DISSERTATION

DISSERTATION

CHAPTER 1

GENERAL OVERVIEW OF THE STUDY

In this particular chapter, the researcher highlights and discusses the context and precisely explains the background of the study and elucidates on the scope and its significance. Furthermore, the theoretical framework, the motivations, research question, main goal and the objectives data analysis, the methods used in the data collection, and their discussion in terms of verification, ethical inclusivity, and the clarification of the key concepts are well expounded on. The chapter summarizes and concludes by positing an appropriate exposition of the main study. It is worth noting that the word” catalyst” and the ” motivation” are used extensively and interchangeably to imply the main factors determining to extend of the development.

1.1 INTRODUCTION

Health systems sustainability in coping up with contemporary health issues is the censorious concern in many of the counties, due to fervently increasing stiff competition among both the public and the private health sectors to maintain their status quo and the relevance in the market. Training and the development of any health sector have over decades occupied the core of the sustainable competitive advantage in various countries Symons G (2012). Essentially the health workers are key assets in the health system and exponentially investing in their talents in terms their capabilities and specialization are vital in sustaining the desired competitive advantage in Nigerian private hospitals .as a matter of concern, the private hospital in Nigeria go through a tedious process in recruiting and hiring the most qualified and deemed suitable health workers, nonetheless, more often than not the consideration of the health worker general welfare fizzles out there and off .according to Silverman(2011) an organization that mutually and extensively engages in employees development, welfare, and the capacity building, maintain their relevance in outdoes all the prevailing competitors and their output in terms of profits increases compared to a health organization that neglects their employees’ development. The well served and the dedicated training and the development immensely catalyze the health workers’ engagement and the aggressive engagement is very crucial in the private hospital delivery of service and the financial development of Slabbert l (2014).

According to the Strydom (2005), capitalizing in the employees’ investment and their professional development is propitious in enhancing teamwork and the health workers retention in the private hospitals in Nigeria Adams R (2002) claims that 94% of the health workers remain loyal and stays in the hospitals for a long time if the investment is tailored to meet their professional capacity building is sustained. A report from the Gallup study shows that almost 40% of the united states workforce is driven based on the millennial .this means that the rate of retaining them for a long in their respective workplaces is efficient. As the health system landscape becomes stiffly competitive, inherent, and considerate improvement of the health worker’s training and development is imperative. Gallup study, therefore, posits that the health workers or rather employees training and the development has ceased to be a bed of the organization’s fame but paramount in the professional development and the auspicious workforce that drive the health system . Prudently, Anon (2010) the training encompasses the programs that introspectively and physically facilitate the health workers to learn the prerequisite skills required to improve and propel the private hospitals’ development in their competitive quest Austin M(2004) .development

program in the private hospitals

boost the employees’ plan and their progressive performance but not their current professional status, as the health issues emerge in the world discourse, so will the new health-related issues, as new diseases emerge. As a result, there will be a great impact on health development and education. Desiring to cope up with these changes by recognizing the relevant skills and the appropriate ways of inculcating them significantly boost the private hospital innovativeness and remain focused on their set goals. Despite, merging the modern skill and the creative development methods potentially maintain the health professionals dynamically adopting new changes in the contemporary health discourse in Nigeria.

According to Bartlett (2009), the frequency in the development initiatives and training mitigates the boredom and redundancy which emanates from the prejudiced working habits. Baenet(2001 ) the regular training of health workers elicits the culture of self -evaluation and regular progress analysis among the workers. Babble E (2009) training and the development zealously instills the sense of candid orientation in future planning .according to (citation) dedicated training and development prompts the employer to assess the existing and unexploited talents among the employees and evaluate the appropriate growth .also, identifying the new talent among the employees facilitate the private hospital to actualize the targeted skill deemed apt in the existing gaps in the health sector.

