EFFECT OF WORK-LIFE BALANCE ON PERFORMANCE OF SELECTED FEDERAL AND STATE HEALTH INSTITUTIONS IN SOUTH -EAST NIGERIA

ABSTRACT

The study investigated the effect of work-life balance on performance of selected federal and state health institutions in South- East, Nigeria. The specific objectives of the study sought to: ascertain the extent to which employee assistance programme affect employee commitment, assess  the nature  of relationship  between  leave  policies  and  job  satisfaction,  assess  the nature of relationship between alternative work arrangements and productivity, explore the effect of dependent care policies on employee turnover  and highlight the extent to which managerial support affects goal attainment. The study adopted survey design. The population of the study was 7,936  medical and non  –medical  staff from five selected  federal health institutions and five selected state health institution in South-East, Nigeria. Staff sample size of  1020  was  determined  using  Freund  and  William’s  statistical  formula  from  the  staff population  of  seven  thousand,  nine  hundred  and  thirty-six  (7,936).  Stratified  sampling technique was used to select the respondents in each of the selected health institution while Bowley’s  proportional  allocation  method  was  adopted  to  determine  the  allocation  of questionnaire to each of the participated health institution. Data were collected through the use of the questionnaire  and oral interview guide. The questionnaire  was structured  on a five–point Likert scale. A pilot study was conducted using test–retest method and tested with Spearman Ranking Order Correlation Coefficient. The result gave a reliability coefficient of

0.92, indicating a high degree of items consistency. The face and content validation of the

instrument  was  done  by  five  management  research  experts  from  both  the  industry  and academia. Simple linear regression and Pearson’s product moment correlation  coefficient were used for the data analysis. The acceptable probability level of significance was 0.05. The  findings  revealed  that  employee  assistance  programs  positively  affected  employees’ commitment (r =0.867; t = 6.31; F = 84.21 p < 0.05). Annual leave, maternity leave and sick leave had a positive relationship with job satisfaction (r = .94, p < 0 .05; r =.79 p < 0.05; r

= .83 p < 0.05). Compress work weeks, telecommuting,  flexi time, and job sharing had  a positive relationship with productivity (r = .94, p < 0 .05; r =.89 p < 0.05; r = .63 p < 0.05; r = .53 p < 0.05). Dependent care policy positively affected turnover intention (r =0.729; t =

4.312;  F =61.22  p  <  0.05).  Managerial  supports  positively  affected  goal  attainment  (r

=0.974; t = 9.44; F = 59.82 p < 0.05).The study concluded that effective implementation of work-life balance indicators did not only benefit the selected health  institutions but it was also  a pointer  for better organizational  performance  in  terms  of competitive  advantage, better  service  delivery,  customer  loyalty,  workers’  commitment,  efficiency,  profitability, employee  retention,  good  corporate  image  and   environmental   friendliness.  The  study recommended that management of health  institutions in South–East and the entire country should effectively implement work-life balance initiatives in order to offer a family-friendly atmosphere  to  attract  and  retain  qualified  employees  for  better  service  delivery  to  the affected Nigerian population.

CHAPTER ONE

1.1      Background of the Study

INTRODUCTION

The history of work -life conflict is very old. During barter system, the concept of work was not so clear. In this era work was not considered as employment rather it was just a source of survival. The work-life conflict was not a social issue, as the conflict between the work and family was very small. The industrial revolution of 18th century changed the work settings as well as social setup. Dramatic changes were seen during this period,  industries were setup and the functional design of factories led to division between employees and the employer. Organizations  were structured  and employee  loyalty wasbased  on the efforts to make the organization  profitable.  The  period  of  industrialization  served  as  a  fore  runner  to  the work/family conflict that intensified in the subsequent years. The relationships, struggles, and conflicts between workers and employers and between families and the workplace grew in this era (Thomas and  Clifton, 2008).However,  the term “work/life balance” was coined in

1986,  although  its  usage  in  everyday  language  was  sporadic  for  a  number  of  years. Interestingly,  work/life programs existed as early as the 1930s. Before World  War II, the W.K. Kellogg Company created  four six-hour  shifts to replace the  traditional three daily eight-hour shifts, and the new shifts resulted in increased  employee morale and efficiency (Lockwood,2003).

World War II (1939-1945), brought significant changes in the composition of workforce in organizations,  it  gave  rise  to  diversified  workforce,  and  increase  the  number  of  female members in workplace. Consequently, work-family issues got significant attention worldwide which  directed  the  government  to  provide  facilities  like  child  care  and  other  welfare packages. With the passage of time, family-friendly policies went beyond the range of mere welfare packages.  In the 1980s and 1990s,  companies began to offer work/life programs. While the first waves of these programs  were primarily to support women with children, today’s work/life programs are less gender-specific and recognize other commitments as well as those of the family (Lockwood, 2003). The origins of research on work-life balance can be traced back to  studies of women having multiple roles, as paid worker, wife and mother (Barnett and Burch, 1985).

