Page 1 of 10
Journal for Studies in Management and Planning
Available at http://internationaljournalofresearch.org/index.php/JSMaP
e-ISSN: 2395-0463
Volume 01 Issue 11
December 2015
Available online: http://internationaljournalofresearch.org/ P a g e | 14
The Role of Private Wing set up in Public Hospitals in Reducing
Medical Professionals’ Turnover
Belayneh Bogale zewdie (MPMP, BA)
(The Case of Public Hospitals under Addis Ababa Health Bureau, Ethiopia)
Abstract
The objective of this article is to assess the role of
private wings in public hospitals to tackle medical
professionals’ turnover in selected public hospitals.
Retention of qualified health staff has become a
major problem in Ethiopia. Medical professionals left
the public sector mainly due to attractive
remuneration elsewhere. To solve this problem the
Ethiopian government launched private wings within
public hospitals in 2008. In this study a descriptive
design with mixed approach was applied. Data was
collected through questionnaire, key informant
interviews, and document review. Purposive
sampling was also utilized to target respondents.
Data was collected from 5 hospitals and 192 health
professionals. The finding revealed that Medical
professionals’ level of awareness on different aspects
of private wing was not satisfactory; however most of
them became happy to know about the chances of
earning extra income at home. On average, 50% of
the doctors’ and 40% of other health professionals’
total monthly income were earned from private
wings. Accordingly, professionals expressed their
intention to continue working in their facilities at
least for the next 3 years. Hospitals’ human resource
documents also reveal a slight but a steady decline in
turnover. The study found out that the initiation of
private wings in public hospitals contributed to
motivation and retention of health professionals.
Major benefits to private wing staff include rise in
sense of hospitals ownership, skill use and better
income.
Key Words: Private Wing set up, Turnover, Medical
Professional, Health care reform and Public
hospitals
INTRODUCTION
The African continent is facing a health crisis
occasioned by very low funding of health services
and deterioration of health service infrastructure
(Dovlo, 2003). The loss of health workers has
significant economic as well as replacement
consequences which include high cost and time taken
to recruit, select and train new staff. Ethiopia is
among many other countries that have been affected
by a turnover and brain drain of health workers.
Many studies show that the shortage of health
workers in Ethiopia has been at a crisis point.
According to FMoH (2008), health professionals
migrate either from rural to urban areas, from
government to private institutions, or to foreign
countries in a very alarming rate for various reasons.
After 1991 the Ethiopian government undertook a
robust reform in deferent sectors. One of the reforms
was health sector reform. After thorough study and
assessment of the health situation, the FMoH of
Ethiopia developed a health care financing strategy in
1998 that was endorsed by the Council of Ministers
and became a very important policy document for
introduction of health financing reforms. The
government recognized that health cannot be
financed only by government and underscored the
importance of promoting cost sharing in provision of
health services (FMoH, 1998).
In line with the health care financing strategy and
based on the approved legal frameworks, a wide
range of health care financing reforms have been
implemented since 2006.
The initial phase of the implementation was very
narrow in few selected regions and health
institutions. However, later the health care financing
reforms have been expanded to nearly all parts of the
country. The reform consists of eight components;
revising user fees charged at government health
facilities, retaining the collected fees at the facility
and using that revenue to improve quality,
rationalizing and systematizing rules for fee waivers,
increasing hospital managerial autonomy, opening
private wings in public hospitals, and outsourcing
nonclinical health services. These reforms are being
implemented in all regions of Ethiopia (USAID,
2012:3).
Establishment of private wings in public hospitals is
one aspect of the Ethiopian government’s health
sector financial reform program which was launched
in 2008. In the last four years or so, certain Ethiopian
public hospitals have created private wards that
function within their physical and organizational
boundaries. According to FMoH (2010) the
Page 2 of 10
Journal for Studies in Management and Planning
Available at http://internationaljournalofresearch.org/index.php/JSMaP
e-ISSN: 2395-0463
Volume 01 Issue 11
December 2015
Available online: http://internationaljournalofresearch.org/ P a g e | 15
establishment of public hospital private wings has the
potential to generate additional income and can
increase the ownership of the hospital services by
health professionals. The establishments provide
services to those who can afford to pay more for
those services. The set up is meant to improve the
quality and timeliness of services. It also helps reduce
the turnover of skilled manpower through additional
compensation, and to motivate staff members to
provide more and better service.
Hence the article will focus on the assessment and
analysis of the role of private wings in reducing
medical professionals’ turnover with particular
reference to government owned hospitals under
Addis Ababa Regional Health Bureau.
STATEMENT OF THE PROBLEM
Although Ethiopia has one of the highest numbers of
health workers in sub-Saharan Africa, its large
population leaves it with a very low health worker to
population ratio. The Ministry of Health reported a
total of 66,314 health workers are in service,
including 30,950 health extension workers. The
national health worker ratio per 1000 population is
0.84. This result is far less than the standard set by
the World Health Organization of 2.3 per 1000
population (FMoH, 2010 cited in AHWO, 2010).
Even out of the total health work force (in terms of
skill mix), Doctors and Midwives form a
significantly smaller share. Despite the government’s
effort to tackle this problem, the shortage and high
turnover of health workers has become a severe
setback. The county is one of 57 countries considered
to have a health workforce crisis (UNDP, 2010).
Retention of highly qualified health staff has become
a major problem in Ethiopia. Between 1987 and
2006, 73.2% of Ethiopian medical doctors left the
public sector mainly due to attractive remuneration in
overseas countries, local NGO’s and private sectors.
