Facilitators and Barriers to Continuing Professional Development Implementation in Healthcare in Ethiopia: Insights from Stakeholders, 2024

Facilitators and Barriers to Continuing Professional Development Implementation in Healthcare in Ethiopia: Insights from Stakeholders, 2024 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Facilitators and Barriers to Continuing Professional Development Implementation in Healthcare in Ethiopia: Insights from Stakeholders, 2024 Tolera Garamu, Ewnetu Genet, Lami Bayisa, Tegene Arega, Assegid Samuel, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8476608/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Background Continuing Professional Development (CPD) is critical for enhancing the quality of healthcare services. In Ethiopia, the engagement of healthcare professionals in CPD has been hindered by various challenges, including limited institutional support, financial constraints, and systemic barriers. This study explores these barriers and facilitators of CPD participation in Ethiopia’s healthcare system. Methods The study employed a phenomenological qualitative design with 15 key informant interviews and six focus group sessions. To guarantee a thorough view, information was gathered from a wide range of stakeholders in both urban and rural Ethiopia, including healthcare providers and regulatory agencies. Results Non flexible work schedules, inadequate institutional support, and disparities between urban and rural areas in CPD accessibility were challenges for CPD implementation. Healthcare professional particularly those are practicing in rural areas faced barriers related to limited resources, inadequate infrastructure, and insufficient financial support. Weak enforcement of CPD policies, and attempts of forging certificate were some of the challenges leading to undermining integrity of CPD systems. However, advocacy efforts and increasing awareness have led to some improvements in CPD participation, particularly in urban areas. Conclusion Effective CPD engagement in Ethiopia requires strengthened institutional support, better communication, and enhanced oversight from accrediting bodies. Addressing the disparities between urban and rural regions and improving regulatory frameworks will be crucial in ensuring that CPD contributes meaningfully to the professional development of healthcare providers and the improvement of healthcare quality in Ethiopia. Barrier Continuing Professional Development Ethiopia Health care Facilitator Stakeholder 1. Introduction Globally, CPD recognized as a fundamental element in maintaining and enhancing the skills and knowledge of healthcare professionals (1,2). CPD is essential for ensuring that practitioners, stay current with evolving medical practices, and effectively respond to the dynamic health care needs of the society (4). Effective CPD must be tailered to address gaps in knowledge, skill and attitudes, inline with health proffestionals role and area of practice (3). In many countries, CPD is a mandatory requirement for medical practitioners, with professional required to accumulate CPD credits for certification or licensure renewal (5). Role of government with stakeholder engagement is important for effective CPD program. However, challenges such as low motivation, financial constraints, and poor working conditions noted in CPD activities. In high-income countries, barriers like lack of time and inflexible requirements also hinder healthcare professionals from engaging in CPD (6). In Ethiopia despite of CPD importance, its utilization is low, with reports indicating a participation rate of just 32.97% in Eastern Ethiopia (7). CPD implementation varies significantly across Ethiopia's regions, with unclear reasons for this variation. To address this gap, it is important to identify barriers and facilitators influencing CPD success. This qualitative study explores stakeholders' lived experiences with CPD in Ethiopia to offer insights for policymakers and implementers. These findings aim to guide tailored interventions that enhance CPD participation and strengthen the health workforce's capacity to deliver quality care. 2. Methods We have conducted the study in 14 regions of Ethiopia, including two City Administration, from May 13 to June 30, 2024. We have employed phenomenological study design to explore the lived experiences of CPD stakeholders, including facilitators, barriers and challenges of CPD implementation. Facility leaders and individuals who are willing to participate and those who gave consent to voice recording were included in the study while individuals with a special interest in the research outcomes were excluded. Dependent variable for the study was implementation of CPD while several independent variables. We have purposively slected 15 key informants and 6 FGDs including for eleven professionals cadres holding Bachelor Degree with speciality. We ensured diversity in profession, gender, and experience, and determined the sample size based on data saturation. We used a semi-structured interview guide with probing questions, developed in English, translated into Amharic, and pretested (1, 10, and 21). We trained data collectors and supervisors. Interviews were audio-recorded, transcribed in Amharic, and translated into English for analysis. We applied thematic analysis, transcribing interviews verbatim and checking them against the recordings. Two researchers coded the data independently, discussed differences, and organized findings into key themes. We triangulated perspectives to strengthen the conclusions. To ensure trustworthiness, we followed credibility, transferability, dependability, and confirmability criteria, provided detailed contextual descriptions, and used participant quotes to support themes. We obtained informed consent after explaining benefits, risks, and discomforts. Ethical clearance came from the Ethiopian Medical Association IRB (EMA0054.01), Johns Hopkins University IRB, and the Ministry of Health. We protected privacy and confidentiality by conducting interviews in private settings. Participation was voluntary, and participants were informed of their right to refuse or withdraw at any time. 3. Result 3.1 Participant Characteristics A total of 15 key informants participated in the KIIs, with a mean age of 39 years (SD ± 5.24), a median age of 35 years, and an age range of 34–45 years. Six FGDs were conducted with 59 participants, whose mean age was 32.46 years (SD ± 6.42) and median age was 32 years. 3.2 Perceptions and Value of CPD Healthcare professionals expressed mixed perceptions regarding the value of CPD. While some participants recognized CPD as essential for maintaining competence, updating clinical skills, and improving patient care, many viewed it primarily as a regulatory requirement linked to license renewal rather than a meaningful professional development opportunity. “Perceptions of CPD vary based on individual experience, education, and background. Some view it as a financial burden linked to licensing rather than a benefit” (FGD, Amhara Region). Participants who valued CPD emphasized its role in improving quality of care and keeping pace with evolving medical practices. “CPD is essential for our development; it ensures we stay updated with the latest medical practices and improve our patient care” (FGD, Addis Ababa). However, many professionals questioned the tangible benefits of CPD for career progression, particularly when programs were generic or poorly aligned with their daily clinical responsibilities. “We know CPD is important, but sometimes it feels disconnected from our daily work” (FGD, Oromia). Specialists and sub-specialists were more likely to question the necessity of CPD, citing their advanced training and perceived sufficiency of existing knowledge. “They claimed that they are highly educated or sufficiently knowledgeable, particularly referring to specialists and sub-specialists” (KII, Regional Health Bureau). 