Sunday Elijah * 1,Abubakar E. Sidney2, Mohammed B. Adamu3 & Mustapha Yusufu4
1 Department of Economics, Federal University Gusau, Zamfara State, Nigeria.
2 & 4 Department of Economics, Modibbo Adama University of Technology, Yola, Nigeria.
3Department of Economics, College for Social Science and Management Studies, Adamawa State Polytechnic, Yola.
*Correspondence Email: [email protected]
Abstract: The importance of human resources management in relation to productivity of health workers cannot be over emphasized because life is the heartbeat of every organization. The study shows that effective human resources management has a strong impact on healthcare quality and improving the performance of hospital’s staff. A cross sectional data set were collected through simple random sampling techniques from 482 health workers within Yola south Local Government health care centers. Ordered Logistic regression model was used in analyzing the data set. Findings from the result shows that more experience increases worker’s productivity, it also shows that paying overtime bonuses makes health workers more probable to be productive, and the frequency in which patients visit health care centers (Patient’s satisfaction) makes it more likely for the health workers to be productive. The study suggests that, the state primary health care development agency has to establish a strong supervision team to monitor the affairs of permanent health workers in all Yola south local government primary health care centers periodically. Government should make sure that the satisfaction of patients is her primary goal, as such all the necessary requirement such as medical care facilities, quality drugs, sensitization, mutual relationship with patients, and public enlightenment on health care related issues are constantly provided and reviewed periodically.
Keywords: Health workers; Human resource; Impact; Management; Productivity.
JEL: H51; H53; I10; J20; M12; M50
Introduction
The importance of human resources management in relation to productivity in an organization cannot be over emphasized because it is the life, more and soul, or heartbeat of every organization. It emphasizes strategy and planning rather than problem solving and medication, so that programs of corporate culture, remuneration, packaging, team building and management development for core employees deliver employee cooperation, while peripheral employees are kept at arm’s length. According to Coyle-shapiro (2013), London School of Economics and Political Science. Human Resource management (HRM) as the management activity taken by commercial firms, state owned enterprises and other organizations to recruit, retain, and motivate their employees, alternatively, the bundle of policies, programs and plans, which organizations adopt, with the objective of making full use of people they employ. Job
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performance has become one of the significant indicators in measuring organizational performance in many studies (Wall, Michael, Patterson, Wood, Sheehan, Clegg and West, 2004). Even though performance is, often times determined by financial figures, it could also be measured through the combination of expected behaviour and task-related aspects (Motowidlo, 2003). In fact, performance that is based on an absolute value or relative judgment may reflect overall organizational performance (Gomez – Mejia, Balkin and Cardly, 2007;
Wall et al, 2004). Schmitt and Chan cited in Motowidlo (2003) categorized employee job performance into “will-do” and “can-do”. The revising (KSAOs) required in performing certain job and the latter denotes the motivation level that individuals may have in performing their work. Noel, Hollenbeck, Gerhat, and Wright (2010) defined Human Resource Management as a philosophy, policy, system and practices that can affect the behaviour, attitude and performance of employees. Human resource management policies and practices are influence by strategy and structure and by external factors such as trade unions, labour market situation and legal system.
The quantity and quality of the products produced by the employees, used as the proxy for performance, are discussed in relation to Human resource management. However, if product is associated with the production sector, service is rendered by the sectors such as health, banking, insurance etc. The need, therefore, arises to determine if Human resource management affect the services rendered by the employees in the health, banking and insurance sectors as it influences the quantity and the quality of products produced by employees in the production sector. This study is designed to shed light on this issue. It will unravel if Human resource management in Yola south Local Government health sector affects the services rendered by the employees of that sector. The main objective of this study is to analyse the impact of human resource management on the productivity of health workers in Yola South Local Government Area while the specific objectives are; To evaluate the impact of experience on health worker’s productivity in various health care Centers in Yola South local government, to examine the impact of training and motivation on the Productivity of Health workers in Yola South primary Health Care Centres, to examine major obstacles or challenges affecting the operation of health care centers in Yola South local government area, to evaluate the level of patient’s satisfaction from the services rendered in Yola South local government primary health care centres. The research question this paper is going to answer is; does experience determine the Health Worker’s Productivity in Health Care Centre? Do Training and Motivation have an Impact on the Productivity of Health Personnel in Yola South Local Government? What are the Obstacles or Challenges that Affect the Operations of Health Care Centre in Yola South Local Government? Are the patients satisfied with the level of services rendered in Yola South local Government primary health care centres?