Until recently, the issue of work-life balance was conceived primarily as a Western idea, in countries like United States of America, United Kingdom etc., but this has radically changed

as African women have taken up paid employment in the contemporary era in order to be part of provision of family needs. Nevertheless, this has also come with a huge price as families, organisations  and social lives are impacted  in the process (Anwar and  Shadzah, 2011).In African patriarchal society, the impact of work-life balance (WLB) on employees particularly women is challenging. This may well be because women combine the very tasking domestic duties which include childcare with their paid work activities  (Cross and Linehan, 2006). Although both men and women are said to experience inter-role conflicts between work and family domains, women typically assume more family responsibilities than men (Pillinger,

2002). Also, managing work and family obligations are particularly difficult for women in a patriarchal society. This is in view of the realities of patriarchy that puts women in a position where  family  commitments  come  into  serious  conflict  with  occupational  life  (Aziz  and Cunningham, 2008). It is common knowledge that African patriarchal system  is essentially one of the major reasons women are subjected to serious work stress as well as work-life imbalance  that  affects  their  motivation  and  commitment  to  work;  this  in  final  analysis impinges on the productivity and performance of African organisations (Aluko, 2009).

However, in the contemporary Nigerian environment with serious economic challenges and labour market pressures added to poor social infrastructures,  poverty, high unemployment, and  corruption,  competing  demands  between  work  and  home  have  assumed  increased relevance for employees in recent years. These conditions further  exacerbate the work and life of the average Nigerian worker whose aim is to make a  living and who may have to arduously  build  up  accommodating   arrangements   and   cognitive  psychological   coping behaviours that stimulate desirable satisfaction and effectual functioning both at work and at home(Idemobi and Akam, 2012). Besides due to demography and workplace changes such as rising numbers of women in the labour force, an ageing population, longer working hours and many others, organizations are increasingly pressured to implement work practices intended to  facilitate  employee’s   efforts  to  fulfil  both  their  employment   duties  and  personal responsibilities(Williams and David, 2006).

Globally, hospitals are experiencing more competition and scarce resources than ever before. They are also  confronted  with  variety of challenges  posed  by the business  environment internally and externally. In spite of these challenges, hospitals are competing to achieve their goals effectively and efficiently. Changes in the work style, work culture, family needs, work demands, are rapidly taking place within the healthcare sector and workers’ attitudes toward

their  hospitals  and  life are affected  by work-life  balance  (Hassan  and  Winefield,  2010). Work-life balance among hospital employees has now become an issue of serious concern worldwide.   The  growing  participation  of  women  in  workplace   has  produced   totally diversified workforce, which give rise to maintaining work-life  balance among workers in healthcare industry (Halpern, 2005). Government concern globally seems to increase in past few decades because imbalance work-life cause negative impact on employee’s health which consequently reduce the productivity and creativity among employees and hospitals (Lewis and Rhona, 2007). Job stress has become the crucial problem in the healthcare industry as most hospitals nowadays suffer with the problem of inadequate staff, more expectations on the  side  of patients  and  their  families,  long  and  odd  working  hours,  inconsistent  salary structure and  poor working condition.  In addition,  exposure to hazardous  substances  and infectious diseases also raise the level of work-stress among healthcare staff (Dickson, 2008). Feather and Rauter (2004) reveal that the level of stress and rates of psychological problems among  healthcare  workers  are  higher  than  any  other  sector.  The  repercussions  of these undesirable  outcomes  not  only  affect  the  employers  but  also  create  negative  impact  on patients’ health.

In Nigeria, primary health care is provided by local governments, secondary health care (state owned general or university hospitals) by state governments and tertiary health care (federal hospitals) by the federal government. In operationalizing this policy, the federal government decided  to  establish  at  least  one  tertiary  health  institution  in each  state of the  Nigerian Federation. Federal Medical Centres (FMCs), were established  nationwide in states that do not have Federal University Teaching Hospitals present. The exception to this rule is Lagos State, which has one such centre in addition to a Teaching Hospital (Okogbue, 2007).In May

1999,   the   government   created   the   National   Health   Insurance   Scheme,   the   scheme encompasses  government  employees, the organised private sector and the  informal sector. The  scheme  also  covers  children  under  five,  permanently  disabled  persons  and  prison inmates. In 2004, the government further gave more legislative  powers to the scheme with positive amendments to the original legislative acts. Although each state can now boast of a state or federal hospital and insurance schemes, health care delivery in Nigeria particularly in the South Eastern still falls short of international standards resulting from poor state of health care  infrastructure,  shortage  of  medical  professionals,  threat  of  re-emerging  infectious diseases  and  poor  sanitation.  Recognisable  demographic  diversity  exists  in Nigeria  with consequent disparity in availability of health care facilities across the country (Okeke, 2008;

Ouma &Herselman,  2008). Nigeria  for a long time has suffered  political  instability,  thus creating  the  opportunity  for  corruption  to  thrive  and  enhancing  poor  macroeconomic management  (Okafor-Dike,  2008).  Following  years  of  military  dictatorship  and  lack  of government   accountability,   infrastructural   decay  did  not   attract  the  desired   attention (Okogbue, 2007).

