Motivational determinants of frontline health extension workers in East Hararge Zone, Ethiopia: implications for primary health care systems in low-resource settings

We found a relatively high motivation among HEWs in East Hararge compared to other regions in Ethiopia and Africa. Both intrinsic and extrinsic motivators identified play a key role in shaping the motivation levels of HEWs. To enhance worker motivation and productivity in the primary health care system, policymakers and health sector authorities need to implement targeted and evidence-based strategies, including structured career development pathways, performance-based incentives, strong collegial knowledge and skill sharing schemes, and decision-making autonomy.