ABSTRACT
Emerging multidrug-resistant tuberculosis (MDR/XDR-TB) has become a major public health concern, placing millions at risk. Moreover, nosocomial transmission of MDR/XDR-TB places both patients and healthcare workers at an even higher risk. For these reason health facilities in high-risk settings need to implement effective tuberculosis (TB) infection prevention and control (IPC) policies/guidelines. The effectiveness of TB control thus implies enhanced organizational performance of the healthcare facilities. However, little research has been conducted in the Nigerian to see the influence of organizational processes and employee skills development on the effectiveness of Tuberculosis Infection Control Policy in public healthcare setting.
The population for this study comprised of nurses and doctors purposively selected from UUTH (TB Hospital, including ten (10) Primary Health care clinics in Akwa Ibom state.
These facilities were selected because of their capacities, as they perform screening, treating, referring and provide DOTS to TB patients.
The sample was selected using purposive sampling technique. The sample included all categories of the nurses and medical doctors who were willing, available and legible to the study. A total of hundred (100) nurses of all categories and doctors participated in this study.
Data collection was conducted with a self-designed questionnaire which was self- administered by consenting study participants. The duration of data collection took eight (8) months, due to the nature of the work condition of the health care workers. The response rate was 100%. No missing data were recorded. The research instrument was found to be reliable.
Data analysis technique involved the use of Statistical Package for the Social Sciences (SPSS) a statistical software to carry out both descriptive and inferential statistics with significance set at P>0.05. As inferential statistics, the study used Partial Least Squares (PLS) regression analysis to determine the strength of each relationship hypothesized by the study model. Ethical consideration adhered to in the study.
The findings revealed a positive influence of organizational processes and employee skills development on the effectiveness of Tuberculosis Infection Control Policy in public healthcare facilities in Akwa Ibom state.
In conclusion the recommendations are that the public healthcare facilities should therefore train key personnel in the aspects of TB IPC concepts. It should also implement appropriate organizational process to ensure that the process effectively support TB IPC policy implementation.
CHAPTER ONE
INTRODUCTION
• Background of study
Despite globally adopted strategies to control tuberculosis (TB) and globally declining incidence and mortality rates of the disease over the years, it remains a major public health problem (World Health Organization (WHO), 2012). Nigeria has a small population of 2, 5 million people. Nigeria has one of the highest case notification rates (CNR) of TB in the world (MOHSS, 2012). 12,625 cases of TB were notified in 2010, equivalent to a CRN of 589/100,000 population. Akwa Ibom state, the site for this study, had the highest TB burden in the country with a total of 3,102 TB patients and a CNR 1 102/100 000 per population in 2004 (MoHSS 2006a:2). The region continued to report the highest burden although in 2006 the total number of patients had reduced to 2 616 with a CNR of 859/100 000 population. This high TB burden puts healthcare workers (HCWs) at increased risk of contracting TB in the work place and TB-infected staff put their patients at risk. In developed countries, TB infection control programmes are rigorous; it is often not possible to duplicate these protocols in resource-limited settings as they are often beyond the financial capabilities of such countries (CDC, 2005).
The distribution of the TB burden varies by region, with the most affected regions as of 2010 being Akwa Ibom and Kavango (MoHSS, 2012). Tuberculosis was included by Stop TB Partnership in the Millennium Development Goals (MDG 6) that was planned to be achieved by 191 United Nations (UN). Member States by the year 2024 (STOPTB Partnership, 2010; United Nations, 2013). The goals and targets beyond 2024 must consider lessons from the current set of MDGs. The first step is to have broad consultations on the future goals by creating fora for local, national, and regional debate involving key stakeholders, including the governments, civil societies, private sectors and development agencies. The Sustainable Development Goals (SDG) identified 5 key lessons from the MGDs, to adapt service delivery models to further expand access, to focus resources on the right interventions for the right populations in the right place in the right way, to increase financing for HIV – related services, to ensure that pharmaceutical innovations are available, affordable and accessible to all and lastly to invest in reducing stigma and discrimination.
South Africa reports more than 100 000 TB cases yearly. This is an incidence rate of more than 500/100 000 population. The latest successful treatment completion rates, recorded in 2002, are 68, 0% with interruption rates of 13, and 0%. Overall TB prevalence among HCWs in South Africa (SA) was 5, 0% in 2009 while HIV prevalence was approximately 16, and 0% in 2002 (Joshi, Reingold, Menzies & Pai (2006).
The TB epidemic is complicated by the multidrug resistant/extensively drug- resistant tuberculosis (MDR/XDR-TB) which is a man-made disease and emerged as a result of inadequate TB treatment. MDR/XDR-TB is defined as “caused by organisms that are resistant to isoniazid and rifampicin (MDR-TB); and by organisms that are resistant to isoniazid and rifampicin as well as any fluoroquinolone and any of the second–line anti-TB injectable drugs (amikacin, kanamycin or capreomycin)” (WHO, 2013b). Once developed, drug resistant strains of TB can be transmitted directly from person to person. Treatment of drug-resistant TB is expensive, long-term (18-24 months), complex requiring daily injections and involving serious side effects.
Another challenge in addressing TB is its interplay with HIV. People living with HIV (PLHIV) have 20 times greater risk of developing active TB than HIV-negative persons (WHO, 2013a). Out of 1.4 million people who died from TB in 2012, 430,000 deaths were among PLHIV (WHO, 2012). There is evidence of significantly higher mortality rate and short