HARAMAYA UNIVERSITY

SCHOOL OF POST GRADUATE STUDIES

PROFESSIONAL COMMITMENT AND ASSOCIATED FACTOR

AMONG HEALTH PROFESSIONALS IN PUBLC HEALTH FACILITY
OF DIRE DAWA CITY ADMINISTRATION, EASTERN ETHIOPIA: A
FACILITY BASED CROSS SECTIONAL STUDY

MPH THESIS

BY: YUSUF REMEDAN

COLLEGE: HEALTH AND MEDICAL SCIENCE

SCHOOL: SCHOOL OF PUBLIC HEALTH

PROGRAM: HEALTH SERVICE MANAGEMENT

Advisors

1. Mr. Moti Tolera (MPH, Assistance Professor)

2. Dr. Ibsa Mussa (PhD, Assistance professor)

October, 2021
Haramaya University, Harar
 HARAMAYA UNIVERSITY
SCHOOL OF POST GRADUATE STUDIES

PROFESSIONAL COMMITMENT AND ASSOCIATED FACTOR

AMONG HEALTH PROFESSIONALS IN PUBLC HEALTH FACILITY
OF DIRE DAWA CITY ADMINISTRATION, EASTERN ETHIOPIA: A
FACILITY BASED CROSS SECTIONAL STUDY

A Research Proposal Submitted to the School of Post Graduate Studies

Haramaya University

In partial fulfilment of the requirements for the Master Degree in Public

Health, Health Service Management

By

YUSUF REMEDAN (BSC)

ADVISORS
1. Mr. Moti Tolera (MPH, Assistance Professor)
2. Dr. Ibsa Mussa (PhD, Assistance professor)

October, 2021
HARAR, ETHIOPIA.

i
APPROVAL SHEET

HARAMAYA UNIVERSITY POSTGRADUATE PROGRAM DIRECTORATE

Professional commitment and associated factors among health Professionals in public
Hospitals in Dire Dawa, eastern Ethiopia, 2021

Submitted by:

Yusuf Remedan ________________ _____________

Name of student signature Date

Approved by:

1. ________________________ _______________ ______________

Name of Major Advisor Signature Date

2. __________________________ _________________ ______________

Name of Co-advisor Signature Date

3. ___________________________ _________________ ______________

Name of Chairman, SGC Signature Date

4. ____________________________ ________________ ______________

_ SGS Coordinator, Health Sc. College Signature Date

5. __________________________ _________________ _______________

Dean, PGPD Signature Date

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STATEMENT OF THE AUTHOR
By my signature below, I declare and affirm that this thesis is my own work. I have followed
all ethical principles, data collection, data analysis and completion of this thesis. All scholarly
matter that is included in the thesis has been given recognition through citation. I affirm that I
have cited and referenced all sources used in this document. Every exertion has been made to
avoid plagiarism in the preparation of this thesis.

This thesis is submitted in partial fulfillment of the requirement for a graduate degree from the
School of Graduate Studies at Haramaya University. The thesis is deposited in the Haramaya
University Library and is made available to borrowers under the rules of the library. I solemnly
declare that this thesis has not been submitted to any other institution anywhere for the award
of any academic degree, diploma or certificate.

Brief quotations from this thesis may be used without special permission provided that accurate
and complete acknowledgement of the source is made. Requests for permission for extended
quotations from, or reproduction of, this thesis in whole or in part may be granted by the Head
of the School or Department or the Dean of the School of Graduate Studies when in his or her
judgment the proposed use of the material is in the interest of scholarship. In all other instances,
however, permission must be obtained from the author of the thesis.

Name: YUSUF REMEDAN Signature: ______________________

Date: October,2021

School/Department: School of public health

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AKNOWLDGEMENT
First, I would like to express my gratefulness to Haramaya University, College of Health and
Medical Science, School of Graduate Studies for bestowed me the opportunity and support to
perform this study.

I would like to thank my entire instructor who deliver Research Methods course for contribution
toward my ambition.

My heartfelt thanks and deepest appreciation goes to my advisors Mr. Moti and Dr. Ibsa Mussa
for sustainable support throughout development of this proposal and Ame mahadi (MSc)
instructor at Haramaya University for his continuous support.

Finally, I would like to express my deepest gratefulness to all of my brothers and sisters and my
entire friends who support me during uncertain occasion of covid-19 pandemic.

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TABLE OF CONTENT

Contents
APPROVAL SHEET ii
STATEMENT OF THE AUTHOR iii
AKNOWLDGEMENT iv
TABLE OF CONTENT v
LIST OF TABLES vii
LIST OF FIGURES viii
ABREVATION AND ACRONYM ix
ABSTRACT x
1. INTRODUCTION 1
1.1 Background 1
1.2 STATEMENT OF THE PROBLEM 3
1.3 Significance of the study 4
1.4. OBJECTIVE 5
1.4.1. General Objective 5
1.4.2. Specific Objective 5
2. LITRETURE REVIEW 6
2.1. Professional commitment 6
2.2. Factors associated with Professional commitment 9
2.2.1. Organizational commitment 9
2.2.2. Job Satisfaction 11
2.2.3. Perceived Organizational Support 13
2.3. Conceptual framework of professional commitment and Its associated factors 16
3. METHOD 17
3.1. Study area\setting and study period 17
3.2. Study design 18
3.3. Population 18
3.3.1. Source population 18
3.3.2. Study population 18
3.4. Inclusion criteria 18
3.5 Exclusion criteria 18
3.6. Sample size determination 18

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 3.7. Sampling procedure and sampling techniques 19
3.8. Study variables 21
3.8.1. Dependent Variable 21
3.8.2. Independent variables 21
3.9. Data collection Method 22
3.9.1 Data collection tool 22
3.9.2 Data collection techniques 22
3.9.3 Data collectors and supervisors 22
3.10. Operational definitions and measurement 23
3.11. Data quality control 24
3.12. Data processing and analysis 25
3.13. Ethical consideration 25
3.14. Information dissemination 25
3.15 Limitation of the study 25
4. RESULT 26
4.1 Socio-demographic Characteristics 26
4.2 Descriptive Statistics of Study Variables 28
4.2.1 organizational commitment 29
4.2.2 perceived organizational support 30
4.2.3 Job satisfaction 30
4.3 Factors associated with professional commitment 31
5. Discussion 34
5.1 Professional Commitment 34
6. Conclusion and Recommendation 37
6.1 Conclusion 37
6.2 Recommendation 37
REFERENCE 38
ANNEX 41
7.1 Annex 41
Facility Head Information Sheet and Informed Consent Form 41
7.2. Annex: Data collection tools 45
Curriculum vitae 55

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LIST OF TABLES
TABLE 1: SOCIO-DEMOGRAPHIC CHARACTERISTICS OF HEALTH PROFESSIONALS WORKING IN DIRE
DAWA ADMINISTRATION HEALTH FACILITIES, EASTERN ETHIOPIA, 2021(N=380). 27
TABLE 2 : FREQUENCY DISTRIBUTION OF FIVE-POINT LIKERT SCALE RESPONSE OF PARTICIPANTS
FOR PROFESSIONAL COMMITMENT MEASURING ITEMS, DIRE DAWA, 2021 (N=330). 28
TABLE 3: MULTIVARIABLE LOGISTIC REGRESSION ANALYSIS FACTOR RELATED WITH
PROFESSIONAL COMMITMENT IN PUBLIC HEALTH FACILITY, DIRE DAWA CITY
ADMINISTRATION, EASTERN ETHIOPIA, 2021 32
TABLE 4 : SOCIODEMOGRAPHIC AND ECONOMIC CHARACTERISTICS OF THE PARTICIPANTS
QUESTIONARIES’ OF PROFESSIONAL COMMITMENT AND ASSOCIATED FACTOR AMONG HEALTH
PROFESSIONALS IN HEALTH FACILITY OF DIRE DAWA, EASTERN ETHIOPIA: A FACILITY BASED
CROSS SECTIONAL STUDY,2021. 45
TABLE 5 : PERCEIVED ORGANIZATIONAL SUPPORT QUESTIONARIES’ OF PROFESSIONAL
COMMITMENT AND ASSOCIATED FACTOR AMONG HEALTH PROFESSIONALS IN HEALTH
FACILITY OF DIRE DAWA, EASTERN ETHIOPIA: A FACILITY BASED CROSS SECTIONAL
STUDY,2021 47
TABLE 6: PROFESSIONAL COMMITMENT QUESTIONARIES’ OF PROFESSIONAL COMMITMENT AND
ASSOCIATED FACTOR AMONG HEALTH PROFESSIONALS IN HEALTH FACILITY OF DIRE DAWA,
EASTERN ETHIOPIA: A FACILITY BASED CROSS SECTIONAL STUDY,2021. 48
TABLE 7: ORGANIZATIONAL COMMITMENT QUESTIONARIES’ OF PROFESSIONAL COMMITMENT AND
ASSOCIATED FACTOR AMONG HEALTH PROFESSIONALS IN HEALTH FACILITY OF DIRE DAWA,
EASTERN ETHIOPIA: A FACILITY BASED CROSS SECTIONAL STUDY,2021. 49

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LIST OF FIGURES
FIGURE 1: CONCEPTUAL FRAMEWORK OF PROFESSIONALS ‘COMMITMENT AND ASSOCIATED
FACTORS, DIRE DAWA, 2021 ADAPTED FROM 16
FIGURE 2: SCHEMATIC DIAGRAM OF SAMPLING PROCEDURE OF PROFESSIONAL COMMITMENT AND
ASSOCIATED FACTORS IN DIRE DAWA CITY ADMINISTRATION, 2021 20
FIGURE 3 : PERCENTAGE DISTRIBUTION OF STUDY PARTICIPANT OF NET MONTHLY SALARY EARNS
OF PROFESSIONAL COMMITMENT AND ASSOCIATED FACTORS AMONG HEALTH
PROFESSIONALS IN DIRE DAWA CITY ADMINISTRATION,2021. 26
FIGURE 4: PERCENTAGE DISTRIBUTION OF STUDY PARTICIPANT WORKING PLACE OF HEALTH
WORKER’S PROFESSIONAL COMMITMENT AND ASSOCIATED FACTORS AMONG HEALTH
PROFESSIONALS IN DIRE DAWA CITY ADMINISTRATION,2021. 29
FIGURE 5: ATTITUDE OF HEALTH PROFESSIONALS TOWARD ORGANIZATION OF PROFESSIONAL
COMMITMENT IN PUBLIC HEALTH FACILITIES IN DIRE DAWA CITY ADMINISTRATION,
EASTERN ETHIOPIA, 2021 30
FIGURE 6: ATTITUDE OF HEALTH PROFESSIONALS TOWARD ORGANIZATION OF PROFESSIONAL
COMMITMENT IN PUBLIC HEALTH FACILITIES IN DIRE DAWA CITY ADMINISTRATION,
EASTERN ETHIOPIA, 2021 30
FIGURE 7: MAGNITUDE OF PROFESSIONAL COMMITMENT IN PUBLIC HEALTH FACILITIES IN DIRE
DAWA CITY ADMINISTRATION, EASTERN ETHIOPIA, 2021 32

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ABREVATION AND ACRONYM
AC affective commitment
AOR Adjusted odd ratio
CC continuance commitment
CSA central statistical agency
DHB District health bureau
EDHS Ethiopian Demographic and Health Survey
ETB Ethiopian birr
HPCS Health Professionals ‘Commitment Score
HPs Health Professionals
HR Human Resource
HRH Human Resource for Health
HRM Human Resource management
IHRERC Institutional health research ethics review committee
MDG Millennium Development Goal
MOH Ministry of Health
NC normative commitment
NOC Normative Organization Commitment
PI Principal Investigator
POS perceived organizational support
QNWL Quality nurses work life
SDG sustainable development goal
SD standard deviation
SRS Simple Random Sampling
UHC universal health coverage
WHO World Health Organization

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ABSTRACT
Background
Professional commitment is vital to improve performance of health workers and accessibility to
competent health professionals, it enhances greater employee job satisfaction, acceptance of
organization’s demands, and the meeting of organization’s goals such as high-quality care.
Currently there is shortage of studies examining professional commitment and associated
factors of health workers in dire dawa city administration.