1.2 BACKGROUND OF THE RESEARCH STUDY

The study carried out by Barky (2007) posits that, due to the incommensurate and the inadequate health program implemented by the Nigerian government to address a myriad of the quagmire afflicting the general health in Nigeria, have seen the negligible improvement the health status .according to the research, the perennial negligence by the Nigerian government to alleviate and address the public health issue has left pangs of the anticipation among the poor Nigerian citizens. There has been the meager motivation in both the private and the public health sectors. According to the World Bureau of Statistics (WBS) and the United Nations Statistical Commission (UNSD), Nigeria is globally known to be the giant of Africa in terms of its population with approximately 182 million inhabitants. This number of the population do not measure up with the number of public hospitals expected to accommodate the required patient capacity (citation).according to the World Health Organization (WHO) the overall life expectancy in Nigeria is tentatively at 54 years and the infants’ mortality rate of approximately 86 in every 1000 live birth. Also, the maternal mortality ratio is estimated to be 840 in every 10000 live birth .in addition, World Health Statistic(WHS), on the status of the non-communicable diseases among the third world countries, Nigeria is at the receiving end as it heftily burdened with these diseases which include but not limited to; cancer, diabetes, cardiovascular disease, obesity, stroke, asthma coronary heart disease. Besides, WHS 2011 the estimated malaria mortality rate of the Nigerian population is 146 out of the 100000 randomized populations. It further reveals that the Nigerian population is leading in the tuberculosis burden and victims globally .which by extension culminating in an unbearable burden in Africa cumulatively. The genera Nigerian health sector is currently writhing in the yoke of the greatest burden that encompasses among others, the containment of the infectious and contagious disease like the current Covid-19 Pandemic and some other related emerging communicable diseases.

According to WHS for the last 10 consecutive years, the has been an acute shortage of health workers in the Nigerian both in the public and the private sector. This shortage has been attributed to the social

brain drain. These multidimensional predicaments are escalated by the newly risen sociopolitical of Nigerian history and the inadequacy in the institutionalized capacity policies to curb the menace. The continued negligence on the health sector and the respective authorities are crippled by the already unstable situation. According to the United Nations Development Program (UNDP) report, the GDP for both the private and the public sector, is approximately 2.6% and 0.8% respectively .intriguingly the respective authorities and the government has notably tried to alleviate the challenge, however, there has been any substantial and material; move to fully iron out the perennial problem. The current Nigerian national health has well-informed policies on the health program. for instance, the blood transfusion, HIV/AIDS food and nutrition, child and drug substance abuse, national healthcare system, food hygiene, and the safety and health national policies .all these revised health policies. I have not significantly curbed the pinch of this excruciating pain on the health sector.

The Nigerian government inter-sectorial movements and the cooperation among the various respective government ministries have not outdone the challenge in the health sector. According to WHO and the Nigerian Bureau of Statistics (NBS), the national health system still wallows in the cocoon of the poor management and ineffective operation in term of management, there is skewed resource distribution in the public and the private sector. Besides, 70%of the doctors are urban residence because the high population of Nigerian is in the rural. As a result, the high percentage of the citizen living in the rural are left in the hand of unscrupulous and incompetent health workers. The Nigerian government, in its quest to assuage this health-related problem, in cooperation with the federal health ministry constituted a National emergency response and preparedness team. Although this team coupled with the public health emergency, the Nigerian citizen still experiences the great challenges in accessing the quality health service. According to the Nigerian federal ministry of health, (FMOH) every year the country records a new case of an outbreak of a disease which in most cases leaves thousands of Nigerians succumbing to the disease. While these emergency outbreaks have been experienced in the recent past there has been an appropriate cushioning measure to alleviate the challenge. According to UNICEF, the outbreak of cholera in Nigeria is deemed to affect about 3 to 5 million populations in Nigeria and the 100,000-to 150,000 cases of deaths yearly.

1.3 SIGNIFICANT OF THE PROBLEM

The formulation of any reasonable research problem is the most critical and profound first step of any academic research process Maxwell (2013). This scholar likens this academic research process the tee ginning of every journey by which an individual has to decide about the destination before kicking off the journey. Furthermore, this author posits that without a destination it is always difficult to determine the kind of inputs one has to inculcate in their journey .the identification of any research problem is deemed a very crucial part of any of the academic research processes Kumar (2011). The research problem provides an appropriate avenue to expounding on the variable and the concepts used. The problem of the research gives an appropriate direction of the whole research and the whole context .in addition the statement of the problem in a context where the various theoretical framework are demystified with the extent to which the statement problem relies upon it.