3.3 Accessibility, Equity, and Regional Disparities Access to CPD opportunities varied widely across regions, with pronounced disparities between urban and rural areas and between public and private sectors. Limited numbers of CPD centers, particularly in remote regions, forced professionals to travel long distances, often at significant personal cost. “The lack of nearby CPD centers forced us to travel long distances, which was often not feasible due to time and financial constraints” (FGD, Amhara Region). Economic barriers, including registration fees and travel expenses, further constrained participation, especially in underserved regions. “The financial burden of CPD activities… often prevented many of us from participating” (FGD, Afar Region). Participants also noted that many CPD programs were overly generic and failed to address specialized or context-specific challenges. “Many CPD programs were too generic and did not address the specific challenges we faced in our specialized fields” (FGD, Oromia Region). 3.4 Digital CPD: Opportunities and Limitations The shift toward digital and online CPD was widely recognized as a positive development, particularly for professionals in remote and underserved areas. Participants highlighted the convenience and reduced need for travel. “Online CPD modules made it easier to participate without the need to travel” (FGD, SNNPR). “Digitization has been a game-changer, enabling professionals in even the most remote areas to access CPD opportunities” (KII, Dire Dawa). Despite these benefits, unreliable internet connectivity, lack of digital skills, and limited technical support remained major barriers, particularly in rural regions. “In rural regions, unreliable internet access limited our ability to engage with online CPD resources” (FGD, Somali Region). The continued reliance on face-to-face training further restricted access for professionals in isolated areas. Participants emphasized the need for hybrid CPD models, improved digital infrastructure, and local support centers equipped with internet access and devices. 3.5 Institutional Support, Leadership, and Governance Institutional commitment to CPD varied considerably. Some participants reported supportive leadership and established structures that facilitated CPD implementation. “Our leaders are supportive, and there is a strong foundation for CPD” (FGD, Addis Ababa). However, others noted weak enforcement of CPD requirements and inconsistencies between public and private sectors, with private institutions often enjoying greater flexibility. “The private sector often had more flexibility, creating an imbalance” (FGD, Amhara Region). Although formal CPD frameworks and guidelines existed in many institutions, their implementation was inconsistent, particularly in regions with limited resources. “Even though there was a framework, it was not always effective in our area due to limited resources and support” (FGD, Somali Region). 3.6 Regulation, Accreditation, and Accountability Weak regulatory enforcement and inconsistent oversight emerged as critical challenges. Informants reported widespread concerns about forged CPD certificates and license renewals, attributed to poor monitoring and inadequate legal frameworks. “Despite the arrest of over 45 professionals for license forgery, they were quickly released due to the lack of enforceable legal rules” (KII, RHB Regulatory, Addis Ababa). Accrediting bodies were perceived as inconsistently fulfilling their roles, sometimes issuing licenses without adequately verifying CPD compliance. “There is a rumor that some accreditors simply provide licenses without checking requirements” (KII, RHB Regulatory, Addis Ababa). 3.7 Resource Constraints: Time, Funding, and Human Capacity Time constraints, heavy workloads, and competing clinical responsibilities were major barriers to CPD participation. “Competing priorities make it challenging to stay committed to CPD” (FGD, Addis Ababa). Shortages of qualified trainers and limited financial resources further undermined CPD quality and sustainability, particularly in peripheral regions. “We face challenges due to a shortage of qualified trainers” (KII, Amhara Region). “Our CPD programs are limited by the small budgets allocated” (KII, Tigray). Although some regions successfully secured external funding, reliance on donor support raised concerns about long-term sustainability. 3.8 Engagement, Motivation, and Communication CPD engagement was often driven by external pressures such as license renewal rather than intrinsic motivation for learning. Many participants reported limited institutional communication and reliance on professional associations or social media for CPD information. “Rather than hearing about CPD from our hospital directors, we hear it from social media” (FGD, Somali Region). Lack of awareness about activities that could count toward CPD further reduced engagement. “We do rounds every day and mentor students, but none of these are registered as CEU because we were not aware” (FGD, Harar Region). 4. Discussion This study highlights the persistent structural, institutional, and individual-level challenges that affect the implementation and utilization of Continuing Professional Development (CPD) among healthcare professionals in Ethiopia. Although CPD is formally recognized as essential for maintaining competence and improving quality of care, its practical implementation remains fragmented and inequitable across regions, professions, and sectors. Ethiopian CPD is designed to support patient safety, professional competence, and lifelong learning in accordance with national CPD rules and directives released by the Federal Ministry of Health (FMoH) [ 1 , 2 ]. However, the results of this study show that many healthcare professionals view continuing professional development (CPD) more as a legal requirement for license renewal than as an important educational activity. Similar attitudes have been documented in research from Ethiopia and other low- and middle-income nations, where involvement in CPD is frequently motivated more by external factors than by internal ones [ 3 , 8 , 15 ]. The instructional value of CPD is undermined and its potential impact on healthcare quality is limited by this mismatch between policy purpose and professional experience. Workload pressure, competing clinical responsibilities, and rigid scheduling were major barriers to CPD participation. These constraints are widely documented in both African and global contexts, where healthcare workforce shortages and high service demands restrict opportunities for structured learning [ 9 , 11 , 19 ]. In Ethiopia, such challenges are compounded by limited funding, weak planning mechanisms, and inefficient utilization of human and financial resources, resulting in inadequate institutional support for CPD activities. Similar findings have been reported among pharmacists, nurses, and physicians, where lack of protected time and organizational support