Research Hypothesis
For the purpose of this study, the following hypotheses will be tested:
H0: Experience of Health workers Does Not significantly Determine the Productivity in Health Care Centre.
H0: Training and Motivation Do Not Significantly Impact on Health Worker’s Productivity.
H0: Obstacles or Challenges Does Not significantly Affect the Operation of Health Care Centre in Yola South Local Government.
Ho: Patients are not significantly satisfied with the level of service rendered to them in Yola South local Government primary health care centers.
178 Literature Review
Role behaviour theory
Role behaviour theory aims to explain and predict the behaviour of individuals and teams in organizations, which, in turn, inform managers for the purposes of decision-making, and what steps they take on people management as well as the expected consequences. Some of the key ideas focus on the need to improve the working environment including the resources in order to stimulate new behavior in employees in order for them to cope with new demands (Prachaska et al. 1982), it includes the use of rewards to induce and promote positive work behavior, and punishments to control negative behavior (Rogers 1983).
Human capital theory
Human capital theory was initially well developed by Becker (1964) and it has grown in importance worldwide because it focuses on education and training as a source of capital. It is now widely acknowledged that one of the key explanations for the rapid development of Asian countries in the 1970s and 80s is high investment in human capital (Robert 1991;
Psacharopolos & Wood hall 1997). Human capital theory changes the equation that training and development are costs the organization should try to minimize into training and development as returnable investments which should be part of the organizational investment capital. Therefore, human resource training and development decisions and evaluations have to be done based on clearly developed capital investment models.
Organizational theories of motivation
Porter et al (2003) suggests there are two schools of motivation research; content theory and process theory. The first contains Maslow’s Hierarchy of Needs, Alderfer ERG theory, Hertberg’s Movitator-Hygine theory, and McClelland’s Learned Needs theory. To this could be added McGregor’s X and Y theory (Armstrong 2002). The second group consists of Vroom’s expectancy theory and the Port-Lawler model; these are then expanded upon with recent research into self-efficacy (Porter et al 2003).
Adwan (2008) with his study entitled "The Reality of workforce planning in the non- governmental health sector in the provinces of Gaza", showed that institutions do not engage workers in the planning processes of the workforce sufficiently, and that the influential considerations of administrative structure regulatory in the process of workforce planning is characterized by lack of clarity, as well as the professional experience in manpower planning and top management support for the process of workforce planning was ineffective. The study recommended to prepare plans and clear vision in a professional and systematic approach to develop human resources in the hospital, with the need to involve employees in the planning of human resources to become part of their thinking and their work and to help them to practice work in a professional sound, and encourage them to commit to the hospital, the study also urge to create a separate department for personnel affairs in the health institutions and the use of external expertise in order to determine the needs of the health institution of human resources.
Salah Mahmoud Diab (2012) in his study entitled "measuring the dimensions of the quality of medical services provided in the Jordanian government hospitals from the perspective of patients and staff’ found an increase rate to quit job among doctors and nurses working in hospitals and the Ministry of Health, and the low degree of satisfaction and low desire among the staff to continue working in the hospital, and this giving impact to the low quality of health services provided to patients. The most important recommendations by the study with regards
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to the condition of individuals working in the hospital: a. Provision of material and moral incentives for employees working in government hospitals to generate their desire to continue to work and provide medical services appropriately. b. Training courses for workers in the hospitals in the area of the dimensions of medical service quality, and to deepen the quality concept between the staff and to achieve the quality dimensions at the best degree.
In addition, Valverde and Ryan (2006) in their research entitled “Distributing HRM responsibilities: a classification of organizations”. The finding of this study shows that the model of HR function adopted by an organization may not be contextually determined, but instead it is a matter of corporate choice. That is, companies actually choose what type or model of HRM they want and distribute the responsibilities of their various agents accordingly, rather than being determined by organizational contingencies. The researcher concluded that a large number of organizations have proved very useful in identifying a wide range of behaviors in the distribution of HR responsibilities.
Methodology
This section of the study outlines the methodology used in carrying out the research.
Sources of data
A cross sectional data were sourced from Yola South Local Government Area using questionnaire instrument. The aim of using this kind of data is to take advantage of sampling a host of individuals at a given point in time. Yola South Local government Area have been chosen because it is one of the largest and had the most populated Local Government in the state, with population of 196,197 (census,2006). In this regards therefore, a structured questionnaires were administered to the respondents, and those respondents are the selected health workers in all twenty-two health care centers within Yola South local Government Area.