The Nigerian hospitals are notorious for their long hour culture and work load which results in neglect of other areas of life with parents not spending enough time with their children and many kids being raised by maids. This long hour culture has also resulted in many couples separating  or divorcing.  This  trend  has  a  negative  influence  on the  individuals  because Nigeria is a family oriented traditional society; hence the failure of a family system is termed as a failure on the individual which tends to affect the success of persons (Oshagbemi, 2003). Atkinson  (2009)  observes  thathospital  employees  are  constantly  affected  by  workforce changes  due  to  technological  advancement  and  high  rate  of  competition  in  the  sector. Changes in the work style, work culture,  family needs, work demands, are rapidly taking place  which  eventually  increased  the  population  of  dual  earner  couples,  single  parent families,  absentee  fathers  and  eldercare  responsibilities  (Atkinson,  2009).  Adams  (2006) points out that the more a person is involved in his or her job, the higher the work family conflict  which  eventually  leads  to  increase  job  burnout,  low  satisfaction,  and  reduced commitment and increased turnover. Okpara (2004) contends that work-life balance among healthcare  workers is especially important because imbalance in work-life causes negative impact  on employee’s  health which  consequently  reduces  the productivity  and  creativity among employees and organizations and results directly or indirectly in financial losses.

Policies are made regarding work-life balance, but its implementation has become an issue that needs to be looked into. Ensuring effective delivery of service to the affected Nigerian population  may be  achieved  by the  ability of  the  management  of  hospitals  to  maintain policies that promote  work-life  balance.The  management  support  is also  an indicator  for favourable treatment, patient satisfaction, employees’ satisfaction and  long term success of the hospital (Okeke, 2011). Availability of efficient and effective work-life balance leads to increased  intake of skilled medical personnel,  reduces  turnover, increases  job satisfaction, commitment,  dedication  and  positive  health  care  provisions  at  large  (Oloyede,  2012). Lambert (2000) asserts that work-life balance involves the incidence of fulfilment in all areas of  a person‘s  life  and  necessitates,  individual  vigour  and  supplies  of  loyalty.  Work-life

balance constitutes a challenge because where employees are unable to achieve their desired work-life  balance,  their welfare,  as well as national  development  is reduced  (Gutek,  and Klepa, 2008).

Performance is a key determinant in the achievement of organizational goals. Efficient and effective performance is a focal point in any establishment. Every policy should be geared towards  increasing  the  employee  performance.  For  organizations  to  remain  on  top  they should be able to improve their employee performance and monitor it. In a situation where this does not occur, they are liable to face several challenges which stands as a set back to the organization in the sector where they belong (Hye, 2014). An employee’s job performance depends on or is a consequence of some combination of ability, effort, and opportunity. But, the measurements  can be done in terms of  outcomes or results produced (Golden, 2012). Performance is defined as the record of outcomes produced on a specified job function or activity  during  a  specified  time   period  (Golden,  2012).  According  to  this  definition performance is a setof outcomes produced during a certain time period. Performance is not only related to the action but  also involves judgment and evaluation process (Kamau and Wagoki, 2013).

Maertz and Boyar (2009) assert that performance is related to that which the individual that is hired does in fulfilling his / her duties and the activities that can be examined and measurable are reflected. An organization needs high performance of its employees, so as to meet its goal and be able to achieve competitive advantage (Kamalanabhanb  and Selvarania, 2011). The organization success depends on the employee performance. Therefore, it is important for a manager  to  create  a  well  –rounded  approach  to  managing  and  coaching  its  workforce. Hospitals are service industry and their main aim is to satisfy their customers. The service medical personnel renders to the  customer and hospital performance  is interrelated.  When medical personnel provide excellent customer service, they are exceeding job expectations (Ojo and Falola, 2014). The popularity of an organization’s service is based in part on the level of service received by the customer. For service industry the business is based almost solely on their employee’s performance. That is why management must look for various ways in improving employee performance (Ojo and Falola, 2014).

Work-life  balance  is  a  very  important  phenomenon  that  is  of  great  concern  to  various employees in both private and public sector. It goes beyond prioritizing the  work role and one’s personal life. It also affects the social, psychological, economical and mental wellbeing

of the individual. All these is been reflected in the output of the individual, which affects his or her performance in the work place on the long run (Oludayo and Gberevbie, 2015). Work- life  balance  has  implication  on  employee  attitudes,  behaviours,  wellbeing  as  well  as organizational effectiveness (Lewis and Gambles, 2007).

Clark (2004) defines work-life balance as contentment and good functioning at work and at home with negligible  role conflicts.  Work-life  balance  is about finding the  right balance between one‘s work and one‘s life (outside work) and about feeling comfortable with both work and non-work commitments (Abbott and De Cieri, 2008). Many people find it difficult to manage their time in a way that is healthy for work and for personal life not because they are poor at time management,  but basically because  a  good part of the time is not theirs (Glass and Finley, 2006). Greenhaus (2009) contends that, work-life balance does not mean an equal balance adding that one’s best individual work-life balance would vary over time. According  to  him,  the  right  balance  for  one  person  today will  without  reservations  be different  for the  same  person  tomorrow.  The right  balances  for a single  person  will be different  at  marriage,  during  child  bearing;  at the  start of a  new career  versus  close  to retirement. He maintains that there is no perfect, one-size fit all, the best work-life balance is different for everyone because people have different priorities and diverse  lives and where employees are unable to suitably balance work and family life, they tend to find it difficult to manage tasks at the workplace and this subsequently shrinks productivity.

