{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T06:40:49Z","timestamp":1763534449540,"version":"3.45.0"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T00:00:00Z","timestamp":1763510400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Health worker motivation affects service quality, retention, and the performance of primary health systems, especially in low-income settings. In Ethiopia, Health Extension Workers (HEWs) form the backbone of the rural health system, yet limited empirical evidence exists on the factors influencing their motivation across diverse regional contexts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A survey was conducted with 314 HEWs from six Woreda (Districts) and one town administration in the Oromia Region of Ethiopia, between July 1 and August 14, 2024. Motivation was operationally defined as the capacity of HEWs to initiate, direct, and maintain goal-oriented working behaviors. Descriptive statistics and logistic regression analyses were performed to identify significant associations between key socio-demographic and institutional factors with motivation, with results expressed as adjusted odds ratios (AOR).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Overall level of motivation among the HEWs was 74.8%. Both intrinsic (socio-demographic) and extrinsic (institutional) factors were significantly associated with motivation. Being married was strongly associated with motivation compared to being single (AOR\u202f=\u202f222.93; CI:95%;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05), as it was having &amp;gt;15\u202fyears of service (AOR\u202f=\u202f5.79; CI:95%;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05) compared to &amp;gt;1\u202fyear of service. Institutional factors: satisfaction with performance related incentives (AOR\u202f=\u202f2.46; CI: 95%;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05), knowledge and skill sharing with co-workers (AOR: 3.52; CI:95%;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05) and decision-making autonomy (AOR\u202f=\u202f3.114; CI:95%;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05) were strong predictors of higher motivation. In contrast, inadequate implementation of the career development system (AOR\u202f=\u202f0.510; CL:95%;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05), routine supervision and feedback (AOR\u202f=\u202f0.503; CI: 95%;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05), and access to on-the-job or off-the-job training (AOR: 0.44; CI:95%;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05) were linked with lower motivation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>We found a relatively high motivation among HEWs in East Hararge compared to other regions in Ethiopia and Africa. Both intrinsic and extrinsic motivators identified play a key role in shaping the motivation levels of HEWs. To enhance worker motivation and productivity in the primary health care system, policymakers and health sector authorities need to implement targeted and evidence-based strategies, including structured career development pathways, performance-based incentives, strong collegial knowledge and skill sharing schemes, and decision-making autonomy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2025.1678937","type":"journal-article","created":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T06:35:10Z","timestamp":1763534110000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Motivational determinants of frontline health extension workers in East Hararge Zone, Ethiopia: implications for primary health care systems in low-resource settings"],"prefix":"10.3389","volume":"13","author":[{"given":"Bereket Yonas","family":"Madebo","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Debela Tezera","family":"Simagn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yonas","family":"Meheretu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,11,19]]},"reference":[{"key":"ref1","first-page":"92","article-title":"Motivators used by foreign and local banks in Pakistan: a comparative analysis","volume":"3","author":"Rajput","year":"2011","journal-title":"Int J Acad Res"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"370","DOI":"10.1037\/h0054346","article-title":"A theory of human motivation","volume":"50","author":"Maslow","year":"1943","journal-title":"Psychol Rev"},{"key":"ref3","first-page":"1","volume-title":"The motivation to work","author":"Herzberg","year":"1959"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"416","DOI":"10.4135\/9781446249215.n21","article-title":"Self-determination theory","volume-title":"Handbook of theories of social psychology","author":"Deci","year":"2012"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1186\/1472-6963-8-247","article-title":"Motivation and retention of health workers in developing countries: a systematic review","volume":"8","author":"Willis-Shattuck","year":"2008","journal-title":"BMC Health Serv Res"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1177\/1077558704263796","article-title":"Motivation of health care workers - review of the theories and empirical evidence","volume":"45","author":"Dolea","year":"2005","journal-title":"Cah Sociol Demogr Med"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1891","DOI":"10.1063\/1.5005376","article-title":"A review of the motivation theories in learning","author":"Gopalan","year":"2017","journal-title":"AIP Conf Proc"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1016\/j.ijnurstu.2019.01.011","article-title":"Job satisfaction among hospital nurses: a literature review","volume":"94","author":"Lu","year":"2019","journal-title":"Int J Nurs Stud"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1080\/1359432X.2016.1257611","article-title":"On the dark side of work: a longitudinal analysis using self-determination theory","volume":"26","author":"Olafsen","year":"2017","journal-title":"Eur J Work Organ Psychol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"164","DOI":"10.3390\/healthcare8020164","article-title":"Determinants of motivation among healthcare workers in the east African community between 2009\u20132019: a systematic review","volume":"8","author":"Muthuri","year":"2020","journal-title":"Healthcare"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1002\/hpm.770","article-title":"Health worker (internal customer) satisfaction and motivation in the public sector in Ghana","volume":"19","author":"Agyepong","year":"2004","journal-title":"Int J Health Plann Manag"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"336","DOI":"10.35248\/2167-1079.20.10.336","article-title":"Job