Training and Development

Training and Development as a Catalyst for gaining Sustainable Competitive
Advantage in Nigerian Private Hospitals: A Case Study of Isalu Hospitals

Limited

A DISSERTATION

Submitted to

The University of Liverpool

in partial fulfillment of the requirements

for the degree of

MASTER OF SCIENCE IN MANAGEMENT

2020

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CERTIFICATION STATEMENT

I hereby certify that this paper constitutes my own product, that where the

language of others is set forth, quotation marks so indicate, and that appropriate

credit is given where I have used the language, ideas, expressions or writings

of another.

Signed

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ABSTRACT

In this particular chapter, the researcher highlights and discusses the context
and precisely explains healthcare delivery by both private sectors and public
healthcare sectors in Nigeria. Whereas the private sector being regarded as more
accountable, sustainable and more efficient of the two, public healthcare is known for
the provision of not only equitable services, but also evidence-based care.
Furthermore, the theoretical framework, 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 performs a
methodical review of study examining the presentation of both private and public
healthcare sector functions within developing countries. It is worth noting that the
words “catalyst” and “motivation” are used extensively and interchangeably to imply
the main factors determining the extent of the development. The study therefore
focuses on ways to carry out the study which involves use of literature review,
questionnaires, sampling, doing research, data analysis, visiting the different sectors
of healthcare and carrying out sampling, interviewing health experts together with
looking at the government directives that are related to the healthcare sectors within
Nigeria.

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ACKNOWLEDGEMENT

Firstly, I would like to thank my Dissertation Advisor Prof Robin MacDonald for
his guidance, support and encouragement. He consistently allowed this paper to be
my own work, but steered me in the right direction whenever he thought I needed it.
I would also like to acknowledge my General Dissertation Instructor Prof Sandra
Mohabir-McKinley for providing leadership throughout my study at the University of
Liverpool.
I would also like to thank the management team of Isalu Hospitals Limited for
their support and co-operation; and for sharing their views on the topic which formed
a major part of the dissertation. Without their passionate participation and input, the
data collection could not have been successfully conducted.
Finally, I must express my very profound gratitude to my spouse and my children for
providing me with unfailing support and continuous encouragement throughout my
years of study and through the process of researching and writing this thesis. This
accomplishment would not have been possible without them.

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Contents

ABSTRACT 3
CHAPTER ONE 7
1.1 Introduction 7
1.2 Background of the Research Study 9
1.4 Research Questions 13
1.4.1 Research Goals 14
1.4.2 Research Objectives 14
1.5 Overview of the Thesis structure 15
1.6 Chapter Summary 16
2.0 CHAPTER TWO 17
LITERATURE REVIEW 17
2.1 Introduction 17
2.2 Theoretical Framework 17
2.2.1 Theories of Employee Training and Development 18
Expectancy. 20
Instrumentality. 20
Valence. 20
2.3 Historical Background 21
2.4 Theory relevant to the Research Question 22
2.5 Factors That Cause Employees Failure to Perform After Training 24
2.7 Training Evaluations Influence on Employee Performance 27
2.8 Skills and Knowledge Evaluation 28
2.9 Training Competency Evaluation 29
2.10 An appropriate Integration of the adequate medical intelligence and
surveillance team 30

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2.10.1 Carrying out regular health campaigns and the awareness 30
2.10.2 Harmonious coordination in the health sector 30
2.11 Conclusion 31
3.0 CHAPTER THREE: METHODOLOGY 33
3.1 Study Design 33
3.1.1 Research Design 33
3.2 Research Philosophy 34
3.3 Population and Sample Selection 37
3.4Threats to Validity of the Research Design 39
3.5 Factors that posed Threats to External Validity 40
3.6 Study Site 42
3.7 Sample Size Consideration 42
3.8 Sampling Method and Sample Size 43
3.9 Eligibility Criteria 43
3.10 Data Analysis Approach 44
3.12 Data Collection Instrument 46
3.13 Reasons for Data Collection Method Used 47
3.14 Data Collection Process 47
3.14.1 Phase 1 47
3.14.2 Phase 2 48
3.14.3 Phase 3 48
3.15 Validity 49
3.16 Quality Assurance and Data Management 49
3.17 Ethical Consideration 49
3.18 Data Analysis 50
3.18.1 Assumptions Based on the Statistical Analysis 51
3.18.2 Determination of Statistical Significance 51