Objective

This study aimed to assess professional commitment and associated factors among Health
worker at public Health facilities in Dire Dawa city administration, Eastern Ethiopia.
Method
Facility based cross-sectional study was conducted among 380 participants. Data were collected
by self-administered structured questionnaires. The Ep-info was used for data entry and Stata
for data analysis. Binary logistic regression, bivariate and multivariate analysis were used to
identify associated factors with level of professional commitment and Hosmer and lame show
for model fitness
Result
The commitment level of professionals among public health facilities in Dire Dawa city
administration, eastern Ethiopia was 64%. Those who paid between 4500-4999 birr were 11
times more likely committed to profession than those who paid 3500-3999 birr [AOR=11, 95%
CI 1, 130], working in health center were 3 times more likely committed to their profession as
compared with hospitals [AOR=3.3, 95%CI=1.4, 7.4], 140 of (36.84%) of health professionals
were satisfied of their professions [AOR, 0.3 95% CI=2, 70] and 217(57.11%) of them has
positive attitude toward organization [AOR 2, 95% CI=1.2, 3.6].

Conclusion and Recommendation

The commitment level of professional among public health facilities in Dire Dawa city
administration, eastern Ethiopia was 64%, so that health administrator, managers and health
bureau should improve on Intervention to enhance health professional satisfaction, working
setup, organizational environment and fair sharing of benefits and related factor.

x
1. INTRODUCTION
1.1 Background

Commitment is a freewill to contribute time and energy to something that is believed in, or a
pledge to accomplish something, intellectually or emotionally achieving a course of action
(Yibeltal S et al., 2018).Commitment is defined as the linkage between the organization and the
employees, It is also described as being a volunteer and steady forces that decide and sustain
the attachment of an individual to a particular organization or it is a psychological affection that
is distinguished by the members’ feeling of attachment, responsibility, and faithfulness to a
given organization (KACHCHHAP, 2016). According to the study done identified three distinct
themes in the definition of commitment: commitment as an affective attachment to the
organization, commitment as a perceived cost associated with leaving the organization, and
commitment as an obligation to remain in organization (Duarte, 2015).

Professional commitment is health care provider willingness, pledge toward his/her profession
and determination to continue working (Admasu BG et al., 2018). Professional commitment
describes beyond commitment for a particular organization and suggest individual attitude
towards their profession and the motivation that they have to continue the job and Impact on
performance and effectiveness of health facility (Yibeltal S et al., 2018). Nowadays professional
commitment is a thought that attracted and got good attention which assist as to understand
better health care worker performance and attitude in work place and relevant to profession is
more suggestive focus for employees than organization (Lobna kh et al., 2012).

In health care organizations, health care providers attitudes in terms of commitment, motivation
and satisfaction can be considered more essential when compared to other sectors, having highly
committed employees within health care institutions plays an important role in improving the
overall performance of the services provided leading to patient satisfaction (Aysen Berberoglu,
2015a). When it comes to employee’s psychology professional commitment is significant parts
of the way employees get motivated, achieve performance excellence and think critically (Gider
O et al., 2019)

Moreover, health systems quality is crucially depending on commitment, the size and skill mix
of the health workforce (Nima et al., 2016). Public health facilities are nowadays concerned to
provide quality care for their clients (Admasu Belay Gizaw, 2018). In healthcare system provide

1
quality care, commitment and maintaining a committed staff is a strong advantage and critical
to organizational success (Hakami A et al., 2020).Therefore, committed and satisfied employee
is essential to delivering quality service (BAAH, 2015).

According to the studies conducted revealed that professional commitment among health
professional and its related factor including work stress, Job satisfaction, psychological
wellbeing(Miho Satoh, 2017), Position, organizational commitment, educational status,
training, experience autonomy and motivation (Admasu Belay Gizaw, 2018), Perceived staff
interaction, work-life balance, affective organizational commitment, normative organizational
commitment, personal characteristics and perceived maternal health goal were independent
predictors of professional commitment (Yibeltal S et al., 2018).

Study conducted in Jimma Zone public hospital depict that 115 (36.3%) of nurses have low
level of professional commitment, 88 (27.8%) have moderate level of commitment and only
one third 114 (36%) of them have high level of commitment to their profession (Admasu BG et
al., 2018) and similarly the other study done in public hospital of jimma zone showed that the
percentage mean score of professional commitment was 72.71% (Yibeltal S et al., 2018).

Despite the fact that many researchers discuss on professional commitment of health
professional the main challenge of health institution is to improve quality of care for their client,
but the main issue is how to achieve and improve this quality, little has been done to clarify the
factors promoting affective professional commitment. There is still a relative paucity of research
comprehensively exploring the factor impacting professional commitment, today, healthcare
organizations are challenged by the lack of commitment from nurses and doctors. And employee
turnover is a growing issue in healthcare organizations in the world due to their choices to leave
the organization (Admasu BG et al., 2018, KACHCHHAP, 2016, Kao, 2020, Miho Satoh, 2017,
Siraneh, 2016).

Studies proposed that occupational commitment was a three-component model comprising

affective, continuance, and normative occupational commitment. From the three components,
strongest predictor of occupational behavior is affective occupational commitment. Affective
occupational commitment described as the emotional commitment one has to an occupation.
Normative commitment refers to employees’ feelings of responsibility to the organization.
Continuance commitment is about employees’ evaluation of whether the costs of leaving the

2
organization are greater than the costs of staying. Employees who perceive that the costs of
leaving the organization are greater than the costs of staying will remain with the organization
(Miho Satoh, 2017, Kao, 2020).

Good human resource management drives employee satisfaction and commitment in the
organization. Satisfied and committed employees deliver better health care, which results in
better outcomes and higher patient satisfaction. Studies revealed factors that might affect
professional commitment could be personal background, organizational support and
commitment, job satisfaction, salary levels, degree of autonomy over work, levels of stress in
the work, gender, educational achievement, seniority, Diversity of roles occupied, values and
attitudes towards the job ((Kumar et al., 2016, Yibeltal S et al., 2018).

1.2 STATEMENT OF THE PROBLEM

Professional commitment is a continuing process through which Health care worker or

professional involvement, promise or resolution towards his/her profession. It describes
individual behavior toward their job, recognized as a form of work commitment that individuals
have on a career and received a good interest Nima et al. (2016). According to Jafaraghaee et
al. (2017) defined Professional commitment as devotedness and desire to stay in a profession,
and a sense of responsibility toward the profession's particular problems and challenges.

The study conducted in Taiwan stated that nurses report experiencing occupational stress can
negatively affect their professional commitment and job satisfaction. A better understanding of
professional commitment and job satisfaction could aid hospital administrators in retaining
staff, so that higher levels of professional commitment substantiate better job performance,
higher productivity, and less absenteeism and tardiness (Hsu et al., 2015).

In Ethiopia health service organization and its’ management is decentralized, but there are still
many challenges like shortage of health professionals in different disciplines and at all levels.
Low density and low training output for key HRH categories, poor HRH management, high
attrition rates, and massive geographic imbalances are other problems of the health service. Job
turnover is commonly high early in one’s profession. About 52% of the nurses and 60% of the
doctors in Ethiopia have stated that they planned to migrate abroad in the year 2009. Those
health care workers were serious about their intention to migrate (Nima et al., 2016).

3
A study conducted in jimma zone public hospital showed, (36.3%) of nurses have low level of
professional commitment, (27.8%) have moderate level of commitment and only one third
(36%) health care providers have high level of commitment to their profession. Position,
organizational commitment and, job satisfaction was identified as factors associated with level
of professional commitment among the study participants, so that only one third of nurses have
better level of professional commitment. Therefore, managers nursing service managers of
jimma zone public Hospital should improve level of commitment with collaborative
intervention on related factor (Admasu BG et al., 2018).

Currently there is shortage of studies examining professional commitment and associated

factors of health workers in dire dawa city administration. So, this study might give health
administrator insight into strategies to improve health care work by delivering quality of care
staff retention and increase their job satisfaction, organizational commitment and in turn their
job performance. This will enhance and support health administrator to meet health problem
challenge.

1.3 Significance of the study

A better understanding of professional commitment among health professionals will provide

new insight in solving the challenge. Hence, it will help in providing effective change
management policies to overcome employees' turnover intention and increase their job
performance. So, this study will have high importance to health human resource managers to
enhance professional commitment and overcome turnover intensions in Dire Dawa city
administration. It will also indicate these managers the contribution of certain organizational
factors as a means to increase the professional commitment of health professionals and
associated factor as well.

Findings from this study will also deliver information to health policy makers in planning
certain staff development programs like trainings and deciding remuneration scales to increase
commitment level of health professionals. Currently there is shortage of studies examining
professional commitment and associate factor of health care worker. So, this study will
contribute to the scientific community through better understanding level of commitment and
associated factor among public health professionals in Dire Dawa.

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1.4. OBJECTIVE

1.4.1. General Objective

 To assess professional commitment and associated factor among health professional

working in public health facility of Dire Dawa city administration, Eastern Ethiopia
from August 2021- December /2021 G.C.

1.4.2. Specific Objective

 To assess level of professional commitment among health professional working in
health public facility of Dire Dawa city administration, Eastern Ethiopia from August
2021- December /2021 G.C.
 To identify factor associated with professional commitment among health worker in
public health facility of Dire Dawa city administration, Eastern Ethiopia from August
2021- December /2021 G.C.

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2. LITRETURE REVIEW
2.1. Professional commitment

Professional commitment refers to the affection and responsibility of health care provider
toward their profession and its significant idea that comprise a profession (Kao, 2020) and the
freewill to continue in a profession, and a sense of trustworthiness toward the profession's
particular problems and challenges.(Jafaraghaee et al., 2017). Professional commitment has got
momentous in health care organization (Zaid et al., 2018).

Professional commitment is a promise toward his or her profession or degree to which a

person’s work performance impact his self-esteem (Lobna kh et al., 2012). It’s also considered
as a foretell for intention to leave the profession which are different from one career to another
and characterized a particular career staffs’ identification, autonomy, and receptivity of the
professional values and goals(Admasu BG et al., 2018). Moreover, researchers have stated that
the concept of professional commitment includes involvement, loyalty, relationships,
professional concerns, recognition, beliefs, ethics, internal satisfaction, professional growth,
and job involvement (Hsu et al., 2015).

Employee commitment refers to a mental state in which the employee shares the values of the
organization and adheres to its objectives found, a negative link between professional
commitment and absenteeism, quitting, stress, work-family conflict and intention to leave the
organization and, conversely, positive links between professional commitment and
organizational citizenship behavior and work efficiency. Support for employees in the
workplace can have a positive effect on employee well-being (IGELLA, 2014). The major
determinant for success of organization is employee commitment. No health institution can
perform unless each employee is committed to their organization, that help to enhance
productivity, achievement and effectiveness (BAAH, 2015).

The main problem of health care organization is delivering quality of care, but the issue is how
to achieve and improve quality of care and potential outcome so that highly committed health
professionals for health care organization, policy makers and professionals is vital for [Link]
obtain the desired result it requires high organizational commitment and professional
commitment which is influenced by job satisfaction and level of professional commitment
(Nima et al., 2016).
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According to study done in some part of Ethiopia level of professional commitment is affected
by age, work experience, marital status job feature such as position, role conflict, role ambiguity
gender, educational level, organizational structure characteristic such as the ratio, power
centralization and employees’ work There is negative relationship was found with years of
experience and level of education, indifferently Commitment has a strong association with
employee retention and job performance in health professions (Admasu BG et al., 2018),(Nima
et al., 2016) &(Yibeltal S et al., 2018).

The study on organizational citizenship behaviors has demonstrate the behaviors has
contributed for the increase of the organizational effectiveness and for the improvement of the
organizational environment and the relationships in work context. Studies has neglected the
effect of professional commitment on organizational citizenship behaviors. Negative
relationship between professional commitment and organizational citizenship behaviors based
on data of nurses. professionals may adopt behaviors that are significant to their profession and
their professional development (Duarte, 2015). Researching and addressing gap is essential for
employees and executives who spend most of their lives in their workplaces for the success of
organizations and then determining their professional commitment levels and how they manage
stress are highly important in terms of contributing to the goal of organization (Barutcu and
Ergin, 2017).

According the study conducted in Public Health Facilities of Jimma Zone, Southwest Ethiopia,
Level and Factors Associated with Professional Commitment of Health Professionals Providing
Institutional Delivery Services, the percentage mean score of professional commitment was
72.71% (SD21.88). The percentage of perceived maternal health goal mean score scale was
68.37% with the total variance explained being 69.68%. Perceived staff interaction, work-life
balance, affective organizational commitment, normative organizational commitment, personal
characteristics and perceived maternal health goal were independent predictors of professional
commitment (Yibeltal S et al., 2018).