The information collected from them will be correct and accurate due to the objectivity in the distribution.
Population of the study
Population refers to the entire group of people, events, or things of interest that the researcher wishes to investigate (Sekaran & Bougei, 2009). The target population will be the entire 22 primary health care centers in Yola South local Government, which consist of 482. In order to have a faster data collection and equal number of respondents from primary health care centers in Yola South local Government Area, the study administer a total of ten (10) questionnaires per primary health care center workers, to give an approximate total of two hundred and forty one (241) respondents for the entire health care centers.
Variable Measurements
Human Resource Management influences workers’ productivity through its various components as earlier identified in the literature. Accordingly, a host of proxies for both dependent and independent variables have been identified. Therefore, this study intends to measure each of the variables to be use in this paper as follows:
Measure of Dependent Variable
Health Workers’ Productivity: this is measure in terms of the number of patients attended to by a particular health worker daily. It is coded in form of ordinal scale as follows: 1 – 5 = 1, 6 – 10 = 2, 11 – 15 = 3, 16 – 20 = 4 and 21 and above = 5.
180 Measures of Independent Variables
This study makes use of various components of Human Resource Management that have been identified to influence workers’ productivity. These are measured as follows:
Sex of health workers: this is measured in terms of the gender of a health worker (1 = male, 0
= female). It is assumed that male workers will be more productive than female as the former are more likely to be constraint by social and health related cases.
Educational qualification of health workers: this is measured in terms of educational level of the respondents which is coded as follows: primary School Certificate = 1, Secondary School Certificate = 2, Certificate/Diploma = 3, HND/Degree = 4, and Masters and above = 5.Going by a priori expectation is that the performance of Health workers is relatively influence by their level of educational qualification. this is because, the more the person further his studies the better he becomes in dealing with health related cases as well as his productivity.
Employment Status of Health Worker: This paper tries to find out whether the health workers are full timers or part timers and going by the a priori expectation is that the higher the number of full time staff the higher the productivity, and it was coded as follows: full time = 1, part time = 0.
Health workers’ years spend in practice: this paper also tries to find out if the number of years spent in practice will determine the productivity of health workers and the variable is going to be measured as stated by the respondents in the questionnaire.
Workshops/seminars: workshops and seminars participation by health workers will improve their skills and experience in dealing with health related cases, as such this study expect a positive result. That is seminars and workshops will influence health worker’s productivity. It coded as follows: yes = 1, no =0.
Motivational factors to health workers: There are many factors that will increase the worker’s productivity, some of these factors are: salary, over time payment or bonuses, timely promotion, and team work. A positive result is expected and it depends upon the choices in ranking based about importance by health worker.
Adequate health care facilities: Based on the a priori expectation is that when there is adequate medical facilities in the health care center the efficiency and productivity is enhanced, as such the study coded the variable options as follows: Less adequate = 1, adequate = 2, highly adequate = 3.
Patient’s visitation to healthcare centers: This paper is trying to measure the level at which patients attends health care centers as an indicator to health workers performance as well as productivity. We expect that when the patients are attending health care centers frequently that means the service rendered is satisfied which are coded as follows: less frequent = 1, frequent
= 2, highly frequent = 3.
Training: The level of training will definitely increase the productivity of health workers in any organization. With this in mind, when the health workers engage in regular training, the level of their productivity will also improve. Therefore, this study measures the productivity by the level of their training, and the variable options are coded as follows: less effective = 1, effective = 2, very effective = 3.
181 Method of data analysis
The statistical package for social science (stata) was used in computing data results obtained from sample size of 220 respondents, which is about 50% of the total population of 482 health workers in twenty (22) Primary health Care centers within Yola south Local Government Area.
Based on Tado Yamane’s formula (1967), 10 respondents were selected without bias in each primary health centers
Model Specification
Thus, the dependent variable is unobservable in nature, which necessitates the use of Categorical Dependent Variable Model (CDVM). Therefore, Ordered Logistic Regression Model (OLRM) was used. The statistical model for ordered logistic regression is:
yi* = β Xi + ei 1
Where: yi* = Unobservable dependent variable Xi = Vector of explain.
Hwpi* = α + β1 EmSta + β2Wexp + β3 Educ + β4WrkSem + β5Mtv + β6tTrai + β7Vstn + β8Hfac
+ β9Sex + µi 2
Where:
Hwpi* = Health Worker’s Productivity α = Constant Parameter of the Equation
βs = Coefficient of the Independent Variables Educ = Educational Qualification
Wexp = Working Experience
EmSta = Employment Status
WrkSem = Workshops and Seminars Mtv = Motivation (over time bonus)
Trai = Training
Vstn = Patient’s Visitation.