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3.11 Conclusion 51
4.0 CHAPTER FOUR 53
FINDINGS AND RESULTS 53
4.1 Introduction 53
4.2 Response Rate 53
4.2 Demographics of the Respondents 53
4.2.1 Gender of the Respondents 53
4.2.2 Management Position 54
4.2.3 Department of the Operation 55
4.2.4 Age Group 56
4.2.5 Level of Education 58
4.2.7: Attendance of Training in the Last One Year 59
4.2.8: Number of Years Worked 60
4.3: The Purpose of Training on Employee Engagement in the Health Sector. 60
4.3.1 Employees` Engagement and Training in the course of Transformation 61
4.3.2 Employee Engagement as well as Training on Innovativeness 65
4.3.3 Training and Employee Engagement for Better Performance 68
4.3.4 Staff training and passion of the workforce 70
4.4: Purpose of Training on Enthusiasm of Workforce 74
4.4.1 Training and Recognition of Workforce 74
4.4.2 Vision of the Institution and Staff Training 76
4.4.3 Training and Leadership Style 78
5.0 CHAPTER FIVE: DISCUSSION OF FINDINGS 85
5.1 Introduction 85
5.2 Training Frequency 88
5.3 Relationship between Training and Performance 90
5.4 Impact of Training on Organizational Vision and Dimension 90

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5.4.1 Training on Staff Performance 91
5.5 Effectivesness of Training and Development on Employee Perfomance 93
5.5.1 Influence of Training on Commitment to Innovativeness 95
5.6 Impact of Training on Improving Passion for Work 95
5.7 Study Implications 98
5.8 Chapter Summary 103
CHAPTER SIX: DISCUSSION, CONCLUSIONS, AND RECOMMENDATIONS 106
6.1 Introduction 106
6.2 Conclusions 106
6.3 Discussion 108
6.3.1 Involvement and Training of Staff 108
6.3.2 Training and motivating employees. 110
6.3.3 Staff training and work gratification. 111
6.4 Conclusions 112
6.4.1 Staff training and involvement 112
6.4.3 Employee Training and Gratification at Work 113
6.5 Recommendations 113
6.5.1 Recommendations for Improvement 113
6.5.2 Recommendations for Further Research 114
REFERENCES 115

CHAPTER ONE

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1.1 Introduction
Health systems sustainability in coping up with contemporary health issues is
the censorious concern in many of the counties and especially Nigeria which is the
area of the research. The study is due to fervently increasing stiff competition among
both the public and private health sectors to maintain their status quo and the
relevance in the market. The examination and area of study explained in the paper is
the creation of the National Health Insurance Scheme (NHIS) which was established
in May 1999 as a major way of intervention by government to improve quality of
healthcare delivery in Nigeria. Training status and the development of any health
sector have over decades occupied the core of the sustainable competitive
advantage in various countries (Ayeleke et al., 2016). Essentially, the health workers
are key assets in the health system and exponentially investing in their talents in
terms of their capabilities and specializations 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 ‌Barney (1991), an organization that mutually and extensively engages
in employees’ development, welfare, and capacity building, maintain their relevance
and outdoes all the prevailing competitors and their output in terms of profit
increases compared to a health organization that neglects their employees'
development. The well served and the dedicated training and 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.
According to ‌Collis and Hussey (2013), capitalizing in the employees’
investment and their professional development is propitious in enhancing teamwork

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and the retention of health workers in private hospitals in Nigeria. ‌Collis and Hussey
(2013) claim that 94% of health workers remain loyal and stays in the hospitals for a
long time if the investment 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 time 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 (‌Collis &
Hussey, 2013). Their study, therefore, posits that employee training and
development is a major factor that drives the professional development and the
quality of workforce in health care organizations.
Prudently, Kash et al. (2014) report that 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. According to Kash et al. (2014), 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 (Kash et al., 2014). 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 Kumah, Ankomah and Antwi (2016), the frequency in the
development initiatives and training mitigates the boredom and redundancy which