7
Organizational change and an empirical observation are connected to employee commitment in
an organizational entity of variations in shape, quality or state over time, after the deliberate
introduction of new ways of thinking, acting and operating. explain that employee commitment
to the organization is critical when an organization engages in change initiatives, as committed
employees will provide many benefits to the organization effort to change, these significances
putting in extra effort to ensure that the change succeeds, serving as public relations
representatives during the change and going above and beyond the norm to assist the
organization to function effectively(Wilson Mugizi et al., 2015).

According to Level of Professional Commitment and Associated Factors among Nurses

Working in Jimma Zone Public Hospitals; Jimma South West Ethiopia, the study showed
(36.3%) of nurses have low level of professional commitment (27.8%) have moderate level of
commitment and only one third (36%) of them have high level of commitment to their
profession. Position, organizational commitment and, job satisfaction was identified as factors
associated with level of professional commitment among the study participants. In essence, only
one third of nurses have better level of professional commitment. So, improving this level of
commitment needs collaborative intervention on related factors which is a big homework for
managers, nursing service managers of Jimma zone public Hospitals (Admasu BG et al., 2018).

8
2.2. Factors associated with Professional commitment
Professional commitment has determined a number of factors such as job satisfaction, perceived
Organizational support and organizational commitment
2.2.1. Organizational commitment

Organizational commitment has been understood in different ways as a multidimensional

concept. Organizational commitment appears to be behavioral, Normative, calculative and
attitudinal. To measure the employee’s commitment, measuring through attitudes and feeling
toward his employing organization attitudinal concept has been widely accepted Organizational
commitment is the psychological devotedness of an employee to the organization (Kumar et al.,
2016). Organizational commitment is the relative strength or a force that connect individual
with organization, Its psychological affinity characterized by employees’ feeling of obligation,
devotedness and attachment to a given organization (Alemayehu et al., 2021).

Organizational commitment was designed to measure three different types (i) affective, (ii)
continuance, and (iii) normative commitment. Affective commitment defines as employee’s
emotional attachment to the organization and its goals. Continuance commitment related to
cognitive attachment between an employee and his or her organization due to the costs
associated with leaving the organization. Finally, normative commitment related to typical
feelings of obligation to remain with an organization. Committed and satisfied professionals
deliver better health care, which results in better desired outcomes, higher patient satisfaction
and high productivity (Kumar et al., 2016, Israel B, 2017, Nima et al., 2016).

Organizational commitment is concept used for understanding of health care provider behavior,
inversely lack of commitment among the staff can be harmful to the organization, resulting in
poorer performance and higher costs. Accordingly commitment and motivation of contractual
staff are lesser than the permanent staff appropriate changes are required in the predictors of
organizational commitment and factors responsible for satisfaction in the organization to keep
the contractual human resource motivated and committed to the organization (Kumar et al.,
2016).

9
Professional’s claims different major factors that contribute to their commitment to the
organization: perceived organizational support, transformational leadership behavior,
interaction opportunities for learning, job satisfaction, a plan to retire from the organization,
monetary benefits, patient care, co-workers, relationships and cultural factors, and job security,
were related with level of organizational commitment. Organizations recruit nurses and retain
to maintain adequate staffing. Despite the fact that increasing recruitment may help to meet the
challenge of nursing shortage in the short term, best strategy is retaining them for long term
because a healthcare goal is to maintain high quality of care at minimal cost costs. So that
organizational commitment is contributing to high staff retention (Siew PL, 2011, Israel B,
2017).

organizational commitment of influenced by many factors, both internal and external, these
factors include leadership style, compensation, career development, perceived leadership style
and training opportunity, perceived value and care for employee and perceived remuneration
organizational culture /climate, spiritual health and learning organizations were predictors of
organizational commitment. Furthermore, perceived staff interaction and perceived resource
availability and work setting were factors affecting organizational commitment in this
study(Erfan Rofiqi et al., 2019, Nima et al., 2016).

According to the study conducted depict that significant and positive correlation between job
satisfaction and organizational commitment with the correlation coefficient of 0.58. Female
worker has higher level of organizational commitment (3.51) and there is no significant
difference in organizational commitment between the male and female groups. The result of
this study stated that significant and positive relationship between employees’ job satisfaction
and organizational commitment, meaning that higher job satisfaction leads to a greater
commitment of individuals to the organization. Paying attention to the employee morale and
motivation is a high priority the success and efficiency of human resources dependent on the
efficient use of behavioral sciences and understanding the concepts that influence human
resource efficiency (Saberinia A and Zadeh M, 2019).

Organizational commitment is the reason for success and high-performance health care
organization in order to deal with nurses’ turnover, most of the healthcare organizations increase
the recruitment and retain nurses to maintain adequate staffing. Although increasing recruitment

10
of nurses may help to solve the problem for short period, retaining them may be the best strategy
in the long term because a healthcare goal is to maintain high quality of care at minimal costs.
Various studies stated that the relationship between job satisfaction and organizational
commitment with nurse retention have different opinion, due to the fact that relationship
between the variables cannot be summarized into an article. So that it is necessary to know how
the influence of job satisfaction and organizational commitment on nurse retention is reviewed
from various appropriate articles (Agit Pratama Putra, 2020, Siew PL, 2011).

2.2.2. Job Satisfaction

Job satisfaction is multidimensional thought that connected with career-related attitude and
belief of staff and their level of satisfaction, or positive feeling, emotional reaction to staff of
different element of their work (Karem et al., 2019). job satisfaction contains six basic
combined and interdependent dimensions such as promotion, Management skills, Job and work
conditions, Pay, External environment, Co-workers (Hegazy et al., 2017). The vision of UHC
(universal Health coverage) can achieved through effective health system equipped with skilled
and satisfied workforce, so that healthcare services providers are crucial part of an efficient and
effective healthcare system (Tasneem et al., 2018).

According to (WHO,2013) report predicts that 12.9 million health care provider (nurses,
midwives, and doctors) shortfalls will be encountered by 2035 in Africa and South East Asian
(25% and 47%, respectively) and 40% of health professionals throughout the globe will leave
their employment due to few incentives and low payment (Abate and Mekonnen, 2021). Job
satisfaction help health care researchers assess and understand various organizational outcomes
such as employee productivity, organizational effectiveness, quality of care delivered, patient
safety, performance management, increased levels of organizational trust, employee
commitment, and job satisfaction positively affect organizational outcomes, which is vital for
success of health care professionals (Gider O et al., 2019).

The Study conducted in China depicted that the mean score of overall perception of job
satisfaction was 3.99 on a scale of 1–6. (Lu et al., 2016), indifferently study conducted in
Northwest Ethiopia stated that the overall level of job satisfaction among health care
professionals was 54% [95% CI (49.3–58.8)] considered as low and recommend health care

11
administration focus their leadership style and provide supportive supervision in the hospital to
enhance the level of job satisfaction of health care professionals (Gedif G et al., 2018).

According to the study of Job satisfaction and associated factors among healthcare staff: a cross-
sectional study in Guangdong Province, China stated that Job satisfaction had significant effect
on sociodemographic variables, occupation, educational background, professional status, years
of service, annual income, night shift frequency, Work stress, work–family conflict and doctor–
patient relationship also had significant effect on job satisfaction (Lu et al., 2016). While study
conducted in Northwest Ethiopia stated that Marital status [AOR = 1.79 (1.140, 2.797)], salary
[AOR = 2.75 (1.269, 5.958)], leadership style [AOR = 2.19 (1.31–3.65)], and supportive
supervision [AOR = 2.05 (1.27–3.32)] were found significant determinants of job satisfaction
(Gedif G et al., 2018).

A better understanding of job satisfaction and professional commitment could aid hospital
administrators in retaining nursing staff thus improving patient outcomes job satisfaction is a
significant issue because of its impact on patient satisfaction and health care quality stated that
employees who had higher levels of professional commitment demonstrated better job
performance, higher job satisfaction and productivity, and less absenteeism and tardiness and
affect patient satisfaction and the quality of health services Highly committed professionals are
more responsive to advancing them professional value (Hsu et al., 2015).

The World Health Organization WHO, (2016) Global strategy on human resources on health
workforce 2030 sets out the policy agenda to ensure a workforce that is fit for purpose to attain
the targets of the Sustainable Development Goals (SDGs). Health care worker’s motivation can
initiate them to exert and maintain an effort towards organizational goals. Motivation depends
up on many factors, and job satisfaction is one of the most important factors (Gedif G et al.,
2018). According to the review of literature job satisfaction are essential factors to keep hospital
employees in the long run. therefore, ensuring hospital employees’ job satisfaction and
motivation is important to effectively deliver health services (Nemmaniwar and Deshpande,
2016).

12
According to the study conducted in Gonder university referral hospital, stated that job
satisfaction could be positively influenced by several factors such as training, career growth,
supportive leadership, recognition by management, better teamwork payment, compensation,
good interpersonal relationship, and safe working environment. Conversely, job satisfaction
could be negatively affected by factors such as improper supervision, lack of training
opportunities, low salaries, financial rewards job satisfaction work load, work–family conflict
and poor doctor–patient relationship (Gedif G et al., 2018).

The study conducted in Turkey stated that both job satisfaction and motivation of health care
professionals had a significant effect on their organizational commitment, according to this
result there was a positive correlation between job satisfaction and organizational commitment
was also supported by various scientific researches and organizational commitment affects job
satisfaction positively whereas job satisfaction affects organizational commitment the same
way. In other words, employees with high job satisfaction tend to be more committed to their
organizations whereas employees with low job satisfaction tend to act in a particular manner
that might impair the organization. Therefore job satisfaction and organizational commitment
operate in such a way that they mutually boost/support each other (Oguz Isik, 2016).

2.2.3. Perceived Organizational Support

Perceived Organizational Support (POS) is defined as familiar sentiment or feeling of

employees toward their organizations, How the organization is mindful of their welfare and
appreciated the efforts for organization, make more effort to engage with attitude and belief of
the organization (K’osuri M. A. et al., 2020). Perceived Organizational Support (POS) is
described as desired emotion of employees toward their organizations; it explains whether they
value their employees’ contributions and pay attention to their well-being. According to
organizational support theory employees develop a sense regarding the extent to which the
organization appreciates and acknowledge their effort and cares about their well-being
(LAMASTRO, 2007).

13
The study conducted Saudi Arabia stated that About 80.6% of staff nurses showed a moderate
Perceived organizational support level, and 63.6% of staff nurses experienced an average level
of QNWL(Salha Malki, 2020). Conversely the study conducted in Benchsheko Zone Southwest
Ethiopia depict that mean score of organizational commitment of health professionals’ was
74.6% (Alemayehu et al., 2021).

World Health Organization consider employment conditions as one of the social determinants
of health, employees who are health are more productive, fewer health claim, and better overall
concentration and mood. Research into organizational factors affecting employee health is
crucial to improve employee health, thus improving organizational effectiveness (Arnold and
Dupré, 2012). Study conducted in Cyprus revealed that their relationship between
organizational commitment and perceived organizational performance has gained significant
attention in the organizational behavior’s literature (Aysen Berberoglu, 2015b).

The organizational support theory framework suggests that providing employees with fairness
in terms of supervisor support, procedures and organizational rewards and/or positive job
conditions results in employees increased feelings of being valued and cared for by the
organization (Arnold and Dupré, 2012). As stated by (POS) theory, employees develop a sense
concerning the organization appreciates their contribution and have cares their well-being. This
confirms the motivation of employee engagement as a result of perceived organizational
support. Perceived organizational support is bringing about employee's loyalty and dedication
to their work which is an indicator of employee engagement. Thereupon, perceived
organizational support predicts both job engagement and that of organization (K’osuri et al.,
2020).

Researcher looking at perceived organizational support (POS) is from employees perspective,

how worker develop a belief system about the degree to which the firm values their contribution
and cares about their wellbeing (Malik et al., 2016). Human resource practices effort to make
employees perceive that the organization takes care about them that finally lead to affective
attachment to the organization, when the career growth opportunities are attractive, pay and
rewards are satisfactory and job autonomy is high, healthcare professionals may believe that the
public health department supports and takes care of them. The positive perception about the
public health department may finally lead to exhibit higher performance, due to positive norm

14
of reciprocity. Therefore, it is expected that perceived organizational support will mediate the
relationship between human resource practices and job performance (SumathiGN, 2018).