Concerning the provided explanation on the background, the esteemed researcher keenly attempts to shed light on what is needed in this research, by formulating a relevant problem of the study. Due to this reason, the problem of the statement will be formulated like this: There is no research-based information on the importance of the training and the development as the motivational aspects to competitive performance in the health sector. According to the Gallup study, there is no much awareness on various organizational institutions on the importance and the significance of the training and the development to the employees and the impact on an organization. According to the LinkedIn learning (2018) on the workplace learning reports the investment in the training and the capacity building on the health workers has a prosperous impact on the output in terms of quality service and the profits. The 2017 study on the workplace by the Gallup, company that engages on the employees’ professional growth, has the rate of employee retention. Bashin H (2018) 82% of the middle-skills level needs an appropriate training mechanism in the professional capacity building. He further says as the skills gaps widen further the employers are under a great obligation to train their employees in upskilling to suit the first moving world. The process entails the creation of a meticulous plan that is associated with set goals. This scholar also argues that employees and emp0loyers should always evaluate their capabilities that will greatly boost their organization’s results. Craig(2018), while the functional training exists in an organization the development in terms of employee development capacity building will not be functional if the prevailing working environment does not provide for adequate learning on the professional skills. According to the world health statistics, Nigeria faces various health-related problems ranging from infectious diseases, air pollution, solid waste disposal, health insurance, and the appropriate control of the vector-borne diseases. Furthermore, WHO reveals that about 58 million people succumbed in the year 2005 due to the infectious diseases globally and by extension, 18.8% were from the African region. In Nigeria, vector-borne and infectious diseases are the major problems threatening the health sector.

Based on the above mention detailed background, the researcher strikes a conclusion. There is an ardent need for substantial and qualitative research to widen knowledge on the importance of the training and the development as the key factor in motivating the private hospital in Nigeria. This research is tailored to demystify the underlying facts about prior research on the importance of training in health workers. Furthermore, the study identifies and discusses how and what training and development to qualitatively meet the urgency of the contemporary health sector in Nigeria.

1.4 THEORETICAL FRAMEWORK

According to (Creswell,2014) the theoretical point of view in substantial research become a foundation in transforming and shaping the types of questions that prevails, as a result, it influences the methods of collecting data and evaluate to meet then call and the urgency of change. In most cases, theory serves as a bottom line in catering the factual information since it specifically identifies the types of data to be analyzed since its element and the variable are logically intertwined. Therefore the hypothesis can be easily inferred basing on the specific elements and the variables of a particular theory. This research is deduced upon the reinforcement approach and the social learning approach that facilitates in exploring and expounding the appropriate training and the development of health care and the health workers using various theoretical perspectives.

1.4.1 Theory of reinforcement

This theory stresses the learning behavior of an individual and further claims that a learner will tend to repeat a behavior associated with positive outcomes. According to Skinner, the theory of reinforcement is training and programs in terms of organizational set goals. It further suggests that training and development when reinforced with appropriate human resource practice. Skinner in further elaborating this concept says that there are various types forms that a reward can be administered . for instance, the award of the certificate after a training and development program can elicit a positive impact on the employees .basing on this theoretical perspective there an appropriate and repeated training will inculcate the culture of determination among the employees and in this case the health workers Gallup (2018).

1.4.2 SOCIAL LEARNING PERSPECTIVE

This is the theoretical perspective that is thus appropriate for the qualitative study of this research. According to Albert Bandura, this theory addresses the fact that the direct reinforcements on an individual have a significant impact. Furthermore, some training programs cannot be imparted through training but learned from the environment. This type of learning, according to this theory, is called observational learning since it involves the observation of human behavior. In an organization, therefore, the environment plays a critical role in promoting professional capacity building. it further explains that in any organization,., the working environment should be suitable and professional such that the employees should be able to learn from it. Sigmund Freud claims that human psychology also plays a role the controlling the human behavior and learning process. What if a mental status of an individual is contemptuous then, there will be no impact on the learning process even if he or she is forced to do so they will not gain any positivity in the learning process. Therefore for any given organization to realize a meaningful impact of their training on their employees, there they must create a conducive environment for their workers. This act wail, in turn, helps them change their attitude and gain in any training given to them.

According to this theory of social learning, the mental state of mind positive toward the organizational training orientation and the development program by closely associating the benefit and the reward gained having gone through any given training this process will, in turn, help the health workers develop a positive attitude towards any given training program in any organization.

`both the social learning perspective and the reinforcement perspective are focused in the prioritization of th health worker as a human being who can the status quo of the bad health conditions to better condition .in addition the two approaches also attempts to put a firm emphasis on the already prejudiced practice that if done and implemented it will lead to an appropriate improvement on the health sector . with the conceived notion that the human beings have the capabilities when their various talents are well natured and blended into usefulness in the organization .the two approaches harmoniously links well with the problem under the study that the training and the development on the employees are the catalysts of the competitive advantage .the apt utilization of the two approaches in mitigating this health-related challenge will greatly help t6he health workers realize their unexploited talents and capabilities in improving the private hospital output Skinner (2000). According to a Gallup study, the investment in the employees’ training and development should be tailored to meet the expectation. The employees should be always viewed as capable and motivated whenever necessary. Training and development are always an important process within human professional development. Every organization needs to have well trained, competent, and experienced people to perform the activities that have to be done. This is the most important aspect of Human Resource Management. It is widely known that Human Resource Management helps people to expand their capabilities and offer numerous opportunities. It is also felt that the expanded capabilities and opportunity for people at work will lead directly to improvement in operating effectiveness. The focus of training is the difference between a company’s requirements for personnel with the skills and knowledge to perform satisfactorily and the capabilities of that personnel. Good human resources departments conduct frequent assessments of the company’s requirements and the level of employee attainment

