AN EVALUATION OF IN-SERVICE TRAINING AND DEVELOPMENT OF PROFESSIONAL HEALTH WORKER

CHAPTER ONE

1.1       INTRODUCTION

Human Resources development has played a significant role in the economic development in most developed countries such as United States of America, Britain and Japan among others. It can, therefore be concluded that a developing country like Nigeria, with its rich natural resources and the necessary financial support can also experience such economic success if the appropriate attention is given to the development and training of her human resource. No wonder Nigeria government is taking adequate steps to ensure that people acquire the necessary knowledge and skills. The provision of secondary and technical schools, vocational training institutes and colleges, professional and tertiary institutions, as well as the educational reforms currently taking place in the country, are all geared towards the acquisition of skills and knowledge to ensure effectiveness and efficiency in our workplaces. According to Ocquaye (2004) with these efforts by the government, it has become necessary to provide long and systematic training and development programs for employees. This is because every aspect and activity of an organization involves people. For instance, a manager in an organization will not be successful until he has subordinates beneath him who are well equipped with skills, talent and knowledge. To manage an organization both large and small requires staffing them with competent personnel. The formal educational system does not adequately teach specific job skills for a position in a particular organization. Few employees have the requisite skills, knowledge, abilities and competencies (SKAC) needed to work. As a result, many require extensive training to acquire the necessary SKAC to be able to make substantive contribution towards the organization’s growth, (Barron and Hagerty 2001). If employees are to experience flexibility and effectiveness on the job, they need to acquire and develop knowledge and skills, and if they are to believe that they are valued by the organization they work for, then they need to see visible signs of  management’s commitment to the their training and career needs. Training and development are the processes of investing in people so that they are equipped to perform. These processes are part of an overall human resource management approach that hopefully will result in people being motivated to perform. (Barron and Hagerty 2001). It goes without saying therefore that the training and development of employees is an issue that has to be faced by every organization. However, the amount, quality and quantity of training carried out vary enormously from organization to organization. According to Cole (2002:329), factors influencing the quantity and quality of training and development activities include; the degree of change in the external environment, the degree of internal change, the availability of suitable skills within the existing work-force and the extent to which management see training as a motivating factor in work.

In-service training within public service agencies is recognized as a key means through which staff are provided with the necessary knowledge and skills to improve overall institutional performance and achieve the objectives of the organization. Training is the process of acquiring specific skills to perform a job better (Chiaburu & Tekleab, 2005, p. 608). It helps people to become qualified and proficient in doing some jobs (Noe, 2009). Usually an organization facilitates the employees’ learning through training so that their modified behavior contributes to the attainment of the organization’s goals and objectives. Reports of training expenditure within social services departments in the UK suggest increasing amounts of monies are invested in such activity in order to meet the changing demands placed on social care and greater expectations for higher standards in service delivery (Clarke, 2001). To make sure that the training program is accomplishing its goals, an evaluation of the training can be valuable. Training should have, as one of its critical components, a method of measuring the effectiveness of the training. Evaluation will help employers determine the amount of learning achieved and whether an employee’s performance has improved on the job.

One of the pivotal purposes of in-service training courses is to equip health workers with the most relevant techniques that can be used in their daily health practices. In-service training (IST) represents a significant proportion of investments made by Ministries of Health and development partners in building the capacity of health workers to competently, safely and efficiently provide quality health services. Scaling up health services requires significant in-service training investments to build the capability of health workers to provide quality health services competently, safely and efficiently. Despite this enormous investment, IST programs are rarely evaluated, and there is growing demand for more effective, efficient and sustainable health worker training. According to Health Workforce Advocacy Initiative (2010) the health workforce plan should strengthen in-service training mechanisms so that health workers can be adequately informed and skilled to provide high quality care, including mechanisms to ensure training, especially on-site training, for health workers in rural areas (including possible use of information technology).  The in-service training should contribute to continuing professional development. The ultimate aim of staff development is to improve the quality of health care delivery for patient, both by improving the standard of health and quality of service delivery, and by developing the community in which the health delivery takes place.  The encouragement of the professional growth of health should contribute both to their professional practice and their part in the wider life of the society, as well to their career enhancement

However, human resource development in Africa, particularly, Nigeria is none of a mis-fortune/match and the issue requires an urgent attention of all the economic stakeholders, both the government, organizations and the concerned private and public outfit. In support of this, Ake (1989), says the development of indigenous manpower to serve as the propelling force for natural growth and development is no doubt a key to Nigeria’s socio-economic and political development. He stressed further that this is a quite indispensable considering the argument of the concept of transfer of technology as a propelling force for the development of the developing countries of which Nigeria is one. It is important to state here that the lack of adequate emphasis on human resources/ manpower development as tool of development in Nigeria particular at this period of global financial and economic meltdown  which the country is yet to device strategies of overcoming on the part of government and private sector could not be far-fetch from the lack of understanding both the concept and methods for manpower development in a post-colonial Nigerian state in which the process of human resources development for natural growth was distorted by colonialism with the attendant negative orientation that was injected into political leadership (Ekpo 1989).