significantly minimized CPD engagement [ 10 , 15 , 16 ]. Marked disparities between urban and rural settings were observed in CPD access and participation. Rural healthcare professionals faced additional challenges related to geographic isolation, limited infrastructure, poor internet connectivity, and the absence of local CPD centers. These findings align with evidence from rural CPD studies, which demonstrate that lack of logistical and institutional support exacerbates inequities in professional development opportunities [ 11 , 12 ]. Such disparities reflect broader systemic weaknesses within the health system and contribute to uneven quality of care across regions. The study also revealed significant concerns regarding CPD governance, regulation, and accountability. Weak monitoring systems, inconsistent enforcement of CPD requirements, and limited regulatory oversight have contributed to malpractice, including fake CPD certificates and license renewals. Similar challenges have been documented in other African contexts, where inadequate regulatory frameworks compromise the credibility and effectiveness of CPD systems [ 11 , 18 ]. Without robust accountability mechanisms, CPD risks losing professional trust and failing to achieve its intended outcomes. Digital CPD emerged as a promising strategy to improve access, particularly for professionals in remote and under served areas. Participants highlighted the flexibility and convenience of online and mobile learning platforms, which allow self-paced learning and reduce travel-related barriers. This finding is consistent with international evidence demonstrating that digital and blended CPD models enhance accessibility, learner autonomy, and participation [ 4 , 6 , 19 , 20 ]. However, persistent challenges related to unreliable internet connectivity, outdated technology, and a lack of technical support limit the effectiveness of digital CPD in rural Ethiopia. Addressing these gaps is paramount for the equitable scale-up of digital learning solutions. Motivational factors also played a critical role in CPD engagement. Encouragement from supervisors, peer collaboration, recognition through certification, and opportunities for career advancement were identified as strong enablers of participation. These findings are supported by literature highlighting the significance of leadership support, professional recognition, and organizational culture in sustaining CPD engagement [ 14 , 16 , 17 ]. In contrast, limited institutional communication and reliance on professional associations or social media for CPD information reflect weak organizational ownership of CPD implementation. Financial sustainability remains precarious, as CPD programs in several regions depend heavily on donor funding. While external aid has enabled short-term program expansion, reliance on donor support introduces vulnerability to shifting priorities and endangers long-term continuity. Similar challenges have been observed in donor-dependent health programs across low-resource settings, underscoring the need for stronger domestic financing and integration of CPD into routine health system budgets [ 13 , 18 ]. Strengths and Limitations This study provides valuable insights into the barriers and facilitators of CPD engagement in Ethiopia. The inclusion of participants from diverse regions allowed for a comprehensive understanding of regional disparities. However, the reliance on self-reported data may introduce recall bias. Additionally, the study primarily involved experienced healthcare professionals, potentially limiting the perspectives of less-experienced individuals. Future research should include a broader demographic to capture varied experiences. Conclusion This study identified significant barriers to CPD participation in Ethiopia, including time constraints, resource limitations, governance challenges, and urban-rural disparities. However, the findings also highlight opportunities to enhance CPD engagement through institutional support, technological innovations, and targeted investments. Addressing these barriers while leveraging facilitators can create a sustainable CPD framework that improves healthcare professionals' competencies and, ultimately, patient outcomes. Declarations Ethical approval and consent to participate The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki and obtained ethical approval from the Ethiopian Medical Association Institutional Review Board (Ref: EMA0054.01), the Johns Hopkins University Institutional Review Board, and the Ministry of Health. All participants provided informed consent after receiving a comprehensive briefing on the study's purpose, potential risks, and benefits. To protect privacy, interviews were conducted in secure, private settings where confidentiality could be strictly maintained. Participation was entirely voluntary, and all individuals were informed of their right to withdraw from the study at any time without penalty. Consent for publishing ‘Not Applicable’ Competing interests There are no competing interests among the authors. Availability of data and materials Data and materials are available and can be shared by the corresponding author. Funding No funding was obtained for this study. Authors’ contributions Design and conception of the study: TG, EG, and AS; Performed the study: TG, AD, LB, TA, TT, and NT; Data analysis and interpretation: AD, TG, EG, TT, and TA; Writing of the manuscript: AD, TG; All the authors have read and approved the final manuscript. Acknowledgment We acknowledge Ministry of Health, Wollega University, Gondar University, Jhpiego-Ethiopia, Menelik II Medical and Health Sciences College, and Adama Hospital Medical College. Authors’ Information TG: Ministry of Health, HRD, Addis Ababa, Ethiopia; E-mail: [email protected] EG: Ministry of Health, HRD, Addis Ababa, Ethiopia; E-mail: [email protected] LB: Wollega University, Institute of Health Science, CPD Director, Nekemte, Ethiopia; E-mail: [email protected] TA: Ministry of Health, CPD Desk, Addis Ababa, Ethiopia; E-mail: [email protected] AS: Ministry of Health, Human Resource Development & Improvement LEO, Addis Ababa, Ethiopia; E-mail: [email protected] TA: Gondar University, Gondar, Ethiopia, E-mail: [email protected] TT: Jhpiego-Ethiopia, Addis Ababa, Ethiopia; E-mail: [email protected] NT: Menelik II Medical and Health Sciences College, Addis Ababa, Ethiopia; E-mail: [email protected] AD : Adama Hospital Medical College, Department of Public Health, Ethiopia; Mobile phone: +251911069074; E-mail: [email protected] References Federal Ministry of Health Ethiopia. Continuing Professional Development (CPD) Guideline for Health Professionals in Ethiopia. Addis Ababa, Ethiopia: Federal Ministry of Health; 2018. Federal Ministry of Health Ethiopia. Continuing Professional Development (CPD) Directive for Health Professionals in Ethiopia. Addis Ababa, Ethiopia: Federal Ministry of Health; 2018. Yadeta TA, Mohamed A, Behir K, et al. Knowledge, perceived needs of continuous professional development, and associated factors among healthcare workers in East Ethiopia: a multi-health facility-based cross-sectional study. BMC Med Educ. 2024;24:497. doi:10.1186/s12909-024-05486-z. Filipe HP, Silva ED, Stulting AA, Golnik KC. Ophthalmic education update: continuing professional development, best practices. Middle East Afr J Ophthalmol. 