Perceived organizational support is potentially involved in dealing with work-related fatigue,

excitement, and depression and reduces stressors in the workplace. Supportive work
environments are the most important essential factor in creating job satisfaction for nurses that
influences positively the patients’ treatment, absorption and maintenance of manpower in the
organization. A climate with high levels of support diminishes occupational tension and
maintains the nurses in the organization. Additionally, some studies have revealed that
perceived organizational support is negatively correlated with work absenteeism, and intent to
turnover, while it is positively correlated with award expectation, role of performance and social
behavior, preventive and civil behaviors, and also organizational commitment and subsequently
self-competency. Nurse leaders’ supportive behavior plays a key role in productivity and
promoting nurses’ professional performance (Navideh Robaee, 2018, SumathiGN, 2018).

According to study conducted on Perceived organizational support and moral distress among
nurse’s study stated that the mean perceived organizational support was low (2.63 ± 0.79). The
mean moral distress was 2.19 ± 0.58, which shows a high level of moral distress. Moreover,
Statistical analysis showed no significant relationship between perceived organizational support
and moral distress (r = 0.01, p = 0.86) Therefore, Given the low level of perceived organizational
support and high moral distress among nurses in this study, Thereupon it is crucial to provide a
supportive environment in hospitals and to consider strategies for diminishing moral distress
(Robaee et al., 2018).

15
 2.3. Conceptual framework of professional commitment and Its associated
factors

Personal x-stics related factor

Perceived punctuality
Perceived skills and motivation
Perceived substance use Organization Commitment
Perceived occupational stress Affective commitment
Perceived workload Continuance commitment
Absenteeism from work Normative commitment
Responsiveness or client centered outcome
Outcome oriented

Socio-demographic
characteristics Perceived organizational
Age support related factor
Gender Perceived concern for employees
Marital status Perceived value and care for
Qualification employees
Work experience Professional commitment Perceived work life balance
Profession Perceived HR policy \practice
Type of facility Perceived compensation and
Type of Health center benefit package
Area of residence Perceived working environment and
Net monthly salary location factors

Job satisfaction related factor

Perceived leadership style and professional
training
Perceived resource\input availability and work
setting
Perceived promotion opportunity
Perceived remuneration
Perceived staff interaction

Figure 1: Conceptual framework of professionals ‘commitment and associated factors, Dire Dawa, 2021 Adapted from

(Admasu BG, et al.2018)

16
3. METHOD
3.1. Study area\setting and study period

A Facility-based cross-sectional study was conducted in public health facility of Dire Dawa city
from August 2021 to December 2021. Dire Dawa is the second largest city in Ethiopia located
about 505 kilometers to the east of Addis. The city administration has nine urban and 38 rural
kebeles (neighborhood associations). There are two government hospitals, five private
hospitals, 15 health centers, and 33 health posts. Dire Dawa is one of the two chartered cities in
Ethiopia (the other being the capital, Addis Ababa). This chartered city is divided
administratively into two woredas, the city proper and the non-urban woreda of Gurgura. Dire
Dawa lies in the eastern part of the nation, on the Dechatu River, at the foot of a ring of cliffs
that has been described as "somewhat like a cluster of tealeaves in the bottom of a slop-basin."
With a latitude and longitude of 9°36′N 41°52′E9.6°N 41.867°ECoordinates: 9°36′N
41°52′E9.6°N 41.867°E Based on the 2007 Census conducted by the Central Statistical Agency
of Ethiopia (CSA), Dire Dawa has a total population of 342,827, of whom 171,930 were men
and 170,897 women; 232,854 or 67.92% of the population are considered urban inhabitants.
With an estimated area of 1,213.20 square kilometers, this chartered city has a population
density of 328.06 people per square kilometer. There were 75,693 households in Dire Dawa
administrative council with an average of 4.5 persons per household. According to the CSA, as
of 2004, 90.76% of the total population had access to safe drinking water: 69.61% of rural and
99.48% of urban inhabitants having access. Values for other reported common indicators of the
standard of living for Dire Dawa as of 2005 include the following: 11.4% of the inhabitants fall
into the lowest wealth quintile; adult literacy for men is 76.6% and for women 53%; and infant
mortality rate is 71 infant deaths per 1,000 live births, which is less than the nationwide average
of 77; at least half of these deaths occurred in the infants in the first month of life. (Dire Dawa
administration Regional Health Bureau: 2017 six months’ report [unpublished])

17
3.2. Study design

A Facility Based cross sectional study design was conducted from August to December, 2021.

3.3. Population
3.3.1. Source population

The source population were all health professionals working in public health facilities of Dire
Dawa city administration, Eastern Ethiopia at the moment of data collection

3.3.2. Study population

The study population were all health professionals working in public health facility which is
currently work in public health facilities of Dire Dawa city administration, Eastern Ethiopia.

3.4. Inclusion criteria

All health Professionals who were working in public health facilities during the data collection
August, 2021 to September, 2021 were included in the study.

3.5 Exclusion criteria

All health professionals working in public Health facilities who were not present on their regular
working time due to annual vacation or illness are excluded from the study.

3.6. Sample size determination

All selected professionals who were working in public Health facility and health center were
study participants of this study. The sample size for objective was determined using the formula
for a single population proportion with the following assumption: total population(N)=1180,
69.4% of magnitude of professional commitment among health care providers(Anshebo M et
al., 2021),5% level of significance,10% non-response rate and 4% margin of error.

Applying the formula

no = (z (α/2)2 p(1-p)/d2

no= (1.96)2 X 0.694 (0.306)

(0.04)2

18
 no= 510

Where, no= the minimum sample size, z (α/2) = 1.96 at 95% level of confidence, P= 69.4%, d=
margin of error 4% (0.04).

Since the source population is less than 10,000 we have to use finite population correction
factor. If sampling is from a finite population of size N, then

After calculating correction formula n=356, then

Non response rate = 10% X 356 = 36

So, n = 356 + 36 = 392

3.7. Sampling procedure and sampling techniques
The sample size was selected by using proportionally allocated (probability proportional to size)
to each hospital and health center, in the study area (Dire dawa city administration). Among
health professionals found in health facility including hospital and health center, through simple
random sampling two hospital ( Sabian and dill chora hospital) and seven health center were
included (Dechatu HC , Addis Ketema HC, Laga Hare, Dire Dawa HC, Ganda Qore HC, Biyo
awale HC and Laga Oda HC were selected), study subject that available at the time of data
collection selected using simple random sampling from selected Health facility depending on
the proportion of number of health care providers in specific health facility.

19
 Study area (Dire Dawa city administration)
N=1180 HP (health professionals)
Dil chora hospital

Addis ketema HC

Melka jabdu HC
Sabian Hospital

Melka qaro HC

Jallo balina HC
Biyo awale HC
Dire Dawa HC

Laga Oda HC
G\Gerada HC
G\Qoree HC

Dechatu HC

Qalicha HC
Gooroo HC

Jaldesa HC
L\Hare HC

Wahil HC
Health facilities were Selected by simple random sampling

Laga Oda HC
Addis ketema
Dechatu HC

Ganda Qore

Biyo awale
L\Hare HC

Dire Dawa
Dil chora

Hospital
hospital

Sabian

HC

HC

HC
Study subjects selected from each health facility
through simple random sampling based on the
proportion of professionals found in each health
facility

Total study subject is 330

Note: HC= health center G= ganda L= laga HP= health professional

Figure 2: schematic diagram of sampling procedure of professional commitment and

associated factors in dire dawa city administration, 2021

20
3.8. Study variables
3.8.1. Dependent Variable
Professional commitment
3.8.2. Independent variables

1. Socio-demographic and economic variables (age, gender, marital status, work experience,
profession, working health facility, area of residence/location of facility and net monthly salary)

2. Job satisfaction related variables

 Perceived promotion opportunity

 Perceived remuneration

 Perceived staff interaction

 Perceived leadership style and professional training

 Perceived resource availability and work setting

3. Organizational support related variables

 Perceived concern for employee

 Perceived value and care for employee

 Perceived work life balance

 Perceived human resource policy and practice

 Perceived compensation & benefit package

 Perceived working env‘t & location factors

4. Personal characteristics related variables

 Perceived punctuality, substance use, occupational stress, work load, responsibility,

responsiveness, skill and motivation

21
5. Organizational commitment variables

Perceived affection for job/affective, fear of loss/continuance, sense of obligation to

stay/normative commitment

3.9. Data collection Method

3.9.1 Data collection tool

The quantitative data was collected using self-administered structured questionnaire that was
adapted from different literatures based on the study objectives. It consists of five parts. part
one was on Sociodemographic and economic data that comprised of 11 items. Part two had 23
items of 5-point Likert scale to measure job satisfaction. Part three contained 8 items of 7-point
Likert type scale to measure perceived organizational support. And part four was made up of 9
items of Organizational Commitment Questionnaire. The response categories were 7-point
Likert scales ranging from 1 strongly disagree to 7 strongly agree. Questionaries’ tool of part
2,3 and 4 adapted from (Hailemicael, 2014) and Part five comprised of 10 items with single
component that measure professional commitment that adopted from (Siraneh, 2016).
3.9.2 Data collection techniques

Quantitative data was collected using self-administered structured and pretested questionnaires.
participants of the pre-test were contacted to give their general feelings, comments and problems
encountered while responding the questions. Finally, relevant modifications were made before
the start of the actual data collection. The study population invited to participate voluntarily by
explaining the rationale of the study at the time of data collection. Trained data collectors
distributed the questionnaires to all eligible health professionals at the same time during the tea
breaks or at the entry or exit times like early morning or lunch time after informing them to fill
the questionnaires privately.

3.9.3 Data collectors and supervisors

Five data collectors were recruited for quantitative self-administered questionnaire who are
student from discipline of health officer and Nurses (Bsc) with experience in data collection,
but fluent in Amharic and Afan oromoo. Over all supervision was conducted by principal
investigator after giving the training for all data collection team on their specific responsibility,
overviews regarding professional commitment and associated factors, on each part of the tool,
ethical consideration and data integrity for one day.

22
3.10. Operational definitions and measurement

1. Health professionals refers to the study subjects who have direct involvement in the care of
client service provision such as medical doctors, nurses, Midwives, health officers, emergency
surgeon and obstetricians, medical lab/technicians, Pharmacist/druggist, and anesthesia.

2. Health Facility: is in general, any location where health care is provided. Health facilities
includes from hospital, health center, health post and small clinics.

3. Job satisfaction: It is negative or positive/pleasurable emotional state resulting from the

appraisal of one ‘s job or job experience or the reverse. It was measured with five pre-assumed
scales such as: perceived remuneration (It includes wage, benefits and incentives or other
payments in the organization), perceived promotion opportunity(It denotes both career
development and educational upgrading opportunity in once organization),perceived resource
availability and work setting (refers to the situation in which the professionals work in and the
presence of adequate supplies and time for each client), perceived leadership style and
professional training (It represents the way how the organizations treat the health professionals
and the presence of on job or off job training programs for the health professionals) and
perceived staff interaction(It is formal/informal relationship that is warm or bad, that practiced
between anyone in the organization.

4. Perceived Organizational Support:

It refers to the extent to which employees see that the organization recognizes their contribution
and cares about their well-being and benefit. It was measured with 6 pre-assumed scales and
total of 30 items: perceived value and care for employee (It defines a job characteristic that the
organization acknowledges the effort of health professionals and care for their wellbeing),
perceived concern for employee (It is the way how the organization is being open to the needs
and questions of the health professionals), perceived work life balance(refers to the efforts of
the organization to provide employment practice that help the professional to balance their work
and personal obligations), perceived HR policy and practice (it indicates the effectiveness of
HR policy and practices of health facilities), perceived compensation and benefit package
(refers to the allowances/payment given to the professionals in addition to the basic salary by
considering relevant issues), and Perceived working environment and location of facility (refers
to the availability of infrastructural and locational advantage of the facility).
23
5. Organizational commitment

It is the relative strength of an individual ‘s linkage to the organization. This was measured
using 3 components of pre-assumed scales (affective/affection for job, continuance/fear of loss,
normative commitment/sense of obligation to stay) that was measured by 8 items each (24 total
items) with 5-point Likert scale, 1 denoting strongly disagree and 5 denoting strongly agree.

6. Perceived personal characteristics

Those characteristics that are highly belongs/contextual to the individual’s life/experience like
substance use (kchat, cigarate, alcohol…), punctuality, stress, work load, skill, motivation,
responsiveness, outcome-oriented, absenteeism at working time, sense of being responsible and
accountable for one ‘s action. This was measured using pre-assumed10 scales/variables that was
measured by 1 item each with 5-point Likert scale, 1 denoting strongly disagree and 5 denoting
strongly agree.

