TABLE OF CONTENTS
Content Page
Title page i
Certification ii
Dedication iii
Acknowledgements iv
Abstract vi
Table of Contents vii
List of Tables x
List of Figures xi
List of Appendices xii
CHAPTER ONE: INTRODUCTION
1.1 Background to the Study 1
1.2 Statement of the Problem 6
1.3 Objective of the Study 8
1.4 Research Questions 8
1.5 Hypotheses 9
1.6 Significance of the Study 9
1.7 Scope of the Study 9
1.8 Operational Definition of Terms 10
1.9 Chapter Outlay 11
CHAPTER TWO: REVIEW OF LITERATURE
2.0 Introduction 12
2.1 Policy 12
2.2 Health policy 14
2.3 Hospital policy 15
2.3.1 Educational development 16
2.3.2 Wage and salary 17
2.3.3 Nurse to patient ratio 17
2.3.4 No work, no pay 18
2.4 Attitude and work attitude 18
Content Page
2.4.1 Causes of employee attitude 19
2.5 Service delivery 21
2.5.1 Health care service delivery 23
2.6 Employee performance 25
2.6.1 Employee participation and performance relationship 27
2.7 Patients’ satisfaction 28
2.8 Health sector organization and their environment 29
2.8.1 Conceptual model 31
2.9 Empirical review 33
2.9.1 Attitude and service delivery 33
2.9.2 Motivation and service delivery 35
2.9.3 Management and service delivery 37
2.9.4 Service delivery through patient-centred care 39
2.9.5 Barriers to patient-centred care 41
2.10 Theoretical framework 43
2.10.1 Motivation theory – Herzberg two factor theory 43
2.10.2 Behavioral organizational theory 46
2.11 Gap in Literature 48
2.12 Conclusion 49
CHAPTER THREE: METHODOLOGY
3.0 Introduction 51
3.1 Research design 51
3.2 Population 51
3.3 Sample size and sampling Technique 52
3.4 Instrumentation 53
3.5 Reliability test and validity of instrument 54
3.6 Method of Data Collection 54
3.7 Method of Data Analysis 55
3.8 Ethical consideration 55
Content Page
CHAPTER FOUR: DATA ANALYSIS AND DISCUSSION OF FINDINGS
4.0 Introduction 56
4.1 Socio demographic analysis of respondents 56
4.2 Analysis of questionnaire items 60
4.3 In-depth interview 71
4.4 Test of hypotheses 77
CHAPTER FIVE: SUMMARY, CONCLUSION AND RECOMMENDATIONS
5.1 Summary 85
5.2 Conclusion 85
5.3 Recommendations 86
5.4 Limitation of the Study 86
5.5 Contribution to Knowledge 86
5.6 Implications for Policy 87
5.7 Suggestion for Further Studies 87
REFERENCES 88
APPENDICES 96
LIST OF TABLES
Table Page
1 Summary of reliability test 54
2 Socio Demographic data of the respondents 56
3 Questions addressing Policies 60
4 Questions addressing nurses’ work attitude 64
5 Questions addressing patients’ satisfaction 66
6 Questions addressing service delivery 68
7 In-depth interview guide 71
8 Regression result for policies vs nurses’ attitude 77
9 Regression result for nurses’ attitude vs service delivery 79
10 Regression result for nurses’ attitude vs patients’ satisfaction 81
11 Regression result for service delivery vs patients’ satisfaction 82
LIST OF FIGURES
Figure Page
1 Conceptual Model 31
2 Herzberg’s two factor theory 45
LIST OF APPPENDICES
Appendix Page
1 Raw Pilot Study data 97
2 Informed consent form 98
3 Questionnaire for nurses 99
4 In-depth interview consent form 104
5. In-depth interview guide 105
6. Turn it in report
CHAPTER ONE
INTRODUCTION
1.1 Background to the Study
Despite bold plans and massive injections of international and domestic resources, public service delivery is still failing in many areas in several developing countries. This according to Mcloughlin and Bately (2012) suggests there is a need to revisit approaches to rendering assistance to service delivery sectors. It is also necessary to focus on understanding how a range of institutional and governance arrangements can shape service delivery processes and outcomes. They went further to say that while the number of political economy studies on different service delivery sectors and different countries is growing, these remain largely one-off or ad hoc studies. Thirdly, their study tends to talk in fairly generic terms about political and governance constraints. For example, concepts like ‘political will’ or the existence of ‘weak incentives’ are often referred to but rarely further developed in terms of the specific institutional and governance arrangements that contribute to these factors, and in terms of which of these may offer strategies for overcoming common bottlenecks or gaps ( Mcloughlin, Batley, 2012). Therefore, the justification for a service delivery reform may lie on the need for efficiency, effectiveness, and accountability (Lufunyo, 2013)
The tools and strategies used by stakeholders to achieve their policy objectives have also evolved and it is now common place to refer to governance as a range of old and new tools and instruments through which public policy goals may be achieved and/or delivered (Zito, Radaelli, Jordan, 2003; Hood, 2006). The very concept implies that the ways to govern the public sector and the tools for doing so have changed (Salamon, 2002) and – implicitly or explicitly – should change further from old command-and-control, public administration or management models (Bovaird, Löffler, 2003). The importance of policy or its implementation cannot be overemphasized particularly as it relates to health. This is becausehealth is an essential component of development, necessary for a nation’s economic growth and internal stability. It is a necessity for everyday life, not the object of living, but a positive concept emphasizing social and personal resources as well as physical capabilities. This may be said to explain the popular saying that a healthy nation is a wealthy nation. It is further emphasized by the definition of World Health Organization (WHO), (1946), that good health is a state of complete physical, social and mental well-being, and not merely the absence of disease or infirmity.