Olowe (2009) believes that work-life balance refers to the flexible working arrangements that allow both parents and non-parents to avail themselves of working arrangements that provide a balance between work responsibilities and personal responsibilities. In practice, it involves “adjusting work patterns so that everyone, regardless of age, race or gender can find a rhythm that  enables  them  more  easily  to  combine  work  and  their  other   responsibilities  and aspirations”.  Kalliath  and  Brough  (2008)  assert  thatwork-life  balance  is  the  individual perception  that  work  and  non-work  activities  are  compatible  and  promote  growth  in accordance with an individual’s current life priorities.

Typical employees who experience high work-life balance tend to invest similar amount of time and commitment to work and non-work domains (Burke and McAteer, 2007). Work-life balance  is  contingent  on  a  number  of  factors  like  family,  demography  and  culture (Beauregard  and Henry, 2009). According to them, individual’s value  system, personality, socialization,   attitudes,  beliefs,   expectations,   motivation  etc.   can   go  a  long  way  in

affectingemployee’s   perceptions   of   Work-Life   Balance.   The   biggest   challenge   that organizations are facing today is not only managing their active resources but also retaining them.  They contend  that  organizations  are  duty bound  to  see  that  practices  which  help maintain a satisfactory relationship between the worker and workplace are encouraged. They stress that retention and attraction strategies to retain employees which   include provisions with regard to family-friendly policies/initiatives such as flexible working hours, alternative work arrangement,  maternity  leave  policies,  employee  assistance  programmes,  dependent care policies, work sharing, part time work, enhanced job mobility, training and development support, health and safety programs and other employee support programs are indispensable for achieving  a right  equilibrium  between  work and life.   In addition,  they contend  that friendly policies  that reduce conflict between job and personal life are likely to affect not only employees physical but also a high level of social, psychological  and spiritual well- being. According to them, employees with a high level of psychological well-being are better, more committed,  and more productive  than employees  with a low level of  psychological well-being.  Peter  and  Johnson  (2007)  assert  that  organizations  with  friendly  work-life strategies will definitely achieve harmony,  job satisfaction  and  positive employee attitude towards the organization and this will lead to employee’s  commitment,  high morale, good corporate image, innovative capacity, and environmental friendliness which will further result to higher productivity and better performance.

1.2      Statement of the Problem

Despite the popularity of work-life conflict as a topic of academics and practitioners, and the mounting prevalence of work-life conflict in organizations, work-life conflict still remains an important  issue  in  human  resource  management.  The  concept  of  work-life  balance  has acquired substantial consideration and been practiced as a campaign by several organizations including  hospitals.  Though  the  notion  has  recorded  significant  attention  by  managers, consultants and from employers in Nigeria, still the status of work-life balance initiatives in Nigerian hospitals is worrisome as employers are not committed towards it, though there are various statuary laws which provide some relief to healthcare employees.

The issue of work-life balance is very significant for healthcare organizations to focus on, the reason being that, the most crucial challenges related to work in healthcare is  exceedingly high level of employee  stress, burnout  and turnover  which is basically  connected  to the frontline employees of the industry. In order to address all these  problems, most hospitals

have taken a one-sided “systems” approach to their work-life efforts. Their focus has been on adopting  organization  policies,  benefits,  and  procedures  to  solve  the  work-life  balance problem. Although helpful, the systems approach overlooks a critical fact: At its core, work- life  balance  is  more  an  individual  issue  that  affects  the  organization   than  it  is  an organizational  issue  that  affects  the  individual.  The  major  issue  that  hinders  effective performance of healthcare workers is that work-life balance initiatives like, leave entitlement, employee assistance programmes,  alternative work  arrangements,  dependent care services, welfare policy, and many others are not  adhered  to by the management of these hospitals Besides, hospitals management are still unaware of the economic implications of not striking equilibrium between work and  personal life. They often do not recognize that unbalanced work-family life caused by increased work demands leads to higher levels of stress and stress caused by higher demands from work results in family-work conflicts which impacts negative not only on the wellbeing of workers but also on their families. On the other hand, achieving better balance in life may be a priority and desire of an employee; still, it’s not his or her sole responsibility.  Unfortunately,  over  time,  these  have  constituted  challenges  to  employees’ performance, retention, and the overall actualization of Nigeria health sector ideals.

This study becomes necessary, therefore, as any strategy adopted by an organization that fails to  realize  that  achieving  a  right  equilibrium  between  work–life  and  personal   life  is problematic    but    an    avoidable    necessity    for    all    workers,    particularly    working parents.Incidentally most reported researches in this area are foreign based with paucity of empirical studies on Nigerian setting, particularly in South-East Nigerian health institutions. From  the  fore  going  the  work  sought  to  unveil  the  effect  of  work-  life  balance  on performance of selected federal and states health institutions in South-East, Nigeria.