7. Professional commitment

It is the relative strength of an individual ‘s linkage to the respective profession. It is beyond a

commitment for a particular organization and implies the individuals ‘perspective toward their
profession and the motivation that they have to stay in their job which refers to one ‘s loyalty
to the profession and the willingness to strive and uphold the values and goals of the profession
to maintain membership in the profession that can be explained by adherence to principles of
ethical practice, effective interactions with patients and with other people working in the
healthcare system, reliability, commitment to autonomous maintenance and continuous
improvement of competence, pride in profession & good behavior outside work. This was
measured using 10 items of 5-point Likert scale and 1 denoting strongly disagree and 5 denoting
strongly agree. Professional commitment score was created and higher score indicates higher
professional commitment.

3.11. Data quality control

Data collected by trained data collectors using questionnaires. Before the actual data collection,
a pre-test conducted among 5% of samples at chelenko DHB (District Health bureau and health
center at chelenko town. The validity of the questionnaire determined based on the view of
experts and the reliability obtained by calculating the value of Cronbach’s alpha. The

24
questionnaires were checked for missing values and inconsistency, Completeness and legibility.
Questionnaires that found to have lots of missing values and inconsistencies were excluded.

3.12. Data processing and analysis

The data entered by epi-info and exported to Stata for analysis. To explain the study population
in relation to relevant variables, binary logistic regression used. Associations between
dependent and independent variables was checked. Both bi-variable and multivariable logistic
regression were used to identify professional commitment and association factor. A P-value <
0.05 was considered statistically significant in the multivariate logistic regression. Hosmer and
lame-show goodness test was done to check for model fitness.

3.13. Ethical consideration

The study was carried out after getting approval from the ethical clearance committee of
Haramaya University Institutional health research Ethics review committee (IHRERC), College
of Health and Medical science. And obtain letter of cooperation from (IHRERC) to the health
facility for collecting the data. Data was collected after getting written Ethical Clearance from
Dire Dawa regional city administration Bureau. Information sheet and written consent forms
were delivered along with each questionnaire and all the subjects were asked if they willing to
participate in the study. Informed, voluntary, written and signed consent were obtained from all
interviewed subjects. Objective of the study were discussed with each participant and privacy
maintained during interview.

3.14. Information dissemination

The study presented to the community of Haramaya University on open defense of public health
researches and defended. Then the finding of the study submitted to Haramaya University. Since
the report from this study expected to be useful for all concerned bodies who want to enhance
and promote to solve the challenge of health problem, and also shared to Dire Dawa city regional
health bureau.

3.15 Limitation of the study

The study experiences the usual limitation of a cross sectional study. The sample size was
relatively small and restricted to health care providers in health facility of Dire Dawa city
administration. Consequently, the findings may not be generalized to health workers in other
city or region.

25
4. RESULT
4.1 Socio-demographic Characteristics
A total of 392 participants took part on this study giving the response rate of 380 (97%) were
returned the questionnaires. About half of the respondents were female. Half of the respondents
were married (186(48.95) and whereas a few of the total 6(1.6%) total participant age between
18-23, Majority of 186(48.95%) of the worker has the experience of less than or equal to 2 years
and 157(41.32% of health care professionals has the work experience of between 2 and 5 years.
Out of 380 health professionals participated on this study 124(32.63%) were nurses, 74(19.47%)
,40(10.53%) and 35(9.21%) were midwife, Health officers and general practitioner respectively.
Out of 380 professionals, 267 (70.26%) of them have bachelor degree level of educational
qualification which is followed by Diploma holders (65(17.11%)).

Regarding participation level, of 288 (775.79%) were from health centers, and 347 (91.32 %)
of the participants live in rural area. 336 (88.42 %) of the participants were working as non-
managerial position while 44 of (11.58) of them has working at managerial position (head, case
team leader, medical director, human resource head). Out of 380 participants 277(%) of them
of net monthly salary was greater than 5000 birrs, while 84 of (22 %) of their net monthly salary
is between 3000-5000 birr. The others 10(2.6 %) paid between 2500 to 2999 birr.

Net monthly salary earn

80 72.11
70
60
50
percent

40
30 22.11
20
10 2.37 2.63
0
salary 3500-3999.99 4000-4499.99 4500-4999.99 >5000
Net montkly salary earn(ETB)

Figure 3 : percentage distribution of study participant of net monthly salary earns of

professional commitment and associated factors among health professionals in dire dawa
city administration,2021.

26
Table 1: socio-demographic characteristics of health professionals working in dire dawa
administration health facilities, eastern Ethiopia, 2021(n=380).
Variables Categories Frequency (%)
Sex Male 200(52.63)
Female 180(47.37)
Age 18-23 6(1.58)
24-29 140(36.84)
30-35 208(54.74)
36 and above 26(6.84)
Marital status Single 148(38.95)
Divorced 33(8.68)
Married 186(48.95)
Widowed 13(3.42)
Work experience ≤2 186(48.95)
2.01-5 157(41.32)
5.01-10 31(8.16)
>10 6(1.58)
Qualification Diploma 65(17.11)
Degree 267(70.26)
Medical doctor 6(1.58)
Other 42(11.05)
Residency Urban 347(91.32)
Rural 33(8.68)
Type of facility Hospital 288(75.79)
Health center 92(24.21)
Type job managerial 44(11.58)
Non managerial 336(88.42)
Profession category Nurse 124(32.63)
midwifery 74(19.47)
Health officer 40(10.53)
Medical lab 30(7.89 )
pharmacist 27(7.11)
Medical doctor 35(9.21)
Other 50(13.16)
Working unit Medical and surgical 30(7.89)
ICU 32(8.42)
Operation room 19(5.00)
psychiatry 32(8.42)
Pediatrics 43(11.32)
Obstetrics and gynecology 66(17.37)
Ophthalmology 24(6.32)
Others 134(35.26)
Job satisfaction dissatisfied 240(63.16)
satisfied 140(36.84)
Perceived organizational support negative attitude 200(52.63)

positive attitude 180(47.37)

Organizational commitment negative attitude 163(42.89)
positive attitude 217(57.11)

27
4.2 Descriptive Statistics of Study Variables
Descriptive statistics was used to compute the overall mean and professional commitment and
percentage mean score. The minimum score is 10 and the maximum score is 50, for questions
about professional commitment. The overall mean professional commitment score of the study
participants in this study was 36.65±7. The calculated mean score was changed to percentage
mean score to identify percentage of professionals who have better level of commitment to their
profession and calculated by using:

Percentage mean score of professional commitment =

Actual mean score
Maximum potential score * 100% = (36.65/50) *100%= 0.733 *100=73.33%

Professional Commitment was computed as having mean score of 36.65±7 with maximum
score=50 then percentage mean score= 73.33%.

Table 2 : Frequency distribution of five-point Likert scale response of participants for

professional commitment measuring items, Dire Dawa, 2021 (n=330).
Strongly

Strongly
disagree

disagree

neutral
Items

agree

agree
No.

1. I am willing to put in a great deal of 27(7.1) 15(3.95) 54(14.21) 228(60) 56(14.74)

effort to develop my profession beyond
expected
2. I am a person who identifies strongly 43(11.32) 10(2.63) 52(13.68) 214(56.3) 61(16)
with my profession
3. I would accept almost any type of job 16(4.2) 7(1.84) 71(18.68) 220(57.89) 66(17.37)
that related to my profession to keep
working beyond expected from me
4. I am a person who feels strong ties with 22(5.79) 36(9.47) 43(11.32) 207(54.47) 72(18.95)
other members of my profession
5. I am a person who is proud to belong to 22(5.8) 14(3.7) 46(12.11) 203(53.42) 95(25)
my profession
6 My profession really inspires the very 17(4.47) 15(3.95) 45(11.84) 214(56.32) 89(23.42)
best in me in the way of job performance
7. I am extremely glad that I chose this 22(5.79) 10(2.63) 57(15) 193(50) 98(25.79)
profession to work for ever in advance
8. I am a person who criticizes my 80(20.05) 21(5.53) 72(18.95) 161(42.37) 46(11.52)
profession
9 I am a person who considers my 26(6.84) 5(1.32) 76(20) 177(46.58) 96(25.26)
profession to be important
10. I am a person who tries to hide 102(26.84) 5(1.32) 71(18.68) 158(41.58) 44(11.58)
belonging to my profession

28
 working place of health professionals

Health center
24%

Hospital
76%

Health center Hospital

Figure 4: percentage distribution of study participant working place of health worker’s

professional commitment and associated factors among health professionals in dire dawa
city administration,2021.
4.2.1 organizational commitment
Organizational Commitment percentage means score of health professionals participated in this
study was 75.52%. On the other hand, mean raw score of this scale was 47.58 ± 9.5. The
minimum score is 15 and the maximum score is 63, for questions about professional
commitment.
Percentage mean score of organizational commitment =
Actual mean score
Maximum potential score * 100% = (47.58/63) *100%= 0.7552 *100=75.52%

Attitude of health professionals toward organization

percent

Negative attitude
42.89
Positive attitude
57.11
Attitude of Health professionals toward
organization

0 10 20 30 40 50 60
Axis Title

29
Figure 5: Attitude of health professionals toward organization of professional
commitment in public health facilities in Dire Dawa City administration, eastern Ethiopia,
2021
4.2.2 perceived organizational support
Perceived organizational support percentage means score of health professionals participated in
this study was 45.9%. On the other hand, mean raw score of this scale was 23.87 ± 7.5. The
minimum score is 8 and the maximum score is 52, for questions about perceived organizational
commitment.
Percentage mean score of organizational commitment =
Actual mean score
Maximum potential score * 100% = (23.87/52) *100%= 0.459 *100=45.9%

4.2.3 Job satisfaction

Level of Job satisfaction percentage means score of health professionals participated in this
study was 66.4 %. On the other hand, mean raw score of this scale was 57.13 ± 12.84. The
minimum score is 24 and the maximum score is 86, for questions about perceived organizational
commitment.
Percentage mean score of organizational commitment =
Actual mean score
Maximum potential score * 100% = (57.13/86) *100%= 0.664 *100=66.4%

Job satisfaction level of health professionals

3
pecent

0 10 20 30 40 50 60 70
Axis Title

satisfaction dissatisifaction Job satisfaction levels of health professionals

Figure 6: Attitude of health professionals toward organization of professional

commitment in public health facilities in Dire Dawa City administration, eastern Ethiopia,
2021

30
4.3 Factors associated with professional commitment

In binary logistic regression analysis, gender, age, marital status, work experience, qualification,
residence, type of facility, types of job, types of profession, working unit, job satisfaction,
perceived organizational support and organizational commitment were found to be associated
with professional commitment. of these all variables, which had statistically associated with
professional commitment in the preceding in binary logistic regression model was entered into
the final model (Multivariable logistic regression model). Out of total only seven (job
satisfaction, age, qualification, salary, organizational commitment, residence and work place
were significantly associated with professional commitment.

A multivariable logistic regression analysis was performed to identify factors associated with
professional commitment of health care professionals. Consequently, four variables were found
to be statistically associated with professional commitment after adjusting for confounders.
These were working place, salary, job satisfaction and organizational commitment.

In this study, those who paid between 4000-4499 birr were 11 times more likely committed to
profession than those who paid 3500-3999 birr [AOR=11, 95% CI 1, 130], those who paid
between 4500-4999 birr were 12 times more likely committed to profession than those who paid
3500-3999 birr [12, 95% CI=2, 70]. those who are working in health center were 3 more likely
committed to their profession as compared to who are working in hospitals [AOR, 3.3, 95%
CI=1.4, 7.4]. Out of total participant of the study 140(36.84%) of health professionals were
satisfied with their professions [ AOR, 0.3, 95% CI=2, 70], 240(63.16%) of were dissatisfied
and 217(57.11%) of health worker has positive attitude toward perceived organizational support
[AOR 2, 95% CI=1.2, 3.6].