2014;21(2):134-141. doi:10.4103/0974-9233.129760. Karas M, Sheen NJL, North RV, et al. Continuing professional development requirements for UK health professionals: a scoping review. BMJ Open. 2020;10:e032781. doi:10.1136/bmjopen-2019-032781. Drude KP, Maheu M, Hilty DM. 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Continuing professional development engagement: a UK-based concept analysis. J Contin Educ Health Prof. 2019;39(4):260-268. doi:10.1097/CEH.0000000000000245. Ikenwilo D, Skatun D. Perceived need and barriers to continuing professional development among doctors. Health Policy. 2014;117(2):195-202. doi:10.1016/j.healthpol.2014.04.006. Manley K, Martin A, Jackson C, Wright T. A realist synthesis of effective continuing professional development (CPD): a case study of healthcare practitioners' CPD. Nurse Educ Today. 2018;69:134-141. doi:10.1016/j.nedt.2018.07.010. Martha J. Relationship between participation in formal continuous professional development, job satisfaction, and attitude towards patient care among nurses in Embu County [thesis]. University of Nairobi; 2019. Merry L, Castiglione SA, Rouleau G, et al. Continuing professional development (CPD) system development, implementation, evaluation, and sustainability for healthcare professionals in low- and lower-middle-income countries: a rapid scoping review. BMC Med Educ. 2023;23:498. doi:10.1186/s12909-023-04427-6. Mustapa MBH, Teo YC, Haji-Abdul-Rahman HK, Abdul-Mumin KH, Abdul Rahman H. Enablers and barriers of continuous professional development (CPD) participation among nurses and midwives. Int J Nurs Educ. 2021;13(3). doi:10.37506/ijone.v13i3.16315. Petersen JA, Bray L, Ostergaard D. Continuing professional development (CPD) for anesthetists: a systematic review. Acta Anaesthesiol Scand. 2023;68(1):2-15. doi:10.1111/aas.14306. Anwara SU, Nmecha CE, Moses EA, Okarekpe E, Mgbeojedo UG, Ekechukwu END, et al. Attitudes and barriers towards continuing professional development among physiotherapists in South-Eastern Nigeria. Afr J Health Sci Technol. 2020;2(1):97-105. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 13 Apr, 2026 Reviews received at journal 13 Apr, 2026 Reviewers agreed at journal 14 Feb, 2026 Reviewers invited by journal 29 Jan, 2026 Editor assigned by journal 29 Jan, 2026 Editor invited by journal 20 Jan, 2026 Submission checks completed at journal 19 Jan, 2026 First submitted to journal 19 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8476608","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":582280030,"identity":"ddaada51-8522-45fb-b294-6ae9b0136eef","order_by":0,"name":"Tolera Garamu","email":"","orcid":"","institution":"Ministry of Health","correspondingAuthor":false,"prefix":"","firstName":"Tolera","middleName":"","lastName":"Garamu","suffix":""},{"id":582280034,"identity":"c1bba7ea-b09d-45a8-9c6c-b21f0ec43e0d","order_by":1,"name":"Ewnetu Genet","email":"","orcid":"","institution":"Ministry of Health","correspondingAuthor":false,"prefix":"","firstName":"Ewnetu","middleName":"","lastName":"Genet","suffix":""},{"id":582280037,"identity":"06ad1ca7-14ca-47d1-92e3-af8dcc78b094","order_by":2,"name":"Lami Bayisa","email":"","orcid":"","institution":"Wollega University","correspondingAuthor":false,"prefix":"","firstName":"Lami","middleName":"","lastName":"Bayisa","suffix":""},{"id":582280038,"identity":"22bc8175-7147-4945-a707-1de547c27cd2","order_by":3,"name":"Tegene Arega","email":"","orcid":"","institution":"Ministry of Health","correspondingAuthor":false,"prefix":"","firstName":"Tegene","middleName":"","lastName":"Arega","suffix":""},{"id":582280040,"identity":"cce855ed-8b4b-4c13-abf6-e6a72200a615","order_by":4,"name":"Assegid Samuel","email":"","orcid":"","institution":"Ministry of Health","correspondingAuthor":false,"prefix":"","firstName":"Assegid","middleName":"","lastName":"Samuel","suffix":""},{"id":582280041,"identity":"ba5a0918-4fc6-4eb4-8e88-a33439130441","order_by":5,"name":"Tarekegn Asemaw","email":"","orcid":"","institution":"Gondar University","correspondingAuthor":false,"prefix":"","firstName":"Tarekegn","middleName":"","lastName":"Asemaw","suffix":""},{"id":582280043,"identity":"48236a43-9f21-4d2b-aa3d-5f078620a8cb","order_by":6,"name":"Trhas Tadesse","email":"","orcid":"","institution":"Jhpiego-Ethiopia","correspondingAuthor":false,"prefix":"","firstName":"Trhas","middleName":"","lastName":"Tadesse","suffix":""},{"id":582280044,"identity":"57db75d9-f739-4c58-acbf-8e3648ed0784","order_by":7,"name":"Nebiyou Tafesse","email":"","orcid":"","institution":"Menelik II Medical and Health Sciences College","correspondingAuthor":false,"prefix":"","firstName":"Nebiyou","middleName":"","lastName":"Tafesse","suffix":""},{"id":582280046,"identity":"d24f8cdd-80b7-49b7-a73c-4cfa09cb2573","order_by":8,"name":"Alem Deksisa","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA30lEQVRIiWNgGAWjYDACdiDmATMagISBBRFamGFaeA6AtEiQokUiAUwS1sHfzHxM4m1bbR7/zOdXN/wokGDgb+9OwKtF4jBbsuHctuPFErdzym72AB0mcebsBvzWHOYxfMzbdiyx4XZO2g0eoBYDiVz8WuQP8384DNIy/+aZtJt/iNFicJiHEWhLTeKGG+zHbhNli+FhNmPDOecOJG48k8N2W8ZAgoegX+SONz+TeFNWlzjv+PFnN9/8sZHjb+8l4H0IOAzEPAYgFg8xykGgDojZHxCrehSMglEwCkYYAABFukoc67TQSgAAAABJRU5ErkJggg==","orcid":"","institution":"Adama Hospital Medical College","correspondingAuthor":true,"prefix":"","firstName":"Alem","middleName":"","lastName":"Deksisa","suffix":""}],"badges":[],"createdAt":"2025-12-30 02:23:37","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8476608/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8476608/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":101754091,"identity":"3eded059-6f21-434b-8d2b-5a79c8ab1ad7","added_by":"auto","created_at":"2026-02-03 10:41:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":625448,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8476608/v1/8f4457fb-63e8-4ae4-bbc0-8333548d86dd.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Facilitators and Barriers to Continuing Professional Development Implementation in Healthcare in Ethiopia: Insights from Stakeholders, 2024","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eGlobally, CPD recognized as a fundamental element in maintaining and enhancing the skills and knowledge of healthcare professionals (1,2). CPD is essential for ensuring that practitioners, stay current with evolving medical practices, and effectively respond to the dynamic health care needs of the society (4). Effective CPD must be tailered to address gaps in knowledge, skill and attitudes, inline with health proffestionals role and area of practice (3).\u003c/p\u003e \u003cp\u003eIn many countries, CPD is a mandatory requirement for medical practitioners, with professional required to accumulate CPD credits for certification or licensure renewal (5). Role of government with stakeholder engagement is important for effective CPD program. However, challenges such as low motivation, financial constraints, and poor working conditions noted in CPD activities. In high-income countries, barriers like lack of time and inflexible requirements also hinder healthcare professionals from engaging in CPD (6).\u003c/p\u003e \u003cp\u003eIn Ethiopia despite of CPD importance, its utilization is low, with reports indicating a participation rate of just 32.97% in Eastern Ethiopia (7).\u003c/p\u003e \u003cp\u003eCPD implementation varies significantly across Ethiopia's regions, with unclear reasons for this variation. To address this gap, it is important to identify barriers and facilitators influencing CPD success. This qualitative study explores stakeholders' lived experiences with CPD in Ethiopia to offer insights for policymakers and implementers. These findings aim to guide tailored interventions that enhance CPD participation and strengthen the health workforce's capacity to deliver quality care.