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emanates from the prejudiced working habits. The regular training of health workers
elicits the culture of self-evaluation and regular progress analysis among the
workers. Babble (2009) argues that training and the development zealously instills
the sense of candid orientation in future planning. Dedicated training and
development prompt 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 within the health care industry.
1.2 Background of the Research Study

A research conducted 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, they have
seen the negligible improvement in 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.
Suffice to say that both the private and public health organizations have witnessed
meager motivation. Statistical report by the United Nations Statistical Commission
(UNSC) and the World Bureau of Statistics (WBS) revealed that Nigeria is globally
known to be densely populated in Africa with approximately 182 million inhabitants.
This number of the population does not measure up with the number of public
hospitals expected to accommodate the required patient capacity. As per 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:

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cancer, diabetes, cardiovascular disease, obesity, stroke, asthma coronary heart
disease. Besides, WHS reports the estimated malaria mortality rate of the Nigerian
population as 146 out of 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
general 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, both the private and public health care organizations have
witnessed acute shortage of health workers in the last 10 years as a result of 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. The United
Nations Development Program (UNDP) reports that 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 have 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 as well as health national policies. All these revised health
policies 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

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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, thereby making private and public
health organizations to experience skewed resource distribution. In addition, 70% of
medical practitioners particularly doctors are concentrated in the urban areas
because the high population of Nigerian is in the rural. As a result, the high
percentage of the citizens 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 quality health service. According to the Nigeria 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 about 100,000 to
150,000 cases of deaths yearly.

1.3 Significance of the Problem

The formulation of any reasonable research problem is the most critical and
profound first step of any academic research process (Kumah, Ankomah and Antwi,
2016). These scholars liken 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

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academic research processes. 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 problem statement is in a context where the various theoretical
frameworks are demystified with the extent to which the problem statement 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 as follows: There is no research-based information on
the significance of the up skilling and the development as the motivational aspects to
competitive performance in the health sector. The Gallup study argues that not
enough awareness has been done to emphasize the impact of training and
development to both the employees and the organization at large. According to
Kumah, Ankomah and Antwi (2016) 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.
From Reinertsen (n.d) perspective, 82 percent of the middle-skills level needs
an appropriate training mechanism in the professional capacity building. He further
explains that as the skills gaps widen further, the employers are under a great
obligation to train their employees in up skilling to suit the first moving world. The
process entails the creation of a meticulous plan that is associated with set goals.
The scholar also argues that employees and employers should always evaluate their
capabilities that will greatly boost their organization’s results. As per Reinertsen
(n.d), while the functional training exists in an organization the development in terms

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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 value of the training and the advancing 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.
The training further identifies and discusses the modalities in which training and
development can be adopted to qualitatively address immediate need of the Nigeria
health sector.

1.4 Research Questions

This section discusses training and development as a concept and also looks
at the importance of training and development to organizations and the process in
identifying the talent among the employees. From the observation made, well trained
employees are the critical pillars of success in any organization. According to the
research, employees who receive requisite training and development are more
productive on the job. When careful employee selection is done, it does not
necessarily promise exemplary performance in an organization (Smith & Prior,
2020).Also, the performance and the employees are always two separate entities.
According to the theory of reinforcement, the employees always associate a reward

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with the kind of training offered. Therefore, the type of motivation administered to
employees during and after a given training period determines the level of success
and performance by the employees (Piotti, Satchell & Lockhart, 2018). The theory of
social learning also articulate that employees learn much from the environment they
are working in, hence training and development alone cannot determine the
capability and the competency of employees. Due to inadequacy of research data to
substantiate the imperativeness of training and development as catalysts for
competitive advantage, the combination of the two theoretical perspectives
significantly helps to identify the hypothetical information on the importance of the
two motivational aspects. Therefore, the mutual understanding and succinct
investment on the employees will not only improve the organization performance but
also the output of an organization.
According to Gomes and Romão (2018), 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 succinctly on what a researcher
needs 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, the 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 research phenomenon. For the purpose of understanding the