31
 magnitude of professional commitment

not committed
36.09

committed
63.94

professional commitment

0 10 20 30 40 50 60 70
percent

Figure 7: Magnitude of professional commitment in public health facilities in Dire Dawa

City administration, eastern Ethiopia, 2021

32
Table 3: Multivariable logistic regression analysis factor related with professional
commitment in public health facility, Dire Dawa city administration, Eastern Ethiopia, 2021
Variable Category Professional commitment COR(95%) CI AOR(95%) CI P-
value

committed Not
committed

Age 18-23 1(16.67) 5(83.33) 1 1

24-28 86(61.43) 54(38.57) 7.96 (CI=0.9,70) 2.7(CI=0.3, 28) 0.36

30-35 134(64.42) 74(35.58) 9(CI=1.03, 79) 7(CI=0.7, 72) 0.1

<35 18(69.23) 8(30.77) 11.3(CI=1.12,112) 6(CI=0.5, 76) 0.16

Salary 3500- 3(33.33) 6(66.67) 1 1

3999.99
4000- 5(50.00) 5(50.00) 2(CI=0.3, 13) 11.4(1, 130) 0.049
4499.99

4500- 63(75.00) 21(25.00) 3(CI=1.3, 26) 12(CI=2, 70) 0.007

4999.99

<5000 168(60.65) 109((39.35) 3(CI=0.8, 12) 4(CI=0.7, 17.5) 0.113

Residence Urban 210(60.52) 137(39.48) 1 1

Rural 29(87.88) 4(12.12) 5(CI=2, 14) 0.6(CI=0.2, 2) 0.361

Work place Hospital 159(55.21) 129(44.79) 1 1

Health 80(86.96) 12(13.04) 5.4(CI=3, 10) 3.3(CI=1.4, 7.4) 0.03

center

Qualification Diploma 50(76.92) 15(23.08) 1 1

Degree 149(55.81) 118(44.19) 0.37(CI=0.002,0.2) 1.8(CI=0.3, 2) 0.61

General 4(66.67) 2(33.33) 0.6(CI=0.3, 0.6) 1.9(CI=0.2, 17) 0.578

practitioner

Others 36(85.71) 6(14.29) 1.8(CI=0.63) 3(CI=0.8, 11) 0.117

Job satisfaction Satisfied 54(38.57) 55(22.92) 0.18(CI=0.11,0.29) 0.3(CI=0.14,0.5) 0.000

Dissatisfied 185(77.08) 86(61.43) 1 1

Organizational Negative 77(47.24) 86(52.76) 1 1

commitment attitude

Positive 77(47.24) 55(25.35) 3.3(CI=2, 5) 2(CI=1.2,3.6) 0.005

attitude

33
5. Discussion
5.1 Professional Commitment
The commitment level of professionals among public health facilities in Dire Dawa city
administration, eastern Ethiopia was 64%. In bi-variate analysis variables such as qualification,
residence, type of facility, gender, age, marital status, work experience, types of job, types of
profession, working unit, job satisfaction, perceived organizational support and organizational
commitment were found to be associated with professional commitment and significant variable
was entered into the final model of Multivariate analysis. Out of total only seven of them
includes job satisfaction, age, qualification, salary, organizational commitment, residence and
work place were significantly associated with professional commitment. Then a multivariable
logistic regression analysis was performed to identify factors associated with professional
commitment of health care professionals. Accordingly, four variables were found to be
statistically associated with professional commitment after adjusting for confounders. Those
were working place, salary, job satisfaction and organizational commitment.

In this study, Health workers who paid between 4000-4499 birr were 11 times more likely
committed to profession than those who paid 3500-3999 birr [AOR=11, 95% CI 1, 130] and
who paid between 4500-4999 birr were 12 times more likely committed to profession than those
who paid 3500-3999 birr [12, 95% CI=2, 70]. Furthermore, health professionals who are
working in health center were 3 more likely committed to their profession as compared to who
are working in hospitals [AOR, 3.3, 95% CI=1.4, 7.4]. Out of total participant of the study
140(36.84%) of health professionals were satisfied with their professions [ AOR, 0.3, 95%
CI=2, 70], 240(63.16%) of were dissatisfied and 217(57.11%) of health worker has positive
attitude toward perceived organizational support [AOR 2, 95% CI=1.2, 3.6].

The finding of this study shows that level of professional commitment was 64%. The finding is
lower than other study findings conducted in shone, southern Ethiopia and Jimma, south eastern
Ethiopia which revealed that level of professional commitments were 69.4% and 72.7%,
respectively (Anshebo M et al., 2021, Yibeltal S et al., 2018). the possible explanation for the
discrepancies might be due to variation in working place and the study setting. This study
finding is almost similar with study result conducted in Gurage Zone, Southern Ethiopia which
showed that the proportion of professional commitment to their organization was 64.81%. The
similarity might be due to enhancement of health workers satisfaction to their job and benefit

34
package that provided to their profession by the organization (Nima et al., 2016, Anshebo M et
al., 2021).

Furthermore, those who are working in health center were 3 more likely committed to their
profession as compared with those who are working in hospitals [ AOR, 3.3 94% CI=1.4, 7.4].
This finding is consistent with study conducted in Japan nurses who worked in hospitals with
more than 700 beds, and nurses who worked in the Kanto district had significantly higher
affective occupational commitment score. the reason for the difference of professional
commitment between were decreased work load in health centers than hospitals (Miho Satoh,
2017).

This study revealed that 140(36.84%) of health professionals were satisfied with their
professions [ AOR, 0.3, 95% CI=2, 70] and 240(63.16%) of were dissatisfied, this finding is
somewhat different from study done in shone (40.8%), Harari region (44.2%) and university of
Gondar (95% CI 49.3, 58.8%). The possible explanation of the difference is due to the payment
and benefit system of their organization and the highest level of job satisfaction score among
domain factors was observed on staff relationship (77%) and the work itself (75%) (54%),
(Anshebo M et al., 2021, Geleto A et al., 2015, Gedif G et al., 2018).

The study revealed that 217(57.11%) of health worker has positive attitude toward perceived
organizational support [AOR= 2(95%CI=1.2, 3.6)]. The finding of this study is different with
the study done in Gurage zone, 64 .8 % and in Saudi Arabia (47.88%). The discrepancy of the
study is might be due to positive attitude of health care provider toward their organization
Furthermore, This study revealed that, those health professionals who have positive attitude two
(2) more likely committed to their profession than workers who have negative attitude toward
their organization (AOR=2, 95% CI=1.2, 3.6).Similarly, this study done in shone district
reveals that health professionals who had positive attitude to their organization were 2.27 times
more likely committed to their professions as compared to health professionals who had
negative attitude to their organization (AOR= 2.27, CI=1.25- 4.12). The similarity of the study
might due to faithfulness of health professional to their organization.(Al-Qahtani, 2020,
Anshebo M et al., 2021).

The result of this study points out that Organizational Commitment percentage means score of
health professionals participated in this study was 75.52%. On the other hand, mean raw score
of scale was 47.58 ± 9.29, 75.52%. The finding was contrary with the study done in Malaysia,

35
stated that 48.07% participant have high level of organizational commitment. The discrepancy
might be due to much of hospital in Malaysia met the accreditation standard and are well
recognized (Siew PL, 2011, Erfan Rofiqi et al., 2019).

The result of this study stated that Job satisfaction percentage means score of health
professionals participated in this study was 66.4, the finding is dissimilar with study conducted
In Pakistan(18%),Amhara (54%),Addis Ababa(43.2), Harar(44.2) due to the less reward system
and budget disparity the public health sector that intern worsened the quality of services offered
by the public health care organizations (Tasneem et al., 2018, Abate and Mekonnen, 2021).

36
6. Conclusion and Recommendation

6.1 Conclusion
The commitment level of health professionals among public health facilities in Dire Dawa city
administration was 64%. A bi-variate and multivariate analysis was performed to identify
factors associated with professional commitment of health care professionals after adjusting for
confounders. Accordingly, working place, salary, job satisfaction and organizational
commitment was the factor associated with professional commitment. Health professional
working in health center was 3 times more likely committed to their profession when compared
to hospital worker, those professional that have positive attitude were 2 time more likely
committed to profession when compared to those have negative attitude.

6.2 Recommendation
Based on this study, the following recommendations were forwarded to the health
administrators, managers and health bureau, health care organization should demonstrate
practically, enhance payment system and fair sharing of benefit packages, improving and
promoting satisfaction of workers, adopting management system that appropriate to the
situational challenge in their organization including making suitable work setting and
environment is essential. finally, they should focus on filling the gap of meeting to enhance
professional commitment through creating effective organization and highly satisfied health
professionals.

37
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40
ANNEX

7.1 Annex
Facility Head Information Sheet and Informed Consent Form

Hello my name is Yusuf Remedan I`m principal investigator for the study conducted by me
who is studying for master’s degree at Haramaya University, College of Health and Medical
Sciences. I kindly request you to lend me your attention to explain you about the study and
being participant.

Study title

professional commitment and associated factor among health worker at health facility in Dire
Dawa city administration, Eastern Ethiopia from August 2021- December /2021.

Aim of Study

The finding of the study helps Dire Dawa city administration regarding professional
commitment and associated factor among health worker at health facility. Moreover, the aim of
this study is to write a thesis as a requirement for the partial fulfillment of master’s program.

Procedure and duration

I will be interviewing them using a questionnaire to provide me a relevant data that is helpful
for the study. I will interview them about 35 questions using a questionnaire that will totally
takes about 35 minutes, so I kindly ask them to spare their time with me.

Risks and benefits

There is a limited minimal harm that may face them when participating in this study and will
take about 35 minutes of their working time. There will not be any direct payment for
participating in this study. Moreover, the finding from this research may reveal important
information for the local health planners and implementers.

Confidentiality

The information they will provide is confidential. There will be no information that will identify
them in particular. The finding of the study will be general to the study population and will not

41
reflect any thing particular of individual person or housing. The questionnaire will be coded to
exclude showing names and other specific identity. No reference will be made in oral or written
reports that could link you to the research.

Rights

Participation for this study is fully voluntary. They have the right to declare to participate or not
in this study. If they decide to participate, they have the right to withdraw from the study at any
time and this will not label them for any loss of benefits which they otherwise entitled. They do
not answer any question that they do not want to answer.

Contact Address

If you have any question inquires at any time please contact with the following addresses:
Principal investigator: Yusuf Remedan, Email: yoomiiyos@[Link] ,Mobile phone:
0940871543, Haramaya University College of Health and Medical Sciences Institutional
Research Ethical Review Committee: Office phone: 0254662011 and P.O. Box: 235, Harar.

Declaration of informed voluntary consent

I have read the participant information sheet. I have clearly understood the purpose of the
research, the procedures, the risks and benefits, issues of confidentiality, the rights of
participating and the contact address for any queries. I have been given the opportunity to ask
questions for things that have been unclear. I was informed that participants have the right to
withdraw from the study at any time or not to answer any question that they do not want.
Therefore, I declare my voluntary consent to allow this study to be conducted in
______________on behalf of the health facility with my initials (signature) as indicated below.

Name & Signature of the head of health facility___________ Date______________

Name & Signature of principal investigator ___________________ Date______________

42
Health care providers Information Sheet & Informed Consent Form

Hello my name is ______________, I am working as data collector for the study conducted by
Yusuf Remedan who is studying for his master’s degree at Haramaya University, College of
Health and Medical Sciences. I kindly request you to lend me your attention to explain you
about the study and being participant.

Study title

professional commitment and associated factor among Health worker at health facilities in Dire
Dawa city administration, Eastern Ethiopia from August 2021- Sep /2021.

Aim of Study

The finding of the study helps Dire Dawa city professional commitment and associated factor
among Health worker at health facility. Moreover, the aim of this study is to write a thesis as a
requirement for the partial fulfillment of master’s program.

Procedure and duration

I will be interviewing you using a questionnaire to provide me a relevant data that is helpful for
the study. I will interview you about 35 questions using a questionnaire that will totally takes
about 35 minutes, so I kindly ask you to spare your time with me.

Risks and benefits

There is a limited minimal harm that may face you when participating in this study and will take
about 35 minutes of your working time. There will not be any direct payment for participating
in this study. Moreover, the finding from this research may reveal important information for the
local health planners and implementers.

Confidentiality

The information you will provide is confidential. There will be no information that will identify
you in particular. The finding of the study will be general to the study population and will not
reflect any thing particular of individual person or housing. The questionnaire will be coded to

43
exclude showing names and other specific identity. No reference will be made in oral or written
reports that could link you to the research.

Rights

Participation for this study is fully voluntary. You have the right to declare to participate or not
in this study. If you decide to participate, you have the right to withdraw from the study at any
time and this will not label you for any loss of benefits which you otherwise entitled. You do
not answer any question that you do not want to answer.

Contact Address

If you have any question inquires at any time please contact with the following addresses:
Principal investigator: Yusuf Remedan, Email: yoomiiyos@[Link] ,Mobile phone:
0940871543, Haramaya University College of Health and Medical Sciences Institutional
Research Ethical Review Committee: Office phone: 0254662011 and P.O. Box: 235, Harar.

