Background: Understanding the turnover intention of healthcare workers in conflict-affected settings can be crucial to crafting strategies for retaining health workers and wider recovery and reconstruction interventions. This study aimed to assess the prevalence of turnover intention and associated factors among healthcare workers working in war-torn Tigray.

Methods: A concurrent mixed methods case study surveyed 2,376 frontline health workers across 44 districts in Tigray September 1 – 21, 2023. A multistage sampling technique was employed to select individuals who worked at 30% of healthcare facilities (hospitals and health centers) from different zones of the region. Quantitative data was collected through a standardized questionnaire. A total of 29 interviews from health professionals, health managers, and physicians who left Tigray, respectively were collected for the qualitative data. Structural Equation Modelling (SEM) analyzed relationships between variables, while thematic analysis was used for qualitative data. The quantitative and qualitative data were mixed at the discussion section.

Results: The prevalence of turnover intentions was 77.5% (95% CI: 75.8%, 79.1%). It was significantly higher among healthcare workers who are younger (as age increased by 10 years, turnover intention decreased by 0.3; P<0.001), males ((Unstandardized coefficient = 0.27, 95% CI [0.16, 0.38]), higher vicarious trauma (Unstandardized coefficient = 0.11 [95% CI: 0.03, 0.20], dissatisfied with their job (Unstandardized coefficient = -0.89 [95% CI: -1.02, -0.75]), and high level of burnout (Unstandardized coefficient = 0.30 [0.25, 0.35]. Additionally, the qualitative data highlighted reasons for turnover intentions, including a sense of insecurity, long-standing salary issues, and other financial incentives inadequacy, unpaid salary and incentive backlog, poor drugs and supplies availability, poor system governance, limited career development, and demotivation.

Conclusion: Turnover intention among healthcare workers in Tigray was alarmingly high, highlighting stakeholders’ intervention to alleviate the future exodus of healthcare workers.