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importance of training and how the process is done, the researcher formulated the
following questions:
i. What are the employers of healthcare organizations’ perspective on the
training and development of their employee and the impact on employee
development?
ii. Why should healthcare organizations develop the competencies of their
employees?
iii. What is the effect of training and development on employee turnover?
iv. What are the critical success factors for using training and development to
achieve competitive advantage in healthcare organizations?
To answer the research question, the researcher was guided by the following set
goals and objectives.
1.4.1 Research Goals
Develop a multidimensional understanding on importance of training and the
growth of employees professionally and the institutional objective in Nigeria.
1.4.2 Research Objectives
According to Parniangtong (2017) and Piotti, Satchell and Lockhart (2018),
the overall purpose and the usefulness of the research is the main objective of
research. In this case, the idea from the research study is translated into substantial
and concrete data and an analytical approach as well as the qualitative approach. It
is used to unravel the underlying fact of 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 (Piotti, Satchell and
Lockhart, 2018). Therefore, based on the stated objective, the following are the
objectives of the study:
i. To explore the importance of the current and the future importance of training
and development in the Nigerian private hospital

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ii. To explore and describe the problems and the benefits of training and
development to the employers in the private hospitals in Nigeria
To be able to conceptualize the reinforcement:
 There was a motivational concept within the context of organizational
development.
 There was analysis and critique of the data obtained in the private hospital
and likewise evaluation of the reliability of the topic under study.
 To conclude and rationally recommend on the importance of training and
development to the private hospital and every other private sector.
Therefore, the objective of this paper is to measure the impact of trainingand
development of the senior management staff and the junior staff of the Isalu
Hospitals. Besides, the research aims to show how these staff contributes
towards the attainment sustainable competitive advantage. Lastly, the research
works towards making conclusions and offering relevant suggestions on critical
success factors for competitive advantage by way of training and development.

1.5 Overview of the Thesis structure

Chapter one of this study has provided a general background of the research
problem. Chapter 2 is the literature review, which summarizes the body of literature
on factors affecting the topic. Chapter 3 contains the data analysis plan for this
dissertation study. Chapter 4 presents the data collection and analysis procedures
utilized in this study. A brief description of the status of the participants and an analysis
of their verbatim interview is analyzed for themes in this chapter. This chapter also
consists of textual description, imaginative variation, structural description, academic,
personal/social, career guidance school counseling, creative textual-structural synthesis,
and conclusion. Chapter 5 presents the conclusion and recommendations implicated by
this study. This chapter contains the background of the study, summary of findings,

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discussion of themes, the significance of research compared to the literature review,
implications, and recommendations for future research, limitations, and conclusion

1.6 Chapter Summary

This chapter has been able to introduce the broad topic of the research and has
been able to consequently narrow this to the research objectives, questions and the
aims. Thus, the literature review section will seek to introduce key research
arguments on the topic and position the current study in context of prior research
that has been done. Further, this chapter has been able to lay foundation for the rest
of the paper.

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2.0 CHAPTER TWO

LITERATURE REVIEW

2.1 Introduction
This chapter reviews the content of the research topic in this field of study.
This review tries to correlate the reviewed theoretical perspective and the research
topic under study. According to Piotti, Satchell & Lockhart (2018), the great future of
the organizational goals is the well trained and skilled employees. On the other hand,
the theory of reinforcement states 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 Theoretical Framework

Employee performance is one of the most important aspects of any organization as it
affects the status of the organization in the industry and how it competes with other
companies (Barake, 2012). It is important to study the influence of training and
development on employee performance because its helps organizations know how
to design and implement a training program in order to achieve maximum benefits.
The human resource department plays a strategic function within the
organization and can be a used to create a competitive advantage against other
companies within the industry using the skills of its employees (Dessler, 2013).
Employees who are properly trained and equipped with the necessary skills required
to effectively perform their given tasks create a competitive advantage and increased
revenue for the company which is why most organizations organize training and
development programs for their employees. Employee training and development
helps in securing the future of the organization through succession planning in that
the human resource department is tasked with the mandate to ensure that whoever
is in line to take up a key post is fully equipped with the necessary skills and