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003eWe have conducted the study in 14 regions of Ethiopia, including two City Administration, from May 13 to June 30, 2024. We have employed phenomenological study design to explore the lived experiences of CPD stakeholders, including facilitators, barriers and challenges of CPD implementation.\u003c/p\u003e \u003cp\u003eFacility leaders and individuals who are willing to participate and those who gave consent to voice recording were included in the study while individuals with a special interest in the research outcomes were excluded.\u003c/p\u003e \u003cp\u003eDependent variable for the study was implementation of CPD while several independent variables. We have purposively slected 15 key informants and 6 FGDs including for eleven professionals cadres holding Bachelor Degree with speciality. We ensured diversity in profession, gender, and experience, and determined the sample size based on data saturation. We used a semi-structured interview guide with probing questions, developed in English, translated into Amharic, and pretested (1, 10, and 21). We trained data collectors and supervisors. Interviews were audio-recorded, transcribed in Amharic, and translated into English for analysis. We applied thematic analysis, transcribing interviews verbatim and checking them against the recordings. Two researchers coded the data independently, discussed differences, and organized findings into key themes. We triangulated perspectives to strengthen the conclusions. To ensure trustworthiness, we followed credibility, transferability, dependability, and confirmability criteria, provided detailed contextual descriptions, and used participant quotes to support themes.\u003c/p\u003e \u003cp\u003eWe obtained informed consent after explaining benefits, risks, and discomforts. Ethical clearance came from the Ethiopian Medical Association IRB (EMA0054.01), Johns Hopkins University IRB, and the Ministry of Health. We protected privacy and confidentiality by conducting interviews in private settings. Participation was voluntary, and participants were informed of their right to refuse or withdraw at any time.\u003c/p\u003e"},{"header":"3. Result","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Participant Characteristics\u003c/h2\u003e \u003cp\u003eA total of 15 key informants participated in the KIIs, with a mean age of 39 years (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;5.24), a median age of 35 years, and an age range of 34\u0026ndash;45 years. Six FGDs were conducted with 59 participants, whose mean age was 32.46 years (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;6.42) and median age was 32 years.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Perceptions and Value of CPD\u003c/h2\u003e \u003cp\u003eHealthcare professionals expressed mixed perceptions regarding the value of CPD. While some participants recognized CPD as essential for maintaining competence, updating clinical skills, and improving patient care, many viewed it primarily as a regulatory requirement linked to license renewal rather than a meaningful professional development opportunity.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;Perceptions of CPD vary based on individual experience, education, and background. Some view it as a financial burden linked to licensing rather than a benefit\u0026rdquo; (FGD, Amhara Region).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eParticipants who valued CPD emphasized its role in improving quality of care and keeping pace with evolving medical practices.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;CPD is essential for our development; it ensures we stay updated with the latest medical practices and improve our patient care\u0026rdquo; (FGD, Addis Ababa).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eHowever, many professionals questioned the tangible benefits of CPD for career progression, particularly when programs were generic or poorly aligned with their daily clinical responsibilities.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;We know CPD is important, but sometimes it feels disconnected from our daily work\u0026rdquo; (FGD, Oromia).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eSpecialists and sub-specialists were more likely to question the necessity of CPD, citing their advanced training and perceived sufficiency of existing knowledge.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;They claimed that they are highly educated or sufficiently knowledgeable, particularly referring to specialists and sub-specialists\u0026rdquo; (KII, Regional Health Bureau).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Accessibility, Equity, and Regional Disparities\u003c/h2\u003e \u003cp\u003eAccess to CPD opportunities varied widely across regions, with pronounced disparities between urban and rural areas and between public and private sectors. Limited numbers of CPD centers, particularly in remote regions, forced professionals to travel long distances, often at significant personal cost.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;The lack of nearby CPD centers forced us to travel long distances, which was often not feasible due to time and financial constraints\u0026rdquo; (FGD, Amhara Region).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eEconomic barriers, including registration fees and travel expenses, further constrained participation, especially in underserved regions.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026ldquo;The financial burden of CPD activities\u0026hellip; often prevented many of us from participating\u0026rdquo; (FGD, Afar Region).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eParticipants also noted that many CPD programs were overly generic and failed to address specialized or context-specific challenges.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;Many CPD programs were too generic and did not address the specific challenges we faced in our specialized fields\u0026rdquo; (FGD, Oromia Region).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Digital CPD: Opportunities and Limitations\u003c/h2\u003e \u003cp\u003eThe shift toward digital and online CPD was widely recognized as a positive development, particularly for professionals in remote and underserved areas. Participants highlighted the convenience and reduced need for travel.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;Online CPD modules made it easier to participate without the need to travel\u0026rdquo; (FGD, SNNPR).\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;Digitization has been a game-changer, enabling professionals in even the most remote areas to access CPD opportunities\u0026rdquo; (KII, Dire Dawa).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eDespite these benefits, unreliable internet connectivity, lack of digital skills, and limited technical support remained major barriers, particularly in rural regions.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;In rural regions, unreliable internet access limited our ability to engage with online CPD resources\u0026rdquo; (FGD, Somali Region).