1.3      Objectives of the Study

The  general  objective  of  this  study  is  to  examine  the  effect  of  work-  life  balance  on performance  of selected  federal  and  state  health  institutions  in South-East,  Nigeria.  The Specific objectives of the study sought to:

i.   ascertain  the  extent  to  which  employee  assistance  programme  affect  employee commitmentin selected federal and state health institutions, South-East, Nigeria

ii.  assess the nature of relationship between leave policies and job satisfaction in selected federal and state healthinstitutions, South-East, Nigeria

iii. assess   the   nature  of  relationship   between   alternative   work  arrangements   and productivity in selected federal and state health institutions, South-East, Nigeria

iv.  explore the effect of dependent care policies on employee turnover in selected federal and state health institutions, South-East, Nigeria

v.   highlight the extent to which managerial support affect goal attainment in selected federal and state health institutions, South-East, Nigeria

1.4Research Questions

i.         To    what    extent    doesemployee    assistance    programme    affect    employee commitmentinselectedfederal and state health institutions, South-East, Nigeria?

ii.        What is the nature of relationship between leave policies and job satisfaction  in selected federal and state health institutions, South-East, Nigeria?

iii.       What  is the  nature  of  relationship  between  alternative  work  arrangement  and productivity in selected federal and state health institutions, South-East, Nigeria?

iv.       What  is the effect of dependent  care policies on employee  turnoverin  selected federal and state health institutions, South-East, Nigeria?

v.         To what extent does managerial support affect goal attainment in selected federal health and state institutions, South-East, Nigeria?

1.5      Research Hypotheses

Based on the highlighted research objectives and research questions, the following research hypotheses were formulated to effectively guide and direct this study.

i.   Employee   assistance   programmesignificantly   affects   employee   commitment   in selected federal and state health institutions, South-East, Nigeria.

ii.  Annual leave, maternity leave and sick leave have a positive relationship  with  job satisfaction in selected federal and state health institutions, South-East, Nigeria.

iii. Compress work weeks, telecommuting,  flexi time, and job sharing have a  positive relationship with productivity in selected federal and state health institutions, South- East, Nigeria.

iv.  Dependent  care  policies  positively  affect  employee  turnover  intention  in  selected federal health and state institutions, South-East, Nigeria.

v.   Managerial  supports positively affect  goal attainment  in selected  federal and  state health institutions, south-East, Nigeria.

1.6      Significance of the Study

This study is of great importance to the following:

Researchers and students of human resources management who need theoretical framework and empirical data on effect of work- life balance on performance of federal and State health institutions will benefit from the study. Also, the study will assist the management of federal and state health institutions in South-East, Nigeria and the  entire country to develop work organizations and working cultures in a direction that willstrike a balance between work and personal lifeand, in doing so, promote a positive social climate and smooth operation that will enhance employees’ performance,  retention  and the overall actualization  of Nigeria  health sector. Besides, the work will serve as reference material for Nigeria health sector to make laws regarding  effective  formation  and implementation  of work-life  balance  policies  and practices.

1.7      Scope of the Study

Thegeographical  scope of the study coveredfive  federal  health institutions  and  five  state hospitals in South-East, Nigeria: University of Nigeria Teaching Hospital, Enugu,  Federal Medical  Center,  Owerri;  Nnamdi  Azikwe  Teaching  Hospital,  Nnewi;  Federal  Teaching Hospital, Abakaliki and Federal Medical Center, Umuahia. The state  health institutions are Abia  State  University  Teaching  Hospital,  Aba;  Odumegwu-Ojukwu  University  Teaching Hospital,   Akwa;   Ebonyi  State   University Teaching   Hospital,   Abakaliki;   Enugu   State University Teaching Hospital, Enugu and Imo State University Teaching Hospital, Orlu. The choice   of   selected   hospitals   was    done   using   convenient    non-probability   random sampling.Thus, the focus of this study will be onwork- life balance as it affects performance inselected federal and state hospitals in South-East, Nigeria. To facilitate a sound grasp of the subject  matter  within  the thought  framework  of the objectives  of the study and research questions,  the  subject scope will cover:concept  of work-life balance,  employee  assistance programme,   leave   policies,   alternative   work   arrangement,   dependent   care   policies, managerial support, work-place  culture and productivity,  work-life balance  and  employee performance.

1.8      Operational Definitions of Terms

For  the  purpose  of clarification  and  understanding  of  this  study,  some  concepts  require operational definition as used in this research work.

Work-life balance:Work-life balance means a state of equilibrium in which one’s work roles and  family  responsibilities  are  or  near  equal.  It’s  also  seen  as  satisfaction  and  good functioning at home and at work with minimum conflict.

Work-Family  Conflict:  Work-family  conflict  is a state  in which incompatible  demands between the work and family roles of an individual makes participation in both roles more difficult.

Role Overload: This results when role expectation of an individual is greater than his ability and motivation to perform the task.

Role Interference: It occurs when conflicting demands arising from multiple roles makes it very difficult for one to participate in either role.

