Health care managers’ perspectives on workforce licensing practice in Ethiopia: A qualitative study
Authors: Teka Eshetu Cherinet , Gebreyes Meron Yakob , Alemneh Endalkachew Tsedal , Tesfaye Biruk Hailu , Desta Firew Ayalew , Asemu Yohannes Molla , Wolde Ermias Gebreyohannes Wolde , Ashena Wondimu Daniel , Mengistu Samuel , Melese Tewodros Abebaw , Biset Fikadie Dagnew , Degefu Bezawit Worku , Kebede Bethlehem Bizuayehu , Azeze Tangut Dagnew , Shewatatek Wudasie Teshome , Seboka Melese Achamo , Gebreegzi Abera Bezabih , Degebasa Mekonnen Dessie , Lemu Tsedale Tafesse , Abebe Yeshiwork Eshetu , Alayu Matias Azanaw , Ebrahim Fatuma Ahmed , Sahlemariam Eden Workneh , woldesemayat Genet Kifle , Admassu Hailemaryam Balcha , Chekol Bethlehem Shikabaw 
Published: September 2022

Background: Active monitoring of entry into the workforce starts with the licensing of professionals before entering the workforce. The professional licensing bodies are potentially valuable sources for tracking the health workforce as many skilled health-care providers require formal training, registration, and licensure to practice their professions.
Objective: The aim of this study was to explore the health professionals’ licensing practice and its challenges among Health care managers in Ethiopia, 2021.
Methods: A cross-sectional study design with a phenomenological approach was employed between March 26/2021 to 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 to Amharic then pretested. Audio recorded data was transcribed verbatim, translated and analyzed thematically. Member check was done to check the credibility of the result.
Results: Four major themes emerged from the data: (1) Awareness on the licensing practices, (2) Enforcement of licensing practices, (3) Systems for assuring the quality of licensing practices, and (4) Challenges to licensing practices. The lack of adequate awareness among managers on proper licensing practices was reported, resulting in practice variability. On the other hand, while regulators were clear on the requirements for professional licensing, employers placed an undue emphasis on ensuring that their employees met government licensing requirements. Importantly, respondents reported the lack of a well-developed quality assurance mechanism to ensure that the licensing system at different levels is regularly evaluated and remedied. Finally, the main practice challenges were identified as organizational, technical, and economic.
Conclusions and recommendations: This study reported a sub-optimal health professionals’ licensing practice in Ethiopia. Challenges for health professionals’ licensing practice were identified as organisational, technical, and infrastructure related factors. Regulators shall establish a reliable system to continuously assure the quality of licensing practice nationally. 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 practice. Other encouraging interventions are recommended to the response of the above identified challenges.