satisfaction and associated factors among rural health extension workers in east Shoa zone, Oromia regional state, Ethiopia","volume":"10","author":"Salgedo","year":"2020","journal-title":"Prim Health Care Open Access"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1353072","DOI":"10.3389\/frhs.2024.1353072","article-title":"Health extension workers\u2019 level of job satisfaction in Western Hararghe zone, eastern Ethiopia: an institutional-based cross-sectional 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Rev"},{"key":"ref17","first-page":"1","volume-title":"Ethiopia health extension program: an institutionalized community approach for universal health coverage","author":"Wang","year":"2016"},{"key":"ref18","author":"Damtew","year":"2016"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"e0324377","DOI":"10.1371\/journal.pone.0324377","article-title":"Multidimensional performance enablers of Ethiopian community-based health extension program: a scoping review","volume":"20","author":"Godana","year":"2025","journal-title":"PLoS One"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"598","DOI":"10.1186\/s12913-023-09878-6","article-title":"Level of job satisfaction and associated factors among rural health extension workers in Hadiya zone, southern Ethiopia","volume":"23","author":"Tamene","year":"2023","journal-title":"BMC Health Serv Res"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"23333928211051832","DOI":"10.1177\/23333928211051832","article-title":"Job satisfaction level and associated factors among rural health extension workers of Sidama region, southern Ethiopia","volume":"8","author":"Kare","year":"2021","journal-title":"Health Serv Res Manag Epidemiol"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"231","DOI":"10.4314\/ejhs.v25i3.6","article-title":"Work motivation and factors affecting it among health professionals in west Shoa zone public hospitals, Oromia region, Central Ethiopia","volume":"25","author":"Beyene","year":"2015","journal-title":"Ethiop J Health Sci"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"9","DOI":"10.11648\/j.cmr.20170601.13","article-title":"Job motivation and associated factors among health care professionals working in public health facilities of Gedeo zone, southern Ethiopia","volume":"6","author":"Berhanu","year":"2017","journal-title":"Clin Med Res"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"e0272551","DOI":"10.1371\/journal.pone.0272551","article-title":"Key factors influencing motivation among health extension workers and health care professionals in four regions of Ethiopia: a cross-sectional study","volume":"17","author":"Abate","year":"2022","journal-title":"PLoS One"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1186\/s12960-023-00803-4","article-title":"Motivation and job satisfaction of community health workers in Ethiopia: a mixed-methods approach","volume":"21","author":"Ejigu","year":"2023","journal-title":"Hum Resour Health"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1002\/hpm.1031","article-title":"Satisfaction, motivation, and intent to stay among Ugandan physicians: a survey from 18 national hospitals","volume":"26","author":"Luboga","year":"2011","journal-title":"Int J Health Plann Manag"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1186\/s12960-023-00834-x","article-title":"What is the impact of integrated care on the job satisfaction of primary healthcare providers: a systematic review","volume":"21","author":"Liu","year":"2023","journal-title":"Hum Resour Health"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1186\/s12960-016-0109-6","article-title":"Retention of health workers in rural Sierra Leone: findings from life histories","volume":"14","author":"Wurie","year":"2016","journal-title":"Hum Resour Health"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1186\/1478-4491-7-65","article-title":"Retention of health workers in Malawi: perspectives of health workers and district management","volume":"7","author":"Manafa","year":"2009","journal-title":"Hum Resour Health"},{"key":"ref30","first-page":"1","article-title":"Health workers\u2019 motivation and job satisfaction in public health facilities of Gamo Gofa zone, south-West Ethiopia","volume":"36","author":"Bekele","year":"2022","journal-title":"Ethiop J Health Dev"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"1452229","DOI":"10.3389\/fpubh.2025.1452229","article-title":"Health workers\u2019 motivation was significantly higher in private hospitals than public hospitals influenced by intrinsic and extrinsic factors in Northwest Ethiopia","volume":"13","author":"Ayichew","year":"2025","journal-title":"Front Public Health"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1186\/1478-4491-12-33","article-title":"Factors affecting motivation and retention of primary health care workers in three disparate regions in Kenya","volume":"12","author":"Ojakaa","year":"2014","journal-title":"Hum Resour Health"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"103","DOI":"10.9745\/GHSP-D-13-00131","article-title":"Keeping community health workers in Uganda motivated: key challenges, facilitators, and preferred program inputs","volume":"2","author":"Brunie","year":"2014","journal-title":"Glob Health Sci Pract"},{"key":"ref34","first-page":"1","article-title":"Potential impact of devolution on motivation and job satisfaction of healthcare workers in Kenya: lessons from early implementation in Kenya and experiences of other sub-Saharan African countries","volume":"5","author":"Oyugi","year":"2015","journal-title":"J Glob Health Care Syst"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"88","DOI":"10.37107\/jhas.198","article-title":"Job satisfaction and its associated factors among primary health care level health workers of Kaski District","volume":"10","author":"Tripathi","year":"2020","journal-title":"J Health Allied Sci"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"e001736","DOI":"10.1136\/bmjph-2025-001736","article-title":"Work motivation and job satisfaction among local government health workers in Chitwan, Nepal: a cross-sectional study","volume":"3","author":"Poudel","year":"2025","journal-title":"BMJ Public Health"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1186\/1478-4491-4-6","article-title":"Improving motivation among primary health care workers in Tanzania: a health worker perspective","volume":"4","author":"Manongi","year":"2006","journal-title":"Hum Resour Health"}],"container-title":["Frontiers in Public 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