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knowledge to handle the pressure and demands that new job will come with hence
the demand for training and development programs within the organization.
According to Noe, (2010), employee training and development plays a considerable
role in enhancing employee performance, firms’ profitability and improving
operational performance of organizations within the industry (pp. 263-265).
According to Dessler, (2013) even when employees are carefully selected, it
does not still guarantee totally acceptable performance from the employees. This is
because while the potential of an employee to perform is one thing, performing is
another and therefore an employee with a high potential to perform may not still
perform his job if he does not go through training and development. This is why
training of newly employed starts with organizational orientation.
2.2.1 Theories of Employee Training and Development
Habib et al. (2015) notes that researchers have engraved through their
studies the different dimensions of training and development in various sectors of the
corporate world in gaining an edge over the competition, not that people are once
trained and the game is over but the actual thing of concern is to continuously train
the workforce about the change and learning to achieve high in such a change.
Ghafoor et al. (2016) assert that organizations use training and development
as a way of closing the gap between the current organizations’ performance to the
expected future performance. They further argued that there exists a significant
relationship between training and development, and employee performance. Training
programs are meant to either improve performance of the present job of the
individual, train new skills for either new job or new position in the future or the
general growth for both the employee and organization (Bunch, 2016). Therefore,
they do so through identifying of the needs for training and development, selecting
methods and programs needed for these needs, planning how to implement and
finally evaluating the outcome results (Hill, 2016).

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The study used a theory that the researcher felt was relevant and valuable
namely victor Vroom’s Expectancy theory. This theory is classified as a Behavioral
theory of learning and motivation and based on the premise that human behavior is
driven by the need to gain rewarding stimuli and eliminate aversive behavior which
makes them best suited for this study as the researcher is trying to find out the
connection between training and development practices and how they affect an
individual’s performance.

2.2.1.1 Expectancy Theory

This theory is relevant and significant to this study in that it acknowledges
individuals are motivated to perform better or change behavior towards their job
based on three factors and they must all be addressed. Therefore, this theory can
help or guide a researcher to establish factors that motivate employee performance.
Expectancy theory suggests that a person’s behavior is based on three
factors namely expectancy, instrumentality and valance. The core argument of
expectancy theory is the force of motivation behind any behavior is the function of
valence, instrumentality and expectancy. In conjunction with skills, abilities, role
perceptions, and opportunities, motivation contributes to job performance.
Expectancy theory suggests that motivation may be enhanced by linking rewards to
performance (as in pay-for-performance plans) and by administering rewards that
are highly valued (as may be done using cafeteria-style benefit plans). In other
words, this theory posits that human behavior results from the interaction of the
individual and the environment in the context of a specific situation and the individual
develops beliefs about the probability of the various possible outcomes of their
behaviors, preferring some over others (Triandis, 2012).
From a training perspective, expectancy theory suggests that learning is most
likely to occur when employees believe that they can learn the content of the
program (expectancy), learning is linked to outcomes such as better job

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performance, a salary increase or peer recognition (instrumentality) and employees
value these outcomes (valence) (Daft, 2014). The following factors stand out as
strong determinants of employee performance.
Expectancy.
According to Vroom, (2016) expectacy is belief about the link between trying
to perform a behavior and actually performing well. Shannon Riley study (as cited in
Dugguh et al., (2014)) states that to achieve or accomplish organizations objectives
can be achieved by organizations setting clear, achievable goals and standards for
each position, and making sure employees know what those goals and strategies
are. It is important for supervisors to give feedback to employees on how they are
doing.
Paarlberg & Perry, (2017) notes that the effort employees put in the training
and development program will determine the performance towards the program.
Paarlberg & Perry, (2017) asserts that in order for a training program to meet the set
out objectives, employees need to gear themselves up to learn and need to have
predetermined objectives or prospects that they want to gain from the program.
Instrumentality.
Vroom, (2016) explains instrumentality as a belief that performing a given
behavior like attending a training program is associated with a particular outcome
like being able to better perform your job. Beardwell, Holden, & Claydon, (2010)
notes in their study that employees should be acknowledged for doing something
well immediately after they have been trained, the study further states the employees
often link the work done to the reward and that if the reward is not beneficial to them,
they may not be as productive.
Beardwell et al., (2010) articulate that there is strong link between expected
reward and job performance and management can utilize that link to ensure that
employee participation in training programs eventually affects employee

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performance. The study further states that as employees grow, they can be provided
opportunities for added responsibility by adding challenging and meaningful work.
Valence.
Vroom, (2016) defines valence as the value that a person places on an
outcome or how important it is to perform better on the job. It is important for an
organization to help the employees believe that the project or task is important and
meaninful and show employees how their work is essential to the overall processes
that make the practice succeed. According to Chiang & Jang, (2017) employees
want to feel that their talents and skills enables them to develop in a certain
organization through opportunities for growth and alinging an individuals values,
needs, goals and preferences motivates them to increase job performance because
they begin to value what they do with the organization.
Valence is one behavioral alternative where the decision is measured on the
value of the reward and management should focus on aspects that most employee
value when deciding the type of reward to be given for attending a training program
(Noe, 2010).