Declaration of informed voluntary consent

I have read/was read to me the participant information sheet. I have clearly understood the
purpose of the research, the procedures, the risks and benefits, issues of confidentiality, the
rights of participating and the contact address for any queries. I have been given the opportunity
to ask questions for things that have been unclear. I was informed that I have the right to
withdraw from the study at any time or not to answer any question that I do not want. Therefore,
I declare my voluntary consent to participate in this study with my initials (signature) as
indicated below.

Name & Signature of the Health care providers___________ Date_______________

Name & Signature of data collector ___________________ Date__________

44
7.2. Annex: Data collection tools
Part I: Sociodemographic and economic characteristics of the participants
Table 4 : Sociodemographic and economic characteristics of the participants
questionaries’ of professional commitment and associated factor among health
professionals in Health facility of Dire Dawa, Eastern Ethiopia: A facility based cross
sectional study,2021.
S. N Question Choice and answer Skip
1. Your Sex 1. Male
2. Female
2. Your age
3. Current Marital status 1. Single
2. Divorced
3. Married
4. Widowed
4. Working Unit/department 1. Medical ward
2. Surgical ward
3. Intensive Care
Unit (ICU)
4. Major Operation
room
5. Psychiatry
6. Pediatrics
7. Obstetrics &
Gynecology
8. Ophthalmology
9. Chronic Illness
Follow Up Clinic
10. OPD

5. Your profession
6. What is your qualification? 1. Diploma
2. Bachelor degree
3. Post graduate
7. Work Experience
8. Area of residence 1. Urban
2. Rural
You are working in? 1. Health center
2. Hospital

10. Type of post 1. Managerial

2. Non-managerial
11. Net monthly salary you earn (ET /birr/)

45
 Part II Job satisfaction questionnaire

Table 6: job satisfaction questionaries’ of professional commitment and associated factor

among health professionals in health facility of dire dawa, eastern Ethiopia: a facility
based cross sectional study,2021.

how satisfied are you with the following aspects of your current job? please circle the number
that applies your current satisfaction level in front of each question/item. the items are scored
as 5 = very satisfied 4 = moderately satisfied 3=uncertain 2 = moderately dissatisfied 1 = very
dissatisfied

S.N

Very satisfied
.

Moderately

Moderately

Dissatisfied
dissatisfied
Uncertain
satisfied

Very
1. pay
1. My income is a reflection of the work I do 1 2 3 4 5
2. I get Compensation for working weekends 1 2 3 4 5
3. My job has more advantages than disadvantages 1 2 3 4 5
2. Promotion
4. I have enough support for continuing education 1 2 3 4 5
5. I have sufficient opportunity for professional growth 1 2 3 4 5
6. I get support for Personal growth and development through education and training 1 2 3 4 5
3. Recognition
7. Adequate Consideration is given to my opinion and suggestion for change in the 1 2 3 4 5
work setting
8. I receive recognition for tasks well done 1 2 3 4 5
9. Adequate consideration is given to my personal needs 1 2 3 4 5
4. Professional training
10. There are training opportunities available to me 1 2 3 4 5
11. Training programs are appropriate to enhance my professional job performance. 1 2 3 4 5
12. My organization gives Training and orientation to new staffs well 1 2 3 4 5
5. Autonomy 1 2 3 4 5
13. I have enough freedom to decide how I do my work 1 2 3 4 5
14. I have support to be fully accountable for those Decisions 1 2 3 4 5
15. I have the freedom to work alone on the job 1 2 3 4 5
6. Interaction and working environment
16. I have a good working relationship with my colleagues 1 2 3 4 5
17. There is a clear channel of communication at my workplace 1 2 3 4 5
18. I can depend on my colleagues for support 1 2 3 4 5
19. There is an atmosphere of co-operation between staff & management 1 2 3 4 5
20. Management does involve staff in decision making 1 2 3 4 5
21. My working environment encourage me to make adjustment in my professional 1 2 3 4 5
practice to suit patient needs
22. I have sufficient time for each client 1 2 3 4 5
23. I don’t experience frustration in my work due to limited Supply 1 2 3 4 5

46
Part III Perceived organizational support
Table 5 : perceived organizational support questionaries’ of professional commitment and
associated factor among health professionals in health facility of dire dawa, eastern
Ethiopia: a facility based cross sectional study,2021
by considering the items score as strongly agree=7, agree=6, slightly agree=5, neutral=4,
slightly disagree=3, disagree=2, and strongly disagree=1. please circle the number that applies
your current perceived organizational support level in front of each question/item.
S.N.

Disagree
Strongly

Strongly
disagree

disagree
Slightly

Slightly
Neutral
Agree
agree

agree
1. The organization values my contribution to its 1 2 3 4 5 6 7
well-being
2. The organization fails to appreciate any extra effort 1 2 3 4 5 6 7
from me.
3. The organization would ignore any complaint from 1 2 3 4 5 6 7
me.
4. The organization really cares about my well- being. 1 2 3 4 5 6 7
5. Even if I did the best job possible, the 1 2 3 4 5 6 7
organization would fail to notice.
6. The organization cares about my general 1 2 3 4 5 6 7
satisfaction at work.
7. The organization shows very little concern for me. 1 2 3 4 5 6 7
8. The organization takes pride in my 1 2 3 4 5 6 7
accomplishments at work.

47
Part IV: Professional commitment questions (to be scored as follows)

Table 6 : professional commitment questionaries’ of professional commitment and

associated factor among health professionals in health facility of dire dawa, eastern
Ethiopia: a facility based cross sectional study,2021.

strongly disagree=1, disagree=2, neutral=3, agree=4 and strongly agree=5. please circle the
number that applies your current professional commitment level in front of each question/item

Strongly disagree

Strongly agree
Disagree

Neutral

Agree
Items

1 I am willing to put in a great deal of effort to 1 2 3 4 5

develop my profession beyond expected
2 I am a person who identifies strongly with my 1 2 3 4 5
profession
3 I would accept almost any type of job that related 1 2 3 4 5
to my profession to keep working beyond
expected from me
4 I am a person who feels strong ties with other 1 2 3 4 5
members of my profession
5 I am a person who is proud to belong to my 1 2 3 4 5
profession
6 My profession really inspires the very best in me 1 2 3 4 5
in the way of job performance.
7 I am extremely glad that I chose this profession 1 2 3 4 5
to work for ever in advance
8 I am a person who criticizes my profession 1 2 3 4 5
9 I am a person who considers my profession to be 1 2 3 4 5
important
10 I am a person who tries to hide belonging to my 1 2 3 4 5
profession

48
Part V Organizational commitment questionnaire (to be scored as follows)

Table 7: organizational commitment questionaries’ of professional commitment and

associated factor among health professionals in Health facility of Dire Dawa, Eastern
Ethiopia: A facility based cross sectional study,2021.

Strongly agree=7, agree=6, slightly agree=5, neutral=4, slightly disagree=3, disagree=2, and
strongly disagree=[Link] circle the number that applies your current organizational
commitment level in front of each question/item.
S.N.

Disagree
Strongly

Strongly
disagree

disagree
Slightly

Slightly
Neutral
Agree
agree

agree
1. I am willing to put in a great deal of effort 7 6 5 4 3 2 1
beyond that normally expected in order to
help this organization be successful
2. I talk up this organization to my friends as a 7 6 5 4 3 2 1
great organization to work for.
3. I would accept almost any type of job 7 6 5 4 3 2 1
assignment in order to keep working for this
organization
4. I find that my values and the organization's 7 6 5 4 3 2 1
values are very similar
5. I am proud to tell others that I am part of 7 6 5 4 3 2 1
this Organization
6. This organization really inspires the very 7 6 5 4 3 2 1
best in me in the way of job performance.
7. I am extremely glad that I chose this 7 6 5 4 3 2 1
organization to work for over others I was
considering at the time I joined.
8. I really care about the fate of this 7 6 5 4 3 2 1
organization.
9. For me this is the best of all possible 7 6 5 4 3 2 1
organizations for which to work.

49
የመረጃ መሰብሰቢያ መጠይቆች
ክፍል አንድ ፡ - የጥናቱ ተሳታፊ ግለሰቦች ምንነት የሚገልጹ ጥያቄዎች
ተ.ቁ. መጠይቆች ምርጫና ጥያቄ ዚለል

1. ጾታ 1. ሴት
2. ወንድ

2. እድሜ

3. የአሁን የትዳር ሁኔታ 1. ያገባ /ች /

3. አግብቶ የፈታ /ች /

2. ያላገባ /ች /
4. አግብቶ የሞተበት /ባት

4. የሚትሰራው ክፍለ 1. የዉስጥ ደዌ ክፍል

2. ሴርጂካል ክፍል
3. የፂኑ ህመምን ክፍል
4. ዋናው የቀዶ ህክምና
ክፍል
5. የአእምሮ ህመምን
ክፍል
6. የህፃናት ክፍል
7. የማዋለድና የማህፀን
ክፍል
8. የአይን ክፍል
9. ልማደኛ ህመምን
ክፍል
10. ተመላላሽ ህክምና
ክፍል

5. የተማሩት ሞያ ምን ይባላል

6. የትምህርት ደረጃዎ ምን ያህል ነው? 1. ዲፕሎማ

2. ዲግሪ
3. ድህረ ምረቃ

7. በዚህ የጤና ተቋም ውስጥ ለምን ያህል ጊዜ አገልግለዋል

አመታት

8. የሚኖሩበት አካባቢ ምን አይነት ነው? 1. ከተማ

2. ገጠር

9. ምን አይነት የጤና ተቋም ውስጥ ነው የሚሰሩት 1. ጤና ጣቢያ

2. ሆስፒታል

10. ምን አይነት ሥራ ነው የሚሰሩት 1. አስተዳደራዊ

2. አስተዳደራዊ ከሆኑ
ነገሮች ውጭ

11. የተጣራ ወርሃዊ ደሞዝዎ በብር ምን ያህል ነው

50
ክፍል ሁለት

በስራዎ ስለመርካቶ የሚመለከቱ ጥያቄዎች

አሁን እየሰሩ በሚገኙት ሥራ ቀጥሎ ከቀረቡ ነጥቦች አንጻር ምን ያህል ረክተዋል? እባክዎን ከእያንዳንዱ ጥያቄ ፊት ለፊት የእርስዎን
አቋም የሚወክለውን ቁጥር ያ ክብቡት፡፡ ነጥቦቹ የሚመዘኑበት ደረጃዎች እንደሚከተሉት ናቸው፡፡ 1. በጣም ረክቻለሁ፣ 2.
በመጠኑም ቢሆን ረክቻለሁ፣ 3. አሻሚ ነው፣ 4. በተወሰነ መልኩ አልረካሁም 5. በፍጹም አልረካሁም

