination and unfairness by local management | Dis-Log | |||
| Personal health and safety | -Aggression by patients because of poor services (resulting from poor facilities) | SOP | ||
| -Exposure to chemicals, unhygienic conditions | SOP | |||
| -Violence by management | Dis-Log | |||
| -Poor access to health services for employees and family | P-RE-M, Fin | |||
| Workload | -Emotional burden to not being able to provide health service due to poor facilities | SOP | ||
| -Cascading effect when others leave as workload increases for the remaining workforce resulting in long, poorly paid overtime | Dis-Log, Fin | |||
| -Perceived workload may be higher because of lack of control and autonomy | Dis-Log, SOP | |||
| Management support | Dominant | -Demotivation through management’s lack of interest in the well-being of the primary process employee | Dis-Log | |
| -Personal relationships may outweigh professional ability in hiring/promotion | Dis-Log | |||
| -Little recognition of professional abilities and autonomy | Dis-Log | |||
| -Employees leave because they feel badly treated, sometimes even violently. | Dis-Log | |||
| -Good management support drives retention | Dis-Log |
Abbreviations of mechanisms (column 5): P-RE-M lack of social and personal opportunities valued by the healthcare employees, Dis-log dissonance between management logic and professional logic, SOP standards of service operations are hard to accept, Fin lack of financial improvement opportunities