Many organizations meet their needs for training in an ad hoc and haphazard way. Training in these organizations is more or less unplanned and unsystematic. Other organizations however set about identifying their training needs, then design and implement training activities in a rational manner, and finally assess results of training. It is worth noting that Nigeria has a huge public sector inclusive, employing the highest number of human resources with varied skills. One such organization in the public sector is the Lagos state university teaching hospital.

1.2       BRIEF BACKGROUND OF LAGOS STATE UNIVERSITY TEACHING HOSPITAL (LASUTH)

Lagos State University Teaching Hospital Ikeja emerged from a modest beginning as a cottage hospital which was established on June 20^th 1959 by old western Region Government to provide health care service for the people of Ikeja and its environs. The cottage hospital later metamorphosed into a full-fledged Ikeja General Hospital which served as secondary level hospital care facility. In 2001, it was transformed into a Teaching Hospital to provide world class tertiary level medical care to the people of Lagos and training environment for medical students of Lagos State University College of medicine and post graduate training for resident doctors.

The transformation of LASUTH continues through the implementation of quality management system that will improve patient satisfaction by significantly reducing waiting time for consultations, collection of prescribed drugs, laboratory tests and results to an acceptable minimum. Facilities for advanced medical and surgical care are being rapidly expanded. The continue surgical programme has been indigenized. Carchere catheterization in conjunction with Reddington hospital has commenced and kidney transplant will commenced shortly. The hospital is a major referred centre for Neurosurgery cases.

Lagos State University teaching Hospital at No 1-5 Oba Akinjobi street, Ikeja very close to Nigeria Police College Lagos. Infrastructures are being renovated, new building put in place constructed and processes are being re-engineered. Directional signage, client communication notices, display of pertinent policies (in-patient, out-patient service quality and diagnostic services) designated vehicular parking, numbered building and roads, appointment of fire marshals and safety officers, designated muster points and training in quality services awareness are in progress.

Lagos State University Teaching Hospital (LASUTH) is a 720 bedded teaching hospital with the driving objectives to become a world class teaching hospital using cutting-edged technology and highly developed human resources, to render medical care to the good people of Lagos. Ultimately we aim to become an international recognized centre for medical tourism and a major health resource for the Lagos mega city.

LASUTH VISION:

To be a centre of excellence in health care delivery

LASUTH MISSION:

To provide high quality health care service in a friendly environment where patient, satisfaction is the ultimate.

1.3       STATEMENT OF THE PROBLEM

Lagos State University Teaching Hospital (LASUTH) is a government health facility in Lagos State, and serves as educational hospital and referral point for the region population, and it serves an estimated population of over 200,000. The hospital does recruitment year in and year out for health workers and supporting staff. This facility encountered a challenge of in ability to deliver a high quality services to the clients. This has been a very complicated problem which is not easy to tackle. And it is difficult to identify the reason for the deterioration in the services provided, given the low resources in the facility. That way, the facility had trouble identifying the causes for this challenge. However, it is understood that this multifaceted challenge anchored mainly on the health workers who need continuous development through training and in service education. In LASUTH, the training unit was observed to be under staffed and not working efficiently. The unit is officially existing in the structure, however, in practice has no role and not active in training and educational activities. This to a large extent influenced the competencies, abilities and skills of the health workers. Accordingly, the percentage of staff receiving internal training is very low and in most cases it depends mainly on individual effort. Health workers are not enthusiased for in service training and no improvement in their capabilities, which in turn lead to the deterioration of the quality of health care delivery.

In the same vein, in-service training (IST) represents a significant proportion of investments made by Ministries of Health and development partners in building the capacity of health workers to competently safely and efficiently provide quality health services. Scaling up health services requires significant in-service training investments to build the capability of health workers to provide quality health services competently, safely and efficiently. Despite this enormous investment, IST programs are rarely evaluated, and there is growing demand for more effective, efficient and sustainable health worker training.  In view of this, it is therefore imperative to carry out an evaluation of in-service training and development of professional health worker in LASUTH

1.4       Objectives of the Study

The objective of this study is to evaluate the in-service training and development of professional health worker in LASUTH. Specifically the study wishes;

1. to ascertain the type of in-service training and development that need staff to improve productivity in LASUTH
2. to determine the training and development policies, principles and practices in LASUTH

• to examine how in-service training and development affect performance of health workers in LASUTH.

1. to ascertain the relevance and effectiveness of in-service training and development to staff performance of LASUTH
2. to find out the relevance of the content of the training materials to the job of the health workers in LASUTH.
3. to examine the quality and presentation of resource personnel in your past in-service training and development.