1.5 Research Question

This chapter discussed the concept of training and the development importance to an organization and the process in identifying the talent among the employees .from the observation made, well train employees are the critical pillars of success in any organization .according to the research, the most productive employees are those who receive extensive training and the development. When careful employee selection is done, it does not necessarily promise exemplary performance in an organization Dressler (2008). Also, the performance and the employees are always two separate entities .the according to the theory of reinforcement, the employees always associate a reward with the kind of training offered, thus the type of motivation administered to employees during and after a given training period determines the level of success and performance by the employees the theory of social learning also articulate that, employees learn much from their environment they are working in, hence the training and the development alone cannot determine the capability and the competency of employees. Since there is no enough research-based information on the fact that, the training and the development are the catalysts for the competitive advantage, the combination of the two theoretical perspectives significantly helps to identify the hypothetical information on the importance of the two motivational aspects Gallup (2018).Therefore the mutual understanding and succinct investment on the employers will not only improve the organization performance but also the output of an organization.

According to Denscombe (2012), a research question is an appropriate tool that strikes a balance on what we want to find out. A research question may presumably take different forms but it serves the intended research purpose. The research question encompasses the important question in addressing the main concern of the research. It fine-tunes the succinctly on what a researcher need and the kind of knowledge to be added to the topic under study.in most cases, the research question is precise and concise such that the questions asked are the real reflection of the topic under the study .in addition a research question gives a basis in terms of viewing and analyzing the topic under the research. Throughout the research process, a researcher is focused in knowing how the underlying assumption of the phenomena under research impact on the research question formulated .out of the research question, the researcher was able to reflect on his already existing knowledge in terms of the biasness and the speculations made about the phenomena under the investigation .for the purpose of understanding the importance of training and how the process is done, the researcher formulated the following questions.

• What are the employers of the organizational institutions’ perspective on the training and the developments on their employee’s development?

To answer the research question the researcher was guided by the following set goals and objectives.

1.5.1 Research Goals

• Develop a multidimensional understanding, on importance of the training and the development to employees and the organizational objective in Nigeria

1.5.2 Research Objectives

According to Denscombe, (2012) and Creswell (2007), the overall purpose and the usefulness of the of research is the main objective of research .in this case the ideas from the research study is translated into substantial and the concrete data and an analytical approach and the qualitative approach, it is used to unravel the underlying fact of in the research problem. Furthermore, the objects represent the core part of the study wherein the sub-objective is the main guideline that drives the main objective of the materializations Kumar(2011). Therefore, based on the stated objective, the following are the objectives of the study found.

• to explore the importance of the current and the future importance of the training and the development in the Nigerian private hospital
• to explore and describe the problems and the benefits of the training and the development to the employers in the private hospitals in Nigeria

To be able to conceptualize the reinforcement

• as a motivational concept within the context of organizational development
• To analyze and critique the data obtained in the various private hospitals and evaluate the reliability of the topic under the study

To conclude and rationally recommend on the importance of the training to the private hospital and every other private sector

CHAPTER 2

LITERATURE REVIEW

2.1 Introduction

This chapter reviews the content that has been in the topic under the research in the field of the study .this review tries to interrelate the reviewed theoretical perspective and the topic under the study. According to Gallup (2014), the great future of the organizational goals is the well trained and skilled employees. on the other hand, the theory of reinforcement states that claims that a well-reinforced training is an appropriate way of motivating the employees in an organization .therefore this chapter will be expounded in detail in the theoretical perspective and the general knowledge on the topic under the study.

2.2 Historical Background

Maxwell (2012) for any study, there must be a reflection on the historical information to determine the type of direction of the study. Basing on the topic under the study, the researcher was trying to investigate on the precarious state of health in Nigeria. There is a chronic mix of challenges including inaccessibility of the affordable and quality health service, lack of preparedness, an outbreak of the pandemics like Covid- 19, malnutrition and related diseases, lack of qualified personnel in the public and the private sector, inadequate health facilities, insufficient health, and investment are poorly done, and lack of sufficient health person. The health ministry performance in improving the health sector has been insignificant. Furthermore, the government has not put into consideration good remuneration f the health worker and mitigates brain drain to the US and other overseas and developed countries.