Figure 1 (Noe, 2010, p. 147)
According to Beardwell et al., (2010), a reward could help to increase the
value of the change and hence increase performance. Expectancy theory works on
perceptions that employees have towards their training programs and encourages
trainers to ensure that trainees have a positive perception of the training and
development practice if it is to successful and yield the expected results.

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2.3 Historical Background

According to Culpan (2008), for any study, there must be a reflection on the
historical information to determine the type of direction of the study. Relying 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 (Culpan, 2008). Furthermore, the government has not put into
consideration good remuneration of 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.
2.4 Theory 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 promotes 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 Co‐creation at orange and
Cisco systems (2010), motivated employees are always focused on improving the
performance of an organization. On the other hand, the two theoretical perspectives
differ in the sense that the learning perspective claims that the behavior of individual

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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. Based on the current literature relevant to research, the
researcher deduced 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.
The 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 are all under the ministry of health
play a crucial role in helping the individual deal with any outbreak. 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 (Co‐creation at orange and Cisco systems, 2010). The Nigerian government
integrated the program of action and the department of health and response to a
contagious disease to help reduce this affliction.

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Albeit the NHIS Act implemented an appropriate provision for children who
according to the world statistics take the largest population in Nigerian population,
children still incur the cost of health services given that they are forced to pay for
health care services even though most of these children are from poor families who
cannot in any way afford to pay and even gather for their upkeep. As a result, they
suffer financial constraints (Sheposh, 2019). The Nigerian government has also
strived 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 and bad governance. All these
stated issues have rendered the various moves by the government to mitigate and
bring normalcy to be null and void. Considering the objective of the study, Sheposh
(2019) deduced the following measures used in reducing the challenges facing the
Nigerian health sector:
2.5 Factors That Cause Employees Failure to Perform After Training
Subba, (2013) notes that employee performance is affected by various
factors, training alone is not a guarantee that will motivate employees to perform
better and become more active within the organization. The study found that some
employees improved performance after a training program but returned to their usual
ineffective after a few months of working. There are numerous factors that make
employees become discouraged with their job and also this will result to low
productivity.
Communication in the workforce is major contributor to employee decine in
perfromance because most employees are not made aware of what is expected of

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them. Whether it is overloaded or underload, communication is the most important
aspects of an employee’s work in modern organization (Rizwan, 2014).
According to Falola et al., (2014) communication overload occurs when an
individual receives too many messages in a short which can result in unprocessed
information that are more difficult that are more difficult to process, this leaves an
employee feeling disconnected from the organization. Communication underload is
usually the results of managerial staff that is isolated and does not know how to
relate to their employees on a professional or personal level because of this an
employee feels neglected, he or she will tend to perform at a lower level (Falola et
al., 2014).
According to Heathfield, (2017), employees want to be noticed in the work
place and to know that there effort is appreciated by the organization. The study
showed that most employee are motivated to work harder when the effort towards
their job is appreciated and valued by the organization, the study showed of the
employee interviwed, 70% said that they would increase their commitment, loyalty
and perfromance to the organoztion recognised and appreciated the effort they put
into the organization.
According to Cropanzano & Wright (2009) in a study to find the reataionship
between employee satisfaction and productivity stated that it is important to give the
feedback to employees in a way that will encourage or motivates them than giving
results in harsh tone leaving an employee feeling neglected and worthless in the
workplace.
Many organizations are missing out on employees that are dedicated to their
organizations and knowledgeable in their fields (Ahmad & Bakar, 2015). According to
Bunch K. J, (2013) failure to provide employees with opportunities to grow within the
organization results in employee frustration, barriers such as favoritism of certain
employees may also prevent employees from reaching their full potential and if these