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThe continued reliance on face-to-face training further restricted access for professionals in isolated areas. Participants emphasized the need for hybrid CPD models, improved digital infrastructure, and local support centers equipped with internet access and devices.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e3.5 Institutional Support, Leadership, and Governance\u003c/h2\u003e \u003cp\u003eInstitutional commitment to CPD varied considerably. Some participants reported supportive leadership and established structures that facilitated CPD implementation.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;Our leaders are supportive, and there is a strong foundation for CPD\u0026rdquo; (FGD, Addis Ababa).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eHowever, others noted weak enforcement of CPD requirements and inconsistencies between public and private sectors, with private institutions often enjoying greater flexibility.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;The private sector often had more flexibility, creating an imbalance\u0026rdquo; (FGD, Amhara Region).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eAlthough formal CPD frameworks and guidelines existed in many institutions, their implementation was inconsistent, particularly in regions with limited resources.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;Even though there was a framework, it was not always effective in our area due to limited resources and support\u0026rdquo; (FGD, Somali Region).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.6 Regulation, Accreditation, and Accountability\u003c/h2\u003e \u003cp\u003eWeak regulatory enforcement and inconsistent oversight emerged as critical challenges. Informants reported widespread concerns about forged CPD certificates and license renewals, attributed to poor monitoring and inadequate legal frameworks.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;Despite the arrest of over 45 professionals for license forgery, they were quickly released due to the lack of enforceable legal rules\u0026rdquo; (KII, RHB Regulatory, Addis Ababa).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eAccrediting bodies were perceived as inconsistently fulfilling their roles, sometimes issuing licenses without adequately verifying CPD compliance.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;There is a rumor that some accreditors simply provide licenses without checking requirements\u0026rdquo; (KII, RHB Regulatory, Addis Ababa).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.7 Resource Constraints: Time, Funding, and Human Capacity\u003c/h2\u003e \u003cp\u003eTime constraints, heavy workloads, and competing clinical responsibilities were major barriers to CPD participation.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;Competing priorities make it challenging to stay committed to CPD\u0026rdquo; (FGD, Addis Ababa).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eShortages of qualified trainers and limited financial resources further undermined CPD quality and sustainability, particularly in peripheral regions.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;We face challenges due to a shortage of qualified trainers\u0026rdquo; (KII, Amhara Region).\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;Our CPD programs are limited by the small budgets allocated\u0026rdquo; (KII, Tigray).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eAlthough some regions successfully secured external funding, reliance on donor support raised concerns about long-term sustainability.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.8 Engagement, Motivation, and Communication\u003c/h2\u003e \u003cp\u003eCPD engagement was often driven by external pressures such as license renewal rather than intrinsic motivation for learning. Many participants reported limited institutional communication and reliance on professional associations or social media for CPD information.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;Rather than hearing about CPD from our hospital directors, we hear it from social media\u0026rdquo; (FGD, Somali Region).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eLack of awareness about activities that could count toward CPD further reduced engagement.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026ldquo;We do rounds every day and mentor students, but none of these are registered as CEU because we were not aware\u0026rdquo; (FGD, Harar Region).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis study highlights the persistent structural, institutional, and individual-level challenges that affect the implementation and utilization of Continuing Professional Development (CPD) among healthcare professionals in Ethiopia. Although CPD is formally recognized as essential for maintaining competence and improving quality of care, its practical implementation remains fragmented and inequitable across regions, professions, and sectors.\u003c/p\u003e \u003cp\u003eEthiopian CPD is designed to support patient safety, professional competence, and lifelong learning in accordance with national CPD rules and directives released by the Federal Ministry of Health (FMoH) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. However, the results of this study show that many healthcare professionals view continuing professional development (CPD) more as a legal requirement for license renewal than as an important educational activity. Similar attitudes have been documented in research from Ethiopia and other low- and middle-income nations, where involvement in CPD is frequently motivated more by external factors than by internal ones [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The instructional value of CPD is undermined and its potential impact on healthcare quality is limited by this mismatch between policy purpose and professional experience.\u003c/p\u003e \u003cp\u003eWorkload pressure, competing clinical responsibilities, and rigid scheduling were major barriers to CPD participation. These constraints are widely documented in both African and global contexts, where healthcare workforce shortages and high service demands restrict opportunities for structured learning [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In Ethiopia, such challenges are compounded by limited funding, weak planning mechanisms, and inefficient utilization of human and financial resources, resulting in inadequate institutional support for CPD activities. Similar findings have been reported among pharmacists, nurses, and physicians, where lack of protected time and organizational support significantly minimized CPD engagement [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMarked disparities between urban and rural settings were observed in CPD access and participation. Rural healthcare professionals faced additional challenges related to geographic isolation, limited infrastructure, poor internet connectivity, and the absence of local CPD centers. These findings align with evidence from rural CPD studies, which demonstrate that lack of logistical and institutional support exacerbates inequities in professional development opportunities [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Such disparities reflect broader systemic weaknesses within the health system and contribute to uneven quality of care across regions.