Performance: This is the actual output or results measured against intended outputs (goals and objectives)

Job Performance: Job Performance is the act of doing or carrying out a given task within the institution successfully and within stipulated time aimed at meeting with set targets.

Employee Assistance Programme (EAP): It is a workplace programme that addresses the psychological or socialproblems of the employees.

Alternate Work Arrangements (AWA): These are programmes, different from the

organisational policies and procedures that are designed to save cost and accommodate the needs of the employee and organization.

Dependent Care Policies: These are policies that allow the employee to be at rest in the workplace while not be distracted by concerns about dependents.

Job Sharing. Job sharingis employment arrangements were by two or more employees are retained on either part time or reduced basis to perform the task of a full time employee. Leave Polices. These are organizational  and governmental  procedures  and guidelines which govern the process and  time frame for time taken off work by an employee without consequences.

1.9      Profile of Selected Health Institutions

University of Nigeria Teaching Hospital, Enugu

University  of  Nigeria  Teaching  Hospital  (UNTH)  began  early  in the  20th  century  as  a standard   general   hospital   for   African   built   by  the   colonial   administrators.   It   later metamorphosed  into a general hospital on the attainment of Nigeria’s  independence in the

1960s. However, at the end of the Nigeria civil war in 1970, the then government of East

Central State transformed it into a specialist hospital with effect from July 1, 1970. At this

time, the hospital had a total of 50 doctors, 10 wards of 300 beds and a chest bay of 60 beds. There were also 350 nurses working in the hospital.

By decree 23 of 1974, the federal military government took over the hospital but left  the management in the hands of the council of the University of Nigeria, Nsukka. The University of Nigeria Hospital became independent in July 1976 with the appointment of an autonomous management board.

Objectives and Functions of UNTH, Enugu

a)           Objective: University of Nigeria Teaching Hospital Enugu has broad objectives of service teaching and research.

b)           Functions:  The  hospital  aims  to  achieve  the  objective  above  through   the following functions.

1.   Provision  of in- patient  and out- patient  services  to its clients  through the  highly trained staff.

2.   Provision of adequate clinical materials for service and training as Well for equipment for research.

3.   Provision of teaching facilities for the training of medical students, resident doctors,- student nurses, pupil pharmacist, laboratory technology students, physiotherapist and radiographers, as well as other persons in the health delivery team.

4.   Conduct and promotion of research on all matters pertaining to health.

Levels of Management

The management board of the UNTH is the highest decision and policy making body of the hospital. The Chief Medical Director/Chief Executive, the Chairman, Medical Administration constitutes the top management in the day to day running of the hospital while the heads of department and consultants constitute the middle management.

Departments

Altogether,  there are 41 main departments  on the present site of the hospital,  with  three outposts’  comprehensive  health  centres  at Obukpa,  near  Nsukka,  Enugu  State,  Abagana Njikoka Local Government Area of Anambra and Isuochi in Abia state.

Present Bed Complement

The present bed complement of the hospital is 702 while the average daily number of beds occupied by patients is 509.

Training Schools

The hospital has 7 training schools/programmes in all. These are:

• Nursing

• Midwifery

• Medical Laboratory Technology Nursing Anaesthetists.

• Community Health

• Post Basic Ophthalmic Nursing

• Pen Operative Nursing

Above is in addition to its commitment to the training of medical students in the college of medicine. It also runs post graduate professional courses in various fields of medicine.

Federal Medical Center, Owerri

In Nigeria, primary health care is to be provided by local governments, secondary health care by state governments and tertiary health care by the federal government. In operationalising this policy, the federal government decided to establish at least one tertiary health institution in each State of the Nigerian Federation. Federal Medical Centres (FMCs), were established nationwide in states that do not have Federal  University Teaching Hospitals present. The exception to this rule is Lagos State,  which has one such centre in addition to a Teaching Hospital. Federal Medical Centre Owerri is a government owned Federal Medical Centre in Owerri Municipal  local  government  area of Imo  State,  Nigeria.  Federal Medical  Centre, Owerri is located at hospital road, Owerri, Imo State.

Federal Teaching Hospital Abakaliki

The former Federal Medical Centre Abakaliki now Federal Teaching Hospital, Abakaliki was established in the 1930s by the then colonial administration to serve as a casualty control post for soldiers wounded in the Cameroon theatre of the 2nd world war. It subsequently became the  Abakaliki  General  Hospital,  administered  successively  by  the  then  Eastern  Regional Government, the then East Central, Anambra, Enugu and finally Ebonyi States Governments.

By 1973, the Hospital  had  a full complement  of Consultant  Staff and was approved  for training of House Officers. Subsequently, the facilities deteriorated and the progressive loss

of Consultant Staff as the East Central State was split into many States impacted adversely on-the  hospital  services.  Thus,  accreditation  for  training  of  House  Officers  lapsed  and services deteriorated to such an extent that the Hospital almost became moribund.

Following the agreement between the Federal government of Nigeria and the Enugu  State Government,  the General  Hospital,  Abakaliki was taken over by the Federal  Ministry of Health as a Federal Medical Centre on March 1, 1990 with Dr. Ekuma  Orji Uzor as the pioneer Medical Director.