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employees are not treated fairy, they are willling to reduce input into the work and
take advantage of other job offers that will provide them with more stability
2.6 Strategies That Promote Employee Performance after Training
A study conducted by the Becker, et al. (2016) revealed that conducting
training and development programs is not always enough as employees can decide
not to utilize the skills and knowledge passed on to them from them. The study
recommended that management needs to engage with employees to ensure that
employees apply their new gained skills, knowledge and competencies towards the
organization for organizational and personal growth.
According to Montana & Charnov (2008) employees have a natural tendency
for management to focus most heavily on senior-level economic incentives. Their
study revealed that economic incentives like pay raise or increased allowances
motivate employee to increase their performance and attitudes towards the job, the
study recommended that management should offer employee special incentives for
improved performance especially when it is in line with organizational objectives.
A study conducted by Falola et al. (2014) on the effectivesness of training and
development on employee perfromace showed that most training programs are do
not reap the inteaded rewards because of the information gap that exists between
management and employees. The study revealed that most employees are not
aware of what the organization wants from them and hence the need for continoius
feedback. Barake (2012) states that feedback is a foundational management skill
and the ability to provide regular, helpful feedback to employees in a manner that
encourages, not discourages, is a cornerstone of effective management, his study
recommended that management should constantly provide feedback to employees
on work related matters if they are to be more productive.
An examination was done on non-governmental organizations in Kenya by
ChaCha (2015) on the human resource factors influencing employee performance.

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The study showed that allowing employees to have some input into the training
strategy gives them a sense of ownership and commitment towards the job as they
recommend areas that they feel need to be dealt with regarding their work
performance. The study showed that employee performance after training improved
greatly when the organization decided to let employees state areas they wanted to
be taught on.
Funder (2010) notes that valued support to employees helps them do their
jobs better because they understand that the organization has their backs and
whenever they are stack, they can rely on the organization for support. Wright &
Geroy (2012) note in their study on the training myth and the need for word-class
performance that employees who are given support during their work showed a
radical increase in perforance compared to those who did not receive support form
management. The recommended that employee support should be considered when
dealing with employee perfromance.
An investigation kenya conducted by Wanyama & Mutsotso (2017) on the
relationship between capacity building and employee productivity on performance of
commercial banks in kenya expressed the need for organizations to utilize employee
skills and knowlegde towards organizational productivity. The study stated that
employee skills and knowledge can be easily lost without practice and recommended
that it is important that after completing their training, employees get a chance to put
it into practice rather than sticking to the previous method of work procedures.
Thomson (2002) articulates that training should not only be aligned with the
needs of each individual and team, but with higher level business strategy as well,
the skills that are developed should be a long-term investment that will deliver long-
term benefits to the business and its customers. Subba (2013) noted that the
organization is more likely to support and promote training programs that add value
and booster the organizational objective.

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2.7 Training Evaluations Influence on Employee Performance
Training evaluation is the process of determining the effectiveness of a
training program that has been or is being implemented by an organization (Noe,
2010). Investments in training evaluations increase the chance that employees will
be trained on right content and competencies. As much as these investments
provide direct benefits to employees, little direct wider returns are evidenced. A study
conducted by Bunch (2016) in the US revealed the existence of a positive
relationship between training evaluation and employee performance. He argued that
evaluation helps trainers and organizations to review components of training and
development that are not working and adjust them accordingly for maximum output.
According to Ghafoor et al. (2016), the importance of training evaluations is to
ensure training programs are in line with that of job competences. In organizations,
performance evaluation is not only seen as what organizations ought to do to
enhance performance, but also what employees’ need to do to enhance their
performance. To this end, Banaii (2017) notes that most organizations do not
conduct effective training evaluations because they do not know in the first place,
what they are supposed to be measuring. There are two main types of evaluations
that are relevant in determining the influence on employee performance and are
listed below

2.8 Skills and Knowledge Evaluation

Skills and knowledge evaluation are important in determining the impact of a
training and development program. According to African Union (2016), knowledge
and skills competencies tend to be visible as surface characteristics, whereas self-
concept, traits and other motive competencies are hidden central to the personality
of the employee. As such, Daft (2014) argues that surface knowledge and skills are
easy to develop and evaluate in training, and also provide most cost-effective way to
secure employee’s capabilities. To this end, it can be argued that skills and

