Satisfaction of health informatics professionals with Ethiopian health system: the case of three zones in Ethiopia

Health Informatics programs are an essential tool that supports the health system. The Health system increasingly demands policy change, prioritization, resource allocation, monitoring of good impact, and progress of health programs using health information [1‐4]. Decision-making in the health system depends on the timely collection, analysis, and dissemination of health information [5]. Health information is a facilitator of health system development and renovation of the health sector. Health information has been applied in designing, developing, planning, implementing, maintaining, and evaluating health systems [6].

The need for a health informatics program emerges from the relevance of the role of maintaining health records and medical services. However, many challenges hinder the achievement of program goals [3, 7]. These challenges include the lack of a national coordination system, an unsupportive health policy, a poor reflection on the need for Health Informatics, and the lack of planning and implementation commitments to support the Health Informatics profession [4, 6, 8]. Challenges are the potential cause of professionals’ dissatisfaction and can lead to poor achievement in Health Informatics-related goals, which can further disrupt patients’ satisfaction [8, 9].

Evidence from Botswana indicates that health decision-making faces many challenges. These challenges can be managed by validating and processing routinely collected health data by Health Informatics professionals [10]. Another study in South Africa underlined that the source of challenges to Health Informatics professionals are related to the profession's expectations and contribution to the health system. The dilemma is that pressure limits professional capacity and work interest, and authorities expect more performance [11]. Poor health professionals’ perception is associated with the data collection and poor culture of information use. This puts Health Information professionals and health information systems at a lower importance level compared to other health professions [12]. This means implementation of health information systems alone is not enough to solve health system problems regarding data completeness, timeliness, reliability, and accuracy unless environmental issues such as workplace pressure and poor perception of health professionals toward health information systems improved as outlined by Garrib et al. [13]. As a solution, a pilot program from Sierra Leone suggested that community engagement is the key to easy unnecessary pressure [14]. However, another study in South Africa indicated that the problem goes back to initial implementations. It indicated that authorities and other professionals understand health information systems after implementing all components and after the achievement of the overall change in management support [15]. A systematic review related to the implementation of the health information system showed that the system was implemented without a coordinating framework and had no strong leadership links in some departments [16]. For instance, Health Informatics professionals in Sub-Saharan countries mostly wanted to drop the system because of poor implementation strategies [17]. Overall, there are many challenges in Health informatics programs in Africa that might affect the satisfaction of professionals in the domain.

In developing countries, limited resources, poor job satisfaction in the health system, inadequate technology skills, and the inability of health systems to incorporate and support technological facilities impose further pressure on the Health Informatics profession [3, 18, 19]. A well-established health information system positively supports the function of the entire health system [20, 21].

In Africa, there is no evidence regarding Health Informatics professionals’ satisfaction. The existing evidence is highly focused on data utilization and Health Management Information System (HMIS) implementation [3, 22, 23]. Professional satisfaction is the key to the success of a given profession. Poor satisfaction with Health Informatics professionals can be a problem for clinical safety, security, information transfer, and knowledge sharing as they can cause ineffectiveness and failure of the entire health system [24, 25].

In Ethiopia, there was no study in the Health Informatics field until 2005 because the program was not started, and there were no training centers or teaching institutions in the country related to Health Informatics. Although some studies appeared after 2005, they focused on HMIS utilization and implementation [26, 27]. Additionally, the lack of knowledge about Health Informatics, the absence of occupational standards, and the lack of career development structure become additional challenges to Health Informatics [3, 28, 29]. Moreover, health professionals see health information systems as a burden to the already overburdened health system [30, 31]. The reason is mostly related to the time it takes for data collection and manipulation. This may negatively affect the satisfaction of Health Informatics professionals.

However, Ethiopia had an overall poor job satisfaction in many programs. For example, only 53.8% of health professionals were satisfied in Addis Ababa health centers [32]. Only 41.7% of health professionals were comfortable with their job in another study [33]. Other statistics show that health professionals’ satisfaction was 31.7% in the Western Amhara region [34], 46.68% in a systematic review and meta-analysis in Ethiopia, 54% in the University of Gondar referral hospital [35], 55.2% in Bahir Dar Hospital, and 46% in the West Shoa Oromia region [36]. This illustrates that overall health professionals’ satisfaction is not good in the country. It also indicates that there is limited evidence in the Health Informatics profession. The challenges might be worse for the newly started Health Informatics program. Thus, the current study aims to assess the Health Informatics professionals’ satisfaction and associated factors to provide information for policy decisions in Ethiopia.