With   the   takeover,   the   Hospital   made   tremendous   progress,   and   assumed   all   the responsibilities of being a Federal Health Institution. Dilapidated facilities were rehabilitated in 1999, broken  equipmentwas  repaired  and modern equipment  acquired.  Two additional modern   theatres   were  constructed   and   a  modern  neo-natal   Unit   commissioned.   An ultramodern Casualty and Children’s Emergency Unit and a Resident’s Hall Complex were put in place as well as an Intensive Therapy Unit. In 2007 Dr. Paul Olisaemeka Ezeonu, the erstwhile Head of Clinical services in the Medical Centre took up the mantle of leadership as the Chief Medical Director.

The  Hospital  now  has  Consultants  in  most  Clinical  Department  and  has  been  able  to reactivate wards that were dormant. Ebonyi State University Teaching Hospital was earlier established  as a Specialist Hospital, Abakaliki,  in the early 1980s. in 1996,  following the creation of Ebonyi State and the take-off of the State University, the Specialist Hospital was converted to a Teaching Hospital to serve Ebonyi State University.

On 7th December, 2011, President Goodluck Jonathan in fulfillment of his election promise to Ebonyi people upgraded the Federal Medical Centre to a Federal Teaching Hospital and directed  that Ebonyi  State  University  Teaching  Hospital  be absorbed  into the new mega Teaching Hospitals. The handover process was completed on 23rd December 2011 including the absorption of the staff of the defunct EBSUTH.The  new  Federal Teaching Hospital is indeed mega with retinue of Consultants in various specialties, 604 bed capacity distributed in  various  departments  and  a  capacity  for  250  House  Officers.  This  foremost  Health Institution which is one of its kinds east of the Niger is continually improving in strength, structure and facility and has the establishment of a School of Nursing and Midwifery on its radar.  The  hospital   complex   of  the  School  of  Nursing  and  Midwifery  is  billed  to accommodate  a  total of 360 nurses. The new hospital complex is designed  as a one stop complex to accommodate various units and departments such as children’s emergency units

and wards, Obstetrics and Gynaecology (O&G) wards and units, administration department, consulting rooms and about sixty wards among others.

New structures constructed include resident Doctors and House Officers’ quarters comprising several units of self-contained accommodations, medical records blocks, laboratories, dental clinics  and  several  other  facilities  with  modem  ancillary  amenities  to  complement  the structures. Other on-going infrastructure developments at the NEW FETHA arena included the   ultra-modem   auditorium   with   five   thousand   sitting   capacity,   a   lecture   hail   to accommodate two-hundred comfortably seated persons, a library and E-library structure and an ultra-modem theatre.

According  to  the  Architect  handling  the  project  Mr.  Eric  Adama,  part  of  the  on-going construction  include  reclamation  of  some  parts  of  the  area  to  control  the   ecological challenges being experience at the site.

Mission

To provide quality, accessible and affordable healthcare services; and effective training and research

Vision

To be a resource centre of excellence; offering value-based, patient-centred, innovative health and academic services that reflect global best practices

Hospital Policies Serenity

Majority of hospital premises is meant to be quiet to avoid distraction and disturbing patients, all sorts of medium for noise should be cautioned like car horns and loud discussions.

Cellular Phones

The use of cell phones in medical area where patients are treated with medical equipment is very dangerous because of the risk of inference or disruptions of the equipment performance there should be areas for telephone calls and use of other devices.

Privacy

Federal teaching hospital is committed  in protecting  your medical information,  in  regards with our effort to avoid your record disclosure we wish that you contribute in  helping us fulfill our promises.

Patient Rights

Patients have the right to express concerns or complaints about their care with the assurance that the quality of their care or future access to care will not be compromised. You also have the right to expect a reasonable and timely response to your concerns.We encourage you to address your concerns immediately to staff or managers of the specific department at the time of service so we can respond quickly to any concerns.

Nnamdi Azikiwe University Teaching Hospital (NAUTH)

The hospital  started  as a community  hospital  Nnewi,  which  later  became  a  Government General Hospital in 1990. The General Hospital was upgraded to Anambra State University of Technology Teaching Hospital (ASUTECH)  to offer clinical  facility for the training of student of Health sciences and technology. Its name was changed later to Nnamdi Azikiwe University Teaching Hospital (NAUTH), which was taken over by the Federal Government in 1992. The school of Nursing is one of the  training school envisaged to cater for health manpower  development  for the nation in  line with the Federal Government  objective  for setting up Tertiary Health Institutions.

The School of Nursing was officially established in October 2000. However, the preliminary preparation  for its set up started  in April same  year. By July 28th  2000,  the school was officially commissioned by then Honorable Minister of Health, Dr. Tim Menakaya. The first batch of student started their normal lectures on October 2000 after the recruitment of school

staff. The hospital had about 355 bed multi annex complex providing both specialized  and comprehensive medical care services in six Local Government Areas of Anambra  State. It also vigorously engaged in vital functions of training and research.