Unless the proper remedial measure is taken, the
problem will even get worse in the coming years
(Birhan, 2008). The 2005 bulletin of the WHO
reports that there are more Ethiopia doctors working
outside Ethiopia than in the country itself.
In developing countries where medical professionals’
turnover is rampant different intervention
mechanisms to tackle the problem are emerging.
Similarly, the Ethiopian government introduced
Health Care Finance Reform including private wing
establishment in public hospitals as one component.
Setting up of private wings in government health
institutions where the professionals could work at
during their leisure time and earn additional income
is mainly aimed at cutting back turnover due to low
payments.
Despite all its benefits, prior researches and
international experience suggests that this type of
ward has much potential for promoting inequity
within hospitals. The three key problems are the
failure to generate sufficient revenue to sustain
hospital-wide quality improvements, the likelihood of
resource allocations within the hospital becoming
biased towards the private wards and failure to meet
their predetermined objective of reducing turnover
(Birn et al., 2000; Suwandono et. al, 2001).
In Ethiopia as these private wing establishments were
created and started delivering services, it became
clear that not much was being done to evaluate them
and to understand their governance arrangements and
the impact on medical professional’s turnover. Even
the limited available data is not rich enough to
provide reliable information on the issue. Therefore,
whether public hospitals has gained benefit of
retaining medical professionals as a result of setting
up private wings and the role the establishments
practically play is a critical knowledge gap that needs
to be addressed. Thus, this study therefore sought to
investigate the role of private wings in public
hospitals in reducing medical professionals’ turnover.
OBJECTIVES OF THE STUDY
The overall objective of this study is to assess and
scrutinize the role played by private wings in public
hospitals to tackle the problem of medical
professionals’ turnover in five selected public
hospitals in Addis Ababa. More specifically:
To assess the extent of private wings’
contribution to motivate medical staff, and
to improve their income;
To describe the contribution and
achievements of the private wings in
retaining medical professionals;
To find out the attitude and awareness of
medical professionals on private wings;
To describe the challenges/constraints of
private wings in reducing medical
professionals’ turnover.
METHODOLOGY
Research Design
It is generally accepted that the selection and
application of a research design is dictated by the
Page 3 of 10
Journal for Studies in Management and Planning
Available at http://internationaljournalofresearch.org/index.php/JSMaP
e-ISSN: 2395-0463
Volume 01 Issue 11
December 2015
Available online: http://internationaljournalofresearch.org/ P a g e | 16
problem at hand. Accordingly, to carry out this
research and achieve the objectives, a mixed research
approach (both qualitative and quantitative) is used.
The mixed research approach is very efficient in
answering research questions compared to the
quantitative and qualitative approach when used in
isolation (Creswell, 2003). Therefore, by using a
mixed approach it is able to capitalize the strength of
quantitative and qualitative approach and remove any
biases that exist in any single research approach.
Besides, the research applied descriptive type of
research design using the survey method. Descriptive
research includes surveys and fact-finding enquiries
of different kinds. The major purpose of descriptive
research is description of the state of affairs as it
exists at present (Creswell, 2003). Since little is
known and researched about the roles and
contributions of private wings in medical
professionals’ turnover, the researcher has no control
or effect on the variables of the study. The study was
rather intended only to describe the roles and
contributions of the wards.
Data Sources and Instruments
In this study, both primary and secondary data
sources were utilized to address the research
objectives. The techniques used to elicit primary data
were questioners, key informant in-depth interviews
and review of organizational documents. The design
of the questionnaire and interview questions was
guided by the objectives of the study and the
literature research. The secondary data was more or
less collected from published documents, books, and
journal articles. Other magazines, internet sources
including access to electronic scientific articles such
as Google’s scholar search facilities, as well as hard
copies or reports and other studies were also utilized
in the process of data gathering.
Sampling and Sampling Procedures
The study was conducted on those government
owned hospitals under Addis Ababa health bureau
that have private wings. These hospitals are five in
number namely Yekatit 12, Dagmawi Minilik,
Gandhi Memorial, Ras Desta Damtew, and Zewuditu
Memorial.
The population of this study was all health
professionals in the five hospitals with diploma and
above academic qualification in their field of work.
According to AAHB (2014), there are 1,281 health
professionals in the five hospitals that have diploma
and above qualification. Since the study population
of this study was homogeneous (all were government
employed medical professionals) 15% (192) medical
professionals were purposively selected as a sample
to fill the questionnaires.
Proportional techniques of study subject allocation to
the five hospitals were also applied. Accordingly,
selection of intended study subjects from the five
governmental hospitals under Addis Ababa health
bureau was made using the following formula:
Where nx – sample size in x hospital
n - Estimated final sample size
Nx – Total number of medical professionals in x hospital
N – Total medical professionals in all hospitals
Table 1: Proportional sampling procedure of the study subjects
Hospitals No of medical Professionals Proportional allocation
samples
Gandhi Memorial 207 32
Ras desta Damtew 177 27
Dagmawi Minilik 298 45
Yekatit 12 306 46
Zewditu 276 42
Total 1281 192
Source: calculated by the researcher based on the HR summary from the health bureau: 2014
The questionnaire was distributed to cover different
categories of health professionals as it was given to
doctors (all types), nurses and midwife, pharmacists,
health officers, laboratory technologists, and
radiologists. On the other hand key informant in- depth interview was also conducted with medical
services directorate director of AAHB, hospital
directors and personnel department heads of each
hospitals.
Method of Data Analysis
nx =
Nx. n
N