\u003c/p\u003e \u003cp\u003eThe study also revealed significant concerns regarding CPD governance, regulation, and accountability. Weak monitoring systems, inconsistent enforcement of CPD requirements, and limited regulatory oversight have contributed to malpractice, including fake CPD certificates and license renewals. Similar challenges have been documented in other African contexts, where inadequate regulatory frameworks compromise the credibility and effectiveness of CPD systems [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Without robust accountability mechanisms, CPD risks losing professional trust and failing to achieve its intended outcomes.\u003c/p\u003e \u003cp\u003eDigital CPD emerged as a promising strategy to improve access, particularly for professionals in remote and under served areas. Participants highlighted the flexibility and convenience of online and mobile learning platforms, which allow self-paced learning and reduce travel-related barriers. This finding is consistent with international evidence demonstrating that digital and blended CPD models enhance accessibility, learner autonomy, and participation [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. However, persistent challenges related to unreliable internet connectivity, outdated technology, and a lack of technical support limit the effectiveness of digital CPD in rural Ethiopia. Addressing these gaps is paramount for the equitable scale-up of digital learning solutions.\u003c/p\u003e \u003cp\u003eMotivational factors also played a critical role in CPD engagement. Encouragement from supervisors, peer collaboration, recognition through certification, and opportunities for career advancement were identified as strong enablers of participation. These findings are supported by literature highlighting the significance of leadership support, professional recognition, and organizational culture in sustaining CPD engagement [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. In contrast, limited institutional communication and reliance on professional associations or social media for CPD information reflect weak organizational ownership of CPD implementation.\u003c/p\u003e \u003cp\u003eFinancial sustainability remains precarious, as CPD programs in several regions depend heavily on donor funding. While external aid has enabled short-term program expansion, reliance on donor support introduces vulnerability to shifting priorities and endangers long-term continuity. Similar challenges have been observed in donor-dependent health programs across low-resource settings, underscoring the need for stronger domestic financing and integration of CPD into routine health system budgets [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cb\u003eStrengths and Limitations\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThis study provides valuable insights into the barriers and facilitators of CPD engagement in Ethiopia. The inclusion of participants from diverse regions allowed for a comprehensive understanding of regional disparities. However, the reliance on self-reported data may introduce recall bias. Additionally, the study primarily involved experienced healthcare professionals, potentially limiting the perspectives of less-experienced individuals. Future research should include a broader demographic to capture varied experiences.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study identified significant barriers to CPD participation in Ethiopia, including time constraints, resource limitations, governance challenges, and urban-rural disparities. However, the findings also highlight opportunities to enhance CPD engagement through institutional support, technological innovations, and targeted investments. Addressing these barriers while leveraging facilitators can create a sustainable CPD framework that improves healthcare professionals' competencies and, ultimately, patient outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the ethical principles outlined in the\u003c/p\u003e\n\u003cp\u003eDeclaration of Helsinki and obtained ethical approval from the Ethiopian Medical Association Institutional Review Board (Ref: EMA0054.01), the Johns Hopkins University Institutional Review Board, and the Ministry of Health. All participants provided informed consent after receiving a comprehensive briefing on the study\u0026apos;s purpose, potential risks, and benefits. To protect privacy, interviews were conducted in secure, private settings where confidentiality could be strictly maintained. Participation was entirely voluntary, and all individuals were informed of their right to withdraw from the study at any time without penalty.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publishing\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026lsquo;Not Applicable\u0026rsquo;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere are no competing interests among the authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData and materials are available and can be shared by the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was obtained for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDesign and conception of the study: TG, EG, and AS; Performed the study: TG, AD, LB, TA, TT, and NT; Data analysis and interpretation: AD, TG, EG, TT, and TA; Writing of the manuscript: AD, TG; All the authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe acknowledge Ministry of Health, Wollega University, Gondar University, Jhpiego-Ethiopia, Menelik II Medical and Health Sciences College, and Adama Hospital Medical College.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTG:\u0026nbsp;\u003c/strong\u003eMinistry of Health, HRD, Addis Ababa, Ethiopia; E-mail: [email protected]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEG:\u003c/strong\u003e Ministry of Health, HRD, Addis Ababa, Ethiopia; E-mail: [email protected]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLB:\u0026nbsp;\u003c/strong\u003eWollega University, Institute of Health Science, CPD Director, Nekemte, Ethiopia; E-mail:[email protected]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTA:\u0026nbsp;\u003c/strong\u003eMinistry of Health, CPD Desk, Addis Ababa, Ethiopia; E-mail:[email protected]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAS:\u003c/strong\u003e Ministry of Health, Human Resource Development \u0026amp; Improvement LEO, Addis Ababa, Ethiopia; E-mail: [email protected]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTA:\u0026nbsp;\u003c/strong\u003eGondar University, Gondar, Ethiopia, E-mail: [email protected]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTT:\u003c/strong\u003e Jhpiego-Ethiopia, Addis Ababa, Ethiopia; E-mail: [email protected]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNT:\u0026nbsp;\u003c/strong\u003eMenelik II Medical and Health Sciences College, Addis Ababa, Ethiopia; E-mail: [email protected]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAD\u003c/strong\u003e: Adama Hospital Medical College, Department of Public Health, Ethiopia; Mobile phone: +251911069074; E-mail: [email protected]\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eFederal Ministry of Health Ethiopia. Continuing Professional Development (CPD) Guideline for Health Professionals in Ethiopia. Addis Ababa, Ethiopia: Federal Ministry of Health; 2018.\u003c/li\u003e\n \u003cli\u003eFederal Ministry of Health Ethiopia. Continuing Professional Development (CPD) Directive for Health Professionals in Ethiopia. Addis Ababa, Ethiopia: Federal Ministry of Health; 2018.