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knowledge evaluation provide management both with the skills and competencies
necessary for performance. This is equally so for enhancing corrective actions
before, during, or after a training
According to Armstrong and Taylor (2014), whenever a training evaluation
opportunity is not taken advantage of, both the employee and the organization
suffers since training skills efficiencies are not captured. Evaluation opportunities
therefore provide an organization with the chance to monitor, and model desired
outcomes out of training and employees through leadership and other transferable
competencies (Weaver, 2017). Therefore, failure to institute training evaluations is
failure to enhance organizations’ training objectives. However, Weaver (2017) had
cautioned that organizations should not over-rely on competency-based education
training since this kind of evaluation and training only trains employees to be
competent in given skills and not experts. This means that if the main aim of an
organization was to develop experts in a given field, then training and evaluations
based on competency model might not be beneficial. An organization might need to
have employees acquire additional professional training or development through
other mechanism. In skills and knowledge training evaluation, it is important that
training must result in improved employee performance and failure to accomplish this
objective would mean that the training was not effective (Bunch, 2016).
2.9 Training Competency Evaluation

Training competency evaluation is defined as the process of examining a set
of competencies that are supposed to be accomplished through a training program
and competencies are work traits that an employee possesses that enable the
employee to accomplish their work functions (Cole, 2004). Ahmad & Bakar (2015)
posits that in evaluating training competencies, performance is not looked on from
objective perspective, but also from competencies that are demonstrated to carry out
such work. This means that training must have the capability to enhance employees’

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ability to carry out their work. Armstrong and Taylor (2014) noted that in cases where
evaluation reveals that competencies within the training program are not effective,
then the entire program would be considered defective. Noe (2010) contends that
competencies are behaviors that encompass the skills and knowledge attributes
required to successfully perform a given function. Some organizations use
knowledge and skills, habits, social roles and even self-image as necessary
requirements for competency based performance. Therefore, when such
organizations develop an evaluation framework, they are basically looking for these
traits.
2.10 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 wellbeing, it will be able to relay the challenges
faced in the health sector in Nigeria. According to the WHO, 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.

2.10.1 Carrying out regular health campaigns and the awareness
This is 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 citizens are well
informed about good health care, the whole nation will benefit from the National
Primary Health Care Developing Agency (NPHCDA). Ochonma and Nwatu (2018)

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also state that the appropriate prioritization of the employees' welfare is to the benefit
of the whole organization.
2.10.2 Harmonious coordination in the health sector
According to Gautam and Bhandari (2017), 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 Gautam and Bhandari (2017), 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.
Therefore, for the employees of any given organization to competently build their
professionalism and become the specialist, substantial training and development
must be adequately imparted. Gautam and Bhandari further states that the
employees who are virtually trained tend to reciprocate meagerly in terms of the
output while on the other hand the trained employee wholeheartedly works towards
the achievement of the set goal of an organization. The reason behind dismal
performance among the various private sectors is that after hiring qualified
employees they exposed them to little or no training leading to continued
retrogressive performance.

2.11 Conclusion

The literature review section has outlined key arguments in the research
jargon in regards to training competence and influence its influence over
organizations. Training competency evaluation is defined as the process of
examining a set of competencies that are supposed to be accomplished through a
training program and competencies are work traits that an employee possesses that
enable the employee to accomplish their work functions (Cole, 2004). Ahmad &

36

Bakar (2015) posits that in evaluating training competencies, performance is not
looked on from objective perspective, but also from competencies that are
demonstrated to carry out such work. This means that training must have the
capability to enhance employees’ ability to carry out their work. Armstrong and
Taylor, (2014) notes that in cases where evaluation reveals that competencies within
the training program are not effective, then the entire program would be considered
defective. Noe, (2010)contends that competencies are behaviors that encompass
the skills and knowledge attributes required to successfully perform a given function.
Some organizations use knowledge and skills, habits, social roles and even self-
image as necessary requirements for competency based performance. Therefore,
when such organizations develop an evaluation framework, they are basically
looking for these traits. The following section will seek to introduce the research
methodology and the last chapter will seek to introduce research findings and
analysis.