• to find out ways of evaluating health workers in-service training and development in LASUTH
• to ascertain the benefits of evaluating in-service training and development of health workers in LASUTH

1.5       Research Question

The following research questions were formulated to guide this study.

1. What type of in-service training and development do staff needs for improve productivity in LASUTH?
2. What are the training and development policies, principles and practices in LASUTH?
3. How does in-service training and development affect staff performance of health workers in LASUTH?
4. What are the relevance and effectiveness of in-service training and development to the staff of LASUTH?
5. How relevant are the content of the training materials to the job of the health workers in LASUTH?
6. How would you rate the quality and presentation of resource personnel in your past in-service training and development?
7. What ways can we evaluate health workers in-service training and development in LASUTH?
8. What are the benefits of evaluating in-service training and development of health workers in LASUTH?

1.6       Research Hypotheses

In order to achieve the objectives of this study the following hypotheses were adopted for testing:

1. Ho: There is no significant relationship in the type of in-service training need by health workers in LASUTH and staff productivity.

Hi: There is significant relationship in the type of in-service training need by health workers in LASUTH and staff productivity.

1. Ho: There is no significant relationship between in-service training and development of staff and performance of health workers in LASUTH

Hi: There is significant relationship between evaluating in-service training and development of staff and performance of health workers in LASUTH

• Ho: There is no significant relationship between the relevance of the content of the training materials and the job of the health worker in LASUTH

Hi: There is significant relationship between the relevance of the content of the training materials and the job of the health worker in LASUTH

1.7       Significance of the Study

The findings of this study will be useful to professional health workers in public and private health sector, schools and researchers as it will provide practical solution and literature in this respect. It will also help medical directors / administrators to map out strategy and introduce modern schemes for training and development for their staff, to be able to meet the challenges of change in the future. The importance of a healthy nation cannot be overemphasized as they say health is wealth, therefore having well trained health personnel to deliver quality health service is what the study is all about.

1.8       Scope and Limitation of the Study 

The study focuses on an evaluation of in-service training and development of professional health worker in LASUTH. The study will investigate:  the type of in-service training and development the staff needs to improve productivity in LASUTH, the training and development policy put in place in LASUTH,  how does in-service training and development affect staff performance of health workers in LASUTH, the relevance and effectiveness of in-service training and development to the staff of LASUTH, the content of the training materials to the job of the health workers in LASUTH, rating the quality and presentation of resource personnel in your past in-service training and development, ways we evaluate health workers in-service training and development in LASUTH and the benefits of evaluating in-service training and development of health workers in LASUTH. The researcher will use the senior and junior professional staff as the population for the study as this will go a long to help us investigate an evaluation of in-service training and development of the health professionals in Lagos state university teaching hospital.

1.9       Limitation

Problems envisage are the unwillingness to respond to the interview question and questionnaire which will leave the researcher seriously appealing to the respondents before they could respond. Their show of indifference and uncomfortable disposition will not really help issues. The absence or inaccessibility of reliable records and reports on LASUTH for the past ten years as regard training and development activities will limit the research investigation. The unwillingness of medical management to divulge strategic information in the name of confidentiality will constitute limitation to the study. Another major limitation envisage is finance and distance. Of course fund is needed to carry out a study of this nature. The distance from home to the place of study will be stressful, combining family issues with a study of this nature will be quite alarming.

1.10     Definition of Terms

Training

Training is improving an employee’s skill to the point where he or she can do the current job. Training is the process by which members of organizations are thought to acquire knowledge, skills and abilities they need to perform effectively the job at hand. Training is directed at the present job. It is also the process of changing the skills, attitudes, and knowledge of employees with the purpose of improving their level of competence. It is a planned process, usually involving a series of stages where incremental improvements can be identified. It takes two main forms. (i) On-the-job training whereby an employee receives instructions within the place of work, usually through observing the tasks, being guided through them by experts, and then practicing them. (ii) Off- the-job training whereby an employee is instructed away from the place of work, either in a training on the premises (Edmund, 2001:372)

In-service training

In-service training is regarded as a form of practical training, short courses or longer formalized programmes  aimed at upgrading the skills and qualification, and sometimes salaries, of unqualified or under qualified teachers. However, new policy directions tend to reconceptualised INSET as an ongoing professional development of health practitioners (Mothatha, 2000:85) This definition links up with the training that is done outside the classroom in a form of seminars and workshops. Health workers are developed and capacitated during these workshops.

Development

Development on the other hand focuses on building the knowledge and skills of organizational members so that they will be prepared to take on new responsibilities and challenges. Development is used in relation to the process of helping managerial employees who perform non-routine jobs to improve their managerial, administrative and decision-making abilities and competence. Development is also the improvement of the skills and job performance of employees through a set of planned learning activities in order for them to move to more responsible positions within the organization. Development is a participatory, transforming process leading to a greater dignity and self-reliance, greater vision and possibility, greater community and interdependence (Welsh, 1990:310-311).

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