According to the research, the annual budget of the government for the health sector is 4.17%, which is not commensurate in improving the vast worse situation in the health sector.

2.3Theory relevant to the Research Question

The applied theoretical perspective on this research is the reinforcement perspective and the social learning perspective .comparatively; the two theoretical perspectives converge under one bottom line in promoting the sense of belongingness and the capacity building among the employees. Furthermore, the two perspectives are in line with the topic of study in that; they both conceptualize their principles in the context of the motivational aspect. According to the skinner, motivated employees are always focused on improving the performance of an organization.-on On the other hand, the two theoretical perspective s differ in the sense that the learning perspective claims that the behavior of individual employees in an organization does not necessarily involve the training. The learning is just acquired through the observation of human behavior . also the proponent says that when a given behavior is repeatedly done, it will elicit a given behavior that will remain as part of the culture in an organization. therefore out of the theoretical point of view, health promotion generally becomes a central and key factor in many countries .due to the frequent outbreak of various pandemic diseases. According to the WHO report, workplace health promotion is the greatest achievement in alleviating the risk involved in the health sector. The report further suggests that the improvement of the employees’ professional capacity immensely improve. Despite, based on the current literature relevant to research the researcher ground that there is an annual increment of the outbreak cases of the various contagious diseases in the Nigerian country. Despite the policies and the measures to mitigate the menace has not been able to actualize the permanent solution .the inability of the government to iron out this health problem is attributed to poor remuneration, poor working condition, and lack of appropriate training and the development among the health workers both in public and private health sector

Then implementation of the various health emergency teams like the national health emergency team, life skill program, the national strategy for the pandemic, and contagious diseases among others which all under the ministry of health. Nonetheless, there is an existing gap between the main objective of the government and the implementation. According to the world health statistics, there has been a structural stumbling block to the realization of these auspicious measures to alleviate the menace Gray (2010). The Nigerian government integrated the program of action, (the world health organization 2012) Gustafson-Wright E, Van Der Gaag J (2008), and the department of health and response to a contagious disease to help reduce this affliction. Albeit the NHIS Act implemented an appropriate provision for children, who according to the world statistics they take the largest population in Nigerian population, children still incur for the cost of health services given they are forced to pay for health care services even though most of these children are from poor families that do not afford to pay and even gather for their upkeep hence the, as a result, suffer financial constraints. The Nigerian government has also strife to provide free health policies and accommodative mechanisms by some of the affiliate states, tailored at children, pregnant women and the entire group in the Nigerian society, Therefore the sluggishness to permanently solve the Nigerian multidimensional public health atrocities has culminated to the perennial and continued great level of abject poverty and carelessness and the recklessness the in the Nigerian health system. Economical constrain bad governance. All these stated issues have renders the various moves by the government to mitigate and bring normalcy to be null and void. Considering the objective of the study the researcher deduce the following measures used in reducing the challenges facing the Nigerian health sector.

An appropriate Integration of the adequate medical intelligence and surveillance team

The medical surveillance team is a body tasked to check the general happening in the health sector. Tasking this team and given proper motivation in terms of training and the general well being. it will be able to relay the challenges faced in the health sector in Nigeria. According to the world health organization, the presence of the MIS will be in a position to provide more reliable statistical data that will lead to more professionalize and the critical analysis in obtaining the reliable data that will be used in coming up with the well-informed decision to curb the challenges in the health sector.

Carrying out regular health campaigns and the awareness

This another way to primarily improve the general healthcare in Nigeria .it is the empirical way of disseminating and transforming the masses on the appropriate way of maintaining a self-actualize status of a country .when the citizen is well informed about good health care the whole nation will, benefit, said the National Primary Health Care Developing Agency (NPHCDA). Besides Gallup (2014) states that the appropriate prioritization of the employees’ welfare is to the benefit of the whole organization.

Harmonious coordination in the health sector

According to Professor Isaac Adewole, there must be a mutual understanding among the health worker both in the private and the public sector according to the Nigerian statistical bureau, the continued atrocities in the health sector are attributed to the poor coordination among the health practitioners. According to the (CNNHC) 2009, two critical issues were discussed. First, lack of coordination among the health workers, fervently deteriorating health services, limited prerequisite resources, including drug and accessibility, insufficient and dilapidated infrastructure, skewed in the distribution of the available resources.