\u003c/li\u003e\n \u003cli\u003eYadeta TA, Mohamed A, Behir K, et al. Knowledge, perceived needs of continuous professional development, and associated factors among healthcare workers in East Ethiopia: a multi-health facility-based cross-sectional study. BMC Med Educ. 2024;24:497. doi:10.1186/s12909-024-05486-z.\u003c/li\u003e\n \u003cli\u003eFilipe HP, Silva ED, Stulting AA, Golnik KC. Ophthalmic education update: continuing professional development, best practices. Middle East Afr J Ophthalmol. 2014;21(2):134-141. doi:10.4103/0974-9233.129760.\u003c/li\u003e\n \u003cli\u003eKaras M, Sheen NJL, North RV, et al. Continuing professional development requirements for UK health professionals: a scoping review. BMJ Open. 2020;10:e032781. doi:10.1136/bmjopen-2019-032781.\u003c/li\u003e\n \u003cli\u003eDrude KP, Maheu M, Hilty DM. Continuing professional development: reflections on a lifelong learning process. Psychiatr Clin North Am. 2019;42(3):447-461. doi:10.1016/j.psc.2019.05.002.\u003c/li\u003e\n \u003cli\u003eWiese A, Galvin E, Korotchikova I, Bennett D. Doctors\u0026apos; attitudes to maintenance of professional competence: a scoping review. Med Educ. 2022;56(4):374-386. doi:10.1111/medu.14678.\u003c/li\u003e\n \u003cli\u003eYadeta TA, Mohammed A, Alemu A, et al. Utilization of continuous professional development among health professionals in East Ethiopia: a multi-health facility-based cross-sectional study. BMC Med Educ. 2024;24(61). doi:10.1186/s12909-024-05036-7.\u003c/li\u003e\n \u003cli\u003eAhmat A, Okoroafor SC, Kazanga I, et al. The health workforce status in the WHO African Region: findings of a cross-sectional study. BMJ Glob Health. 2022;7:e008317. doi:10.1136/bmjgh-2021-008317.\u003c/li\u003e\n \u003cli\u003eAldakhil S, Baqar SM, Alosaimi B, Almuzirie R, Farooqui M, Alsahali S, Almogbel Y. Perceived needs, barriers, and challenges to continuing professional development (CPD): A qualitative exploration among hospital pharmacists. Pharmacy (Basel). 2024;12(5):140. doi:10.3390/pharmacy12050140.\u003c/li\u003e\n \u003cli\u003eBwanga O. Barriers to continuing professional development (CPD) in radiography: a review of literature from Africa. Health Prof Educ. 2020;6(4):472-480. doi:10.1016/j.hpe.2020.09.002.\u003c/li\u003e\n \u003cli\u003eCampos-Zamora M, Gilbert H, Esparza-Perez RI, et al. Continuing professional development challenges in a rural setting: a mixed-methods study. 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A realist synthesis of effective continuing professional development (CPD): a case study of healthcare practitioners\u0026apos; CPD. Nurse Educ Today. 2018;69:134-141. doi:10.1016/j.nedt.2018.07.010.\u003c/li\u003e\n \u003cli\u003eMartha J. Relationship between participation in formal continuous professional development, job satisfaction, and attitude towards patient care among nurses in Embu County [thesis]. University of Nairobi; 2019.\u003c/li\u003e\n \u003cli\u003eMerry L, Castiglione SA, Rouleau G, et al. Continuing professional development (CPD) system development, implementation, evaluation, and sustainability for healthcare professionals in low- and lower-middle-income countries: a rapid scoping review. BMC Med Educ. 2023;23:498. doi:10.1186/s12909-023-04427-6.\u003c/li\u003e\n \u003cli\u003eMustapa MBH, Teo YC, Haji-Abdul-Rahman HK, Abdul-Mumin KH, Abdul Rahman H. Enablers and barriers of continuous professional development (CPD) participation among nurses and midwives. Int J Nurs Educ. 2021;13(3). doi:10.37506/ijone.v13i3.16315.\u003c/li\u003e\n \u003cli\u003ePetersen JA, Bray L, Ostergaard D. Continuing professional development (CPD) for anesthetists: a systematic review. Acta Anaesthesiol Scand. 2023;68(1):2-15. doi:10.1111/aas.14306.\u003c/li\u003e\n \u003cli\u003eAnwara SU, Nmecha CE, Moses EA, Okarekpe E, Mgbeojedo UG, Ekechukwu END, et al. Attitudes and barriers towards continuing professional development among physiotherapists in South-Eastern Nigeria. Afr J Health Sci Technol. 2020;2(1):97-105.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Barrier, Continuing Professional Development, Ethiopia, Health care, Facilitator, Stakeholder","lastPublishedDoi":"10.21203/rs.3.rs-8476608/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8476608/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eContinuing Professional Development (CPD) is critical for enhancing the quality of healthcare services. In Ethiopia, the engagement of healthcare professionals in CPD has been hindered by various challenges, including limited institutional support, financial constraints, and systemic barriers. This study explores these barriers and facilitators of CPD participation in Ethiopia\u0026rsquo;s healthcare system.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe study employed a phenomenological qualitative design with 15 key informant interviews and six focus group sessions. To guarantee a thorough view, information was gathered from a wide range of stakeholders in both urban and rural Ethiopia, including healthcare providers and regulatory agencies.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eNon flexible work schedules, inadequate institutional support, and disparities between urban and rural areas in CPD accessibility were challenges for CPD implementation. Healthcare professional particularly those are practicing in rural areas faced barriers related to limited resources, inadequate infrastructure, and insufficient financial support. Weak enforcement of CPD policies, and attempts of forging certificate were some of the challenges leading to undermining integrity of CPD systems. However, advocacy efforts and increasing awareness have led to some improvements in CPD participation, particularly in urban areas.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eEffective CPD engagement in Ethiopia requires strengthened institutional support, better communication, and enhanced oversight from accrediting bodies. Addressing the disparities between urban and rural regions and improving regulatory frameworks will be crucial in ensuring that CPD contributes meaningfully to the professional development of healthcare providers and the improvement of healthcare quality in Ethiopia.\u003c/p\u003e","manuscriptTitle":"Facilitators and Barriers to Continuing Professional Development Implementation in Healthcare in Ethiopia: Insights from Stakeholders, 2024","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-02 18:57:38","doi":"10.21203/rs.3.rs-8476608/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"148497981078489624324802992037288643871","date":"2026-04-14T02:10:51+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-13T07:31:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"129341037618085050189880553742446832909","date":"2026-02-14T08:22:13+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-29T08:14:53+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-29T08:12:53+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-20T13:39:41+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-20T03:09:14+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2026-01-20T03:05:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"85de6697-8282-4207-8881-2045fb360603","owner":[],"postedDate":"February 2nd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-02T18:57:38+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-02 18:57:38","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8476608","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8476608","identity":"rs-8476608","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}