Hfac = Adequacy of Healthcare Facilities
sex =sex of health worker
µi; = Error term
Results and Discussion
This section deals with analysis of data collected, interpretation and discussion of results, in order to assess the impact of human resource management on the productivity of health workers within Yola south Local government Primary health care centers.
Table 1. Summary of the socio-economic characteristic of respondent
Variables Maximum Mean Minimum
Age 55 64 20
Output 10 1
Gender Frequency Percentage%
Male 294 61
Female 188 39
Source: Researcher’s computation
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Table 1 shows the descriptive statistic of the socio- economic characteristics of the respondents.
The result shows that the maximum age of the respondents is 55 years and the minimum age of the respondents is 20 years. Their mean value is 64. The gender ratio is 294:188, with females representing 61% and 39% respectively.
Table 2: Ordered Logistic Regression on the impact of HRM on health workers’
productivity
Robust standard errors in parentheses *** p<0.01, ** p<0.05, * p<0.1
Table 2 above reports the ordered logistic regression results on the impacts of human resource management on health workers’ productivity. Coefficient and odd ratio of each variable in the model were presented in the table. The estimated results reveal that gender (if male), age, workshop and seminar, employment status (if full time), overtime bonus and patients’ visits and health facility are the significant determinants of health workers productivity.
The results show that being a male health worker brings about less likelihood for the health worker to attend to more patients daily and the variable is statistically significant at 5 percent since its (sex) p-value is less than 5 percent or 0.05. The odd ratio of sex suggests that being a male health worker makes the odds of health workers’ productivity to decrease by 44 percentage points (1-0.56). This is of course the reality as most workers in primary health care centres in Nigeria are mostly female as such, health cases related to female and children are usually treated by them. Hence, female health workers are more likely to be more productive than their opposite gender.
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The results also show that as the age of a health worker increases he/she is more likely to attend to more patients per day based on his or her experience to service, and it is statistically significant at 1 percent level of significance, i.e. half of its coefficient is far greater than its standard error. The odd ratio of age reveals that as the age of health worker goes up, the odds of high health worker’s productivity will be 1.13 times larger than the odds when the age is low. This is perhaps goes in line with the reality because the longer the time a health worker spend in attending health related cases, the more solutions he has to solve as well as his productivity.
Attending workshops and seminars makes it more likely for a health worker to be less productive and the variable is statistically significant at 1 percent. The odd ratio indicates that attending workshops and seminars make the odds for a health worker’s productivity to reduce by (1-0.32) 68 percentage points. This may be because the health workers use the skills acquired, from workshops and seminars, for their personal gains instead of at the workplace.
A times when health workers are attending workshops or seminars they accumulate a lot of skills and those attributes they possess may give them alternatives to establish a private hospitals, which they will charge public a little bit higher than when they rendered the same service in public hospitals and at the same time their productivity will be low compared to when it is in their hospitals (private).
It is also reported that a full-time health worker is more likely to be less productive than a part-time health worker is and it is significant at 1 percent. According to the odd ratio of employment status, the odds for a full-time health worker to be productive reduce by 52 percent (1-0.48) than the part-time health worker. This is may be as a result of being a full time staff will make him to be redundant because he has a job security, as such an output that is expected from his service would not be attend. Unlike the part time staff which he/she wants to get trusted from his/her employers and perhaps makes the staff to work harder, with the expectation of getting a permanent appointment which makes his productivity to be much higher than that of a permanent health worker.
The table also reports that paying overtime bonus makes health workers more probable to be productive and the variable is significant at 10 percent. The odds for paying a health worker overtime bonus makes the worker 1.83 times productive than not paying. Financial motivation in form of money motivates them to perform well in health care institutions in Nigeria, and not when they are discourage with such financial motivations as stated earlier, or may be its by nature that when an employer want to get maximum output from employees he/she have to encourage them financially.
The frequency at which patients visit health facility makes it more likely for the health workers to be productive and it is statistically significant at 1 percent. The odd for frequent visit to make health workers more productive is 2.16 times larger than the odds for low visit. Moreover, the model is collectively significant at 1 percent level of significance. This is may be because when more patients are visiting health care centres, the patients attend by each health worker will be higher as such his productivity will also be high. Therefore, for a health worker to be more productive he has to attend a considerable number of patients in a day.