Federal Medical Centre, Umuahia

The  Federal   Medical   Centre,   Umuahia   came   into   existence   in  November   1991.   It metamorphosed  from the queen Elizabeth Hospital which was commissioned on March 24,

1956 by Sir Clement Pleas representing Queen Elizabeth the second of England. It started as a joint mission hospital administered by the Methodist, Anglican and Presbyterian churches. Before its takeover by the Federal Government, it had first been taken over from the missions by the then Imo State Government under the then Military Governor-Navy Captain Godwin Ndubuisi Kanu (now A retired rear Admiral). It was renamed Ramat Specialist Hospital in honour of the late slain Head of State, General Murtala Ramat Mohammed. During the first republic under the administration of late Chief Sam Mbakwe, Governor of the old Imo state,

it reverted  to its original name — Queen Elizabeth Hospital.  It thus became the  Federal Medical Centre (FMC), Umuahia on its takeover in November 1991. It is the first FMC to be so recognized.

Geographical Location

The hospital covers an area 77 acres of land bounded on the south by the Nigerian prisons, Umuahia; east by Ndume Ibeku; North by Umuahia urban and west by Afara clan.

Mission Statement

“As the foremost Federal Medical Centre we will provide specialized  and  comprehensive health care services to our clients using modern equipment, research  and training through highly motivated manpower operating in a friendly and conducive environment that captures our antecedent as a mission hospital.”

Vision of F.M.C. Umuahia

By 2015, we will improve the quality of existing services; increase our level of research and the scope and depth of training and teaching. We will develop new functional areas; Renal Centre,   Endoscopy  Centre,   Centre  for  In  Vitro  Fertilization,   Mammography   Centre, Dermatology  Unit,  Oncology  Unit,.  Endocrinology  Unit,  Respiratory  Medicine  Unit  and Palliative Care Unit. We will achieve Full  Accreditation  in Internal Medicine,  Pediatrics, Family Medicine,  Public Health,  Ophthalmology,  and Anaesthesiology.  Human Resources Development  to support our  growth and needs will be accorded priority. We will develop facilities to support the above units and as well as attract medical tourism. We will be alive to our social responsibility as a tertiary hospital.

Motto of the Hospital

Their motto is “Serving Beyond Expectation”

Number of Wards and Capacity

Ward 1 Crowther Male Orthopaedics                                    30 Beds Ward 2 Batley Female Surgical                                             l 20 Beds Ward 3 New Surgical Male Surgical                                     10 Beds Ward 4 Eye Ophthalmology                                                  6 Beds Ward 5 Ludlow Gynaecology                                               20 Beds Ward 6 Obioma Labour Maternity (Booked)                        6 Beds

Ward 7 Obioma Lying-In Maternity (Booked)                     20 Beds Ward 8 Nkasiobi Maternity (Unbooked)                               36 Beds Ward 9 Okpara Paediatrics (Combined) Psychiatry              20 Beds Ward 10 Female Medical Ward                                             20 Beds Ward 11 Male Medical                                                          18 Beds Ward 12 Mental Health Psychiatry                                       5 Beds Ward 13 Kirk Tb + Infectious Disease                                  20 Beds Ward 14 New Born Special Care Neonatology                     20 Beds

Their hospital, though a 247 bedded hospital is often overstretched to admit up to or more than 300 patients.

Awards

The hospital has won the 2nd prizes at the SERVICOM hospital evaluation in Health zone II

in 1999 by the Federal Ministry of Health and UNICEF.

Special Projects

Other giant achievements of Federal Medical Centre, Umuahia include the Centre designated as a Centre of Excellence in Oncology and Communicable diseases in 2004.

Outreach Centres

The hospital has in obedience to the recent directives of the Ministry of Health adopted  2

Health Centres for partnership aimed at improving quality of care in the rural areas with a view to improving the MDGs. They are:

–    Primary Health Centre in Isukwe, Ubakala, Umuahia South L.G.A.

–    Comprehensive Health Centre, Umuigu, Ikwuano L.G.A. all in Abia State.

Nnamdi Azikiwe University Teaching Hospital NAUTH

The hospital  started  as a community  hospital  Nnewi,  which  later  became  a  Government General Hospital in 1990. The General Hospital was upgraded to Anambra State University of Technology Teaching Hospital (ASUTECH)  to offer clinical  facility for the training of student of Health sciences and technology. Its name was changed later to Nnamdi Azikiwe University Teaching Hospital (NAUTH), which was taken over by the Federal Government in 1992. The school of Nursing is one of the  training school envisaged to cater for health manpower  development  for the nation in  line with the Federal Government  objective  for

setting up Tertiary Health Institutions.The  School of Nursing was officially established  in October 2000. However, the preliminary preparation for its set up started in April same year. By July 28th  2000, the school was officially commissioned by then Honourable Minister of Health, Dr. Tim Menakaya. The first batch of student started their normal lectures on October

2000  after  the  recruitment  of school  staff.  The  hospital  had  about 355 bed  multi  annex complex providing both specialized and comprehensive medical care services in  six Local Government  Areas of Anambra  State. It is also  vigorously engaged  in vital  functions  of training and research.

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