አልረካሁም

አልረካሁም
በመጠኑም
ረክቻለሁ፣

ረክቻለሁ፣

በተወሰነ

በፍጹም
በጣም

አሻሚ

መልኩ
ቢሆን
1. ክፍያን በተመለከተ
1. የሚከፈለኝ ክፍያ ከምሰራው ሥራ ጋር ተመጣጣኝ ነው 1 2 3 4 5
2. በእረፍት ሰዓቴ ከሰራሁ ማካካሻ ይከፈለኛል 1 2 3 4 5
3. ስራዬ ከጉዳቱ ጥቅሙ ይበልጣል 1 2 3 4 5
2. የደረጃ እድገትን በተመለከተ
4 ተከታታይ ትምህርት እንድማር ድጋፍ ይደረግልኛል 1 2 3 4 5
5 የደረጃ እድገት እንዳገኝ በቂ እድል ይመቻችልኛል 1 2 3 4 5
6 በትምህርትና በስልጠና እራሴን እንዳሳድግና እንዳሻሽል 1 2 3 4 5
ድጋፍ ይደረግልኛል፡፡
3. እውቅናን በተመለከተ
7 በሥራ ወቅት ለማቀርበው አስተያየት ወይም ሀሳብ በቂ 1 2 3 4 5
ትኩረት ይሠጠኛል፡፡
8 በጥሩ ሁኔታ ላከናወንኳቸው ተግባራት ዕውቅና ይሰጠኛል 1 2 3 4 5
9 ግለሰባዊ ፍላጎቴ ከግንዛቤ ውስጥ ይገባል 1 2 3 4 5
4. ሞያዊ ስልጠናን በተመለከተ
10 ስልጠና የማግኘት ዕድል ይመቻችልኛል 1 2 3 4 5
11 የሚሰጡኝ ስልጠናዎች ሞያዊ የሥራ አፈፃፀሜን ለማሻሻል 5 4 3 2 1
የሚረዱኝ ናቸው
12 መሥሪያቤታችን ለአዳዲስ ሠራተኞች በቂ የሆነ የመግቢያ 5 4 3 2 1
ስልጠናና አቅጣጫዎች ይሰጣል
5. በራስ የመወሰን መብት በተመለከተ 5 4 3 2 1
13 ስራዬን እንዴት መስራት እንዳለብኝ የመወሰን ነፃነት አለኝ 5 4 3 2 1
14 ለወሰንኳቸው ውሳኔዎች ሙሉ ተጠያቂ የመሆን ድጋፍ 5 4 3 2 1
ይደረግልኛል
15 ሰራዎችን በራሴ አቅም የማከናውን ነፃነት ይሰጠኛል 5 4 3 2 1
6. በስራ ቦታዎ ከሰዎች ጋር ያለዎት ግንኙነትና የሥራ ቦታ 5 4 3 2 1
ሁኔታ በተመለከተ
16 ከሥራ ባልደርቦቼ ጋር ስራን በተመለከተ ጥሩ ግንኙነት አለን 5 4 3 2 1
17 በሥራ ቦታዬ ቀጥተኛና ግልፅ የመግባባት ሥርዐት አለኝ 5 4 3 2 1
18 ከሥራ ባልደረቦቼ ጋር በስራ ቦታ ጥሩ የመተጋገዝ መንፈስ 5 4 3 2 1
አለን
19 በአስተዳደርና በሰራተኛ መሀል ጥሩ የመተባበር መንፈስ 5 4 3 2 1
አለ
20 አስተዳደሩ በውሳኔ አሰጣጥ ሂደት ላይ ሰራተኛን ያሳትፋል 5 4 3 2 1
21 የስራ ቦታዬ የታካሚዎችን ፍላጎት ለማርካት ሞያዊ 5 4 3 2 1
ማስተካከያዎችን ለማድረግ ይመቻል
22 እያያዳንዳቸው ደንበኞች የማስተናግድበት በቂ ጊዜ አለኝ 5 4 3 2 1
23 በግብአት ዕጥረት ምክንያት ስራዬ ተ ደናቅፎ አያውቅም 5 4 3 2 1

51
ክፍል ሦስት

መሥሪያ ቤትዎ ያደርግልኛል ብለው ስለሚያስቡት ድጋፍ ያልዎት አስተያየት የሚለኩ ጥያቄዎች

እያንዳንዱ ነጥብ ከግምት ውስጥ በማስገባት በሚከተለው ደረጃ መሰረት የአርስዎን አቋም የሚወክለው አንዱ ቁጥር ያክብቡት በጣም
እስማማለሁ = 7፣ እስማማለሁ = 6፣ በጥቂቱ ተስማምቻለሁ = 5፣ ገለልተኛ አቋም = 4፣ በጥቂቱ አልስማማም = 3፣ አልስማማም =
2፣ በፍጹም አልስማማም = 1
ተ.ቁ.

አልስማማም

አልስማማም

አልስማማም
እስማማለሁ

እስማማለሁ

እስማማለሁ

ገለልተኛ

በፍጹም
በጥቂቱ

በጥቂቱ
በጣም
1 ለመስሪያ ቤቴ ደህነት የማበረክተው አስተዋፅኦ ዋጋ ይሰጠዋል 7 6 5 4 3 2 1
2 ለመሥራያ ቤቴ በተጨማሪነት የማበረከታቸው ጥረቶች 7 6 5 4 3 2 1
አይረዳልኝም
3 መሥራያ ቤቴ ለማቀርባቸው እሮሮዎች ቦታ አይሰጥም 7 6 5 4 3 2 1
4 መሥራያ ቤቴ ስለደህንነቴ ያስባል /ጥንቃቄ ያደርጋል) 7 6 5 4 3 2 1
5 ምንም እንኳን ስራዬን በተሻለ ሁኔታ ባክናውንም መስሪያ ቤቴ 7 6 5 4 3 2 1
ግን አያስተውለውም
6 መስሪያ ቤቴ በ አጠቃላይ በ ስራዬ እንድረካ እንክብካቤ 7 6 5 4 3 2 1
ያደርግልኛል
7 መስሪያ ቤቴ ለእኔ ያለው ትኩረት አናሳ ነው 7 6 5 4 3 2 1
8 መስሪያ ቤቴ ስራን በትክክል በማ ከናወን ችሎታዬ 7 6 5 4 3 2 1
ይተማመንብኛል

52
ክፍሌ አራት

ለሙያ ያለሇዎት ቁርጠኝነት ደረጃን የሚለኩ ጥያቄዎች

እባክዎ ለሙያዎ ያለሆዎት ቁርጠኝነ ደረጃን የሚያመለክተውን አንደን አማራጭ ከጥያቄው ቁጥር ፊት ለፊት እንደማከተለው ከተሰጡት
ቁጥሮች አንደን በማክበብ ይተባበሩን በፍጹም አሌስማማም = 1 ፤ አሌስማማም = 2፤ ገለልተኛ አቋም =3፤ እስማማሇሁ = 4፣
በጣም እስማማሇሁ = 5
ተ. መጠይቆች

እስማማሇ

እስማማሇ
አሌስማማ

አሌስማማ
ቁ

በፍጹም

ገሇሌተኛ

በጣም
ም

ሁ
1 ለሙያዬን ለማሳደግ ከሚጠበቅብኝ በሊይ በፍላጐት እጥራሇሁ 1 2 3 4 5
2 በሙያዬ የምገለፅ ወይም ለሙያ የሚገሌፀኝ ጠንካራ ሰዉ ነኝ 1 2 3 4 5
3 ከሙያዬ ጋር የተያያዘ የትኛውም ስራ ሲሰጠኝ በመቀበሌ ከሚጠበቅብኝ 1 2 3 4 5
በሊይ እሰራሇሁ
4 ከላሊ የሙያ ባሌደረቦቼ ጋር ጥብቅ ቁርኝት እንዲለኝ ይሰማኛሌ 1 2 3 4 5
5 በሙያዬ የምኮራ ሰው ነኝ (በያዝኩት ሙያ አባሌ ስለሆንኩ) 1 2 3 4 5
6 ለስራ አፈፃፀሜ፤ ሙያዬ እጅግ በጣም ያነሳሳኛሌ 1 2 3 4 5
7 ሁሌጊዜ በዚህ ሙያ መስራት ምርጫዬ ስለሆነ እጅግ በጣም እኮራለሁ 1 2 3 4 5
8 ሙያዬን የምነቅፍና የማዋርዴ ሰው ነኝ 1 2 3 4 5
9 ሙያዬ ጠቃሚ እንደሆነ የምገነዘብ ሰው ነኝ 1 2 3 4 5
10 በዚህ ሙያ ውስጥ መሆኔን የምደብቅ ሰው ነኝ 1 2 3 4 5

53
ክፍል አምስት

ለመሥሪያ ቤትዎ ያለዎት ቁርጠኝነት ደረጃ የሚለኩ ጥያቄዎች

እባክዎ ለመስሪያ ቤትዎ ያለዎትን ቁርጠኝነት ደረጃ የሚያመለክተውን አንዱን አማራጭ ከጥያቄው ቁጥር ፊት ለፊት እንደሚከተለው
ከተሰጡት ቁጥሮች አንዱን በማክበብ ይተባባሩን በጣም እስማማለሁ = 7፣ እስማማለሁ = 6፣ በጥቂቱ ተስማምቻለሁ = 5፣
ገለልተኛ አቋም = 4፣ በጥቂቱ አልስማማም = 3፣ አልስማማም = 2 በፍጹም አልስማማም = 1

አልስማማም
አልስማማም

አልስማማም
እስማማለሁ
እስማማለሁ

እስማማለሁ

ገለልተኛ

በፍጹም
በጥቂቱ

በጥቂቱ
በጣም
1 ይህ መስሪያ ቤት ውጤታማ እንዲሆን ዘወትር ከሚጠበቅብኝ ተግባር 7 6 5 4 3 2 1
በተጨማሪ የበለጠ አሰተዋፅኦ ለማበርከት ፍቃ ደኛ ነኝ
2 ይህ መስሪያ ቤት ለስራ የሚመች ትልቅ መስሪያ ቤት መሆኑን ለጓደኞቼ 7 6 5 4 3 2 1
አወራለሁ
3 በዚህ መስሪያ ቤት ውሰጥ እየሰራሁ መቀጠል ስለምፈልግ የሚሰጡኝን 7 6 5 4 3 2 1
ማንኛቸውንም አይነት የቤት ስራዎች እቀበላለሁ
4 የመስሪያ ቤቴንና የራሴ እሴቶች አንድ ሆኖ አግኝቼዋለሁ 7 6 5 4 3 2 1
5 የዚህ መስሪያት ቤት አካል መሆኔን ለሌሎች ሳወራ ኩራት ይሰማኛል 7 6 5 4 3 2 1
6 ይህ መስሪያ ቤት የተሻለ የሥራ አፈፃፀም እንዲኖረኝ ያበረታታኛል /ይረዳኛል/ 7 6 5 4 3 2 1
7 ይህ መስሪያ ቤት ሥቀላቀል ከሌሎች ተቋማት የተሻለ አድርጌ መርጬው 7 6 5 4 3 2 1
በመቀላቀሌ ደስተኛ ነኝ
8 ስለዚህ ተቋም እጣፈንታ ሁሌም ከውስጤ ያሳስበኛል 7 6 5 4 3 2 1
9 ለእኔ ይህ ተቋም ካሉት ጤና ተቋማት ሁሉ የተሻለ የጤና ተቋም ነው 7 6 5 4 3 2 1

54
Curriculum vitae
Tel:+251940871543 E-mail: yoomiiyos@[Link]

1. Personal Information

 Name : Yusuf Remedan Alemu

 Age 27

 Sex : Male

 Date of Birth : February 13, 1991 G.C

 Place of Birth : Chelenko

 Marital status : Single

 Nationality : Ethiopian

 Language skills : Excellent in Afan Oromo, Amharic and English

2. Educational Background

s.n Level School/university Year Award

1 Elementary Goro Muti primary school 1996 –

2003G.C

2 High school & Chelenko senior secondary 2004 – 2007

preparatory and preparatory school G.C

3 University Wollega University health 2008 – 2011 Bsc in

science college G.C Professional
Midwife

55
 3. Trainings and Work Shops Attended

 Training on midwife Mentoring

 Covid-19 training for Health worker using online mobile application platform developed by
FEDERAL MINISTRY OF HEALTH (FMOH) and Ethiopian Public Health Institute (EPHI)
supported by community health Academy-last mile Health using oppia mobile +app technology
which Include

 Guidance on covid-19 prevention and control measure in school setting

 Home based Isolation and care for Covid-19 patient
 Surveillance
 Guidance for professional health worker in primary health care setting
 Covid-19 clinical case management
 Covid-19 epidemiological surveillance
 Infection prevention and control training on novel corona virus
 Laboratory testing for Covid-19 in suspected human case
 Risk communication and community engagement

 Professional certificate of competency senior midwifery professional

 Training on public health emergency management (PHEM)

 Training on BEMONC (basic emergency obstetric and newborn care)

 Training of online English language writing skills

 Training of English for academic purpose

4. Computer Skills

S.n Application program Statistical package software

1 Microsoft word SPSS

2 Microsoft Excel, MS-Access Epi-info

3 Microsoft power point Epi DATA

4 Basic window operating system STATA

56
Dire Dawa city administration health Bureau

Name of All health center and Hospital found in dire dawa

Hospital

1. Dil chora Hospital

2. Sabian Hospital

Urban Health canter

1. Goro Health centre

2. Ganda Qoree Health center

3. Addis Ketema

4. Dechatu Health center

5. Laga Hare Health Center

6. Genda Garada Health center

7. Dire Dawa Health center

8. Malka Jabdu Health Center

Rural Health Center

1. Jaldesa Health Center

2. Malka Qaroo Health center

3. Biyo Awale Health center

4. Qalicha Health Center

5. Wahil Health center

6. Laga Odaa Health Center

7. Jalloo ballina Health Center

57
Name of selected Hospital and Health center

from Dire Dawa city administration health Bureau

Hospital

1. Dilchora hospital

2. Health center

Urban Health Center

1. Dechatu Health center

2. Addis Ketema Health center

3. Laga hare Health center

4. Dire Dawa Health Center

Rural Health center

1. Ganda Qore Health center

2. Biyo awale Health center

3. Laga Oda Health Center

58