Health Informatics is a newly implemented program in the last two decades in Ethiopia. There has been many problem, which may hinder its establishment in the Ethiopian health system. This study aims to assess the satisfaction of Health Informatics professionals in Ethiopia’s health system. From our analysis, the overall satisfaction of Health Informatics professionals was 2.54 ± 1.05 or 50.8% (95%CI: 47.74%-53.86%). The finding is less than that of Wuhan Medical Informatics (58.28%) and consistent with Lahore health professionals’ satisfaction (53.6%) [45, 46]. The inconsistent information might indicate pressure on the Health Informatics profession in Ethiopian. It might also indicate the contextual differences. Remuneration (35%) and promotion (42%) are the two parameters that scored less on Health Informatics professionals’ satisfaction. Other evidence also shows that the two parameters have been the consistent source of dissatisfaction in the health system [21, 47]. Thus, remuneration and promotions are the key parameters that need change to improve Health Informatics professional satisfaction.

The satisfaction of Health Informatics professionals with their work was 51%. A report from another study is consistent with this finding showing that the work also contributes to dissatisfaction [45]. This shows that dissatisfaction is also attributable to overall low job satisfaction in Ethiopia [45, 46]. For instance, only 32% of health professionals were satisfied with their work in Ethiopia [48]. In this regard, some health professionals might have poor interest in their profession. In other words, supervision is key in the health system; though, only 58% of participants in our study were satisfied with their supervisors. This is lower than the 91.2% reported in China [47]. The inconsistency might be an indication of the difference in leadership style, setting, and development of Health Informatics.

Satisfaction decreased with the increased age of the participants. The inverse relationship between age and satisfaction is also reported by another related study in Western Ethiopia [49]. This might indicate that over time satisfaction among health professionals including Health Informatics decreases. Married participants showed higher satisfaction than single participants, which is also evident from other studies [24, 45]. At this point, we might link satisfaction to a stable family and social relationships.

Additionally, rural residents showed higher satisfaction than urban residents. This is also evidenced by higher job satisfaction in rural than urban areas from another study [50]. The pressure might be higher in urban areas and can be attributable to the low client or community-professional relationship [26, 45, 51].

The relationship between Health Informatics professionals and clients is positive during the analysis. Other studies also showed positive professional satisfaction with service-takers [21, 45]. This might show that the deteriorating factors are not community or client related, but might be due to the workplace, leadership, and pressure around the work. In the analysis, the negative relationship between families and Health Informatics is linked with poor satisfaction. Another study also reported an association of dissatisfaction with poor family-Health Informatics relationships [50], and it might be a potential link to future implications. Similarly, poor relationships between organizations and Health Informatics professionals were connected with poor satisfaction. A study in Pennsylvania showed that a positive relationship between organizations could improve employee satisfaction [36]. This might also indicate that the poor relationships between the profession, organization, and environment contribute to the dissatisfaction reported in this study [52].

However, the lack of implementation framework and strong leadership in Africa might be the source that creates poor links among Health Informatics professionals, health officials, the community, the organizations, and the work environment. Organizational culture, family, work itself, and social relationships might create further pressure that leads to dissatisfaction [16, 17]. Overall, our findings show that the effect of work stress, family-work-conflict, Health Informatics-community/patient relationship, and organizational environment might lead to low satisfaction. Furthermore, the initial source of challenges in the African context led to the lack of a strong national coordination system, an unsupportive policy system, the poorly substantiated importance of Health Informatics, and the lack of planning and implementation commitments in the countries and contributed to the problem [4, 6, 8].

The limitations of this study include a small sample size, the cross-sectional nature of data, and limited generalizability of the findings. The authors followed the scientific methods of determining the sample size. The findings should be used cautiously, considering the locality of the study. Recommendations were provided for wider area investigations and further implications that might be an awakening bell for Ethiopia and most African countries.

The evidence shows that 50.8% satisfaction in our study is low compared to previous studies on health professionals. Promotions, remunerations, and the work environment are factors associated with decreased satisfaction. Evidence also shows that poor implementation and health leadership systems in Africa take a substantial portion in decreasing satisfaction. This shows that responsible bodies need to cover multidimensional approaches to solving the Health Informatics professionals’ multi factorial causes of poor satisfaction. Government commitments and strong workplace leadership to ensure equality among health professionals improve the challenges. Additionally, work experience, working hours, and work department should be an integral part of future implementations. We recommend quality studies to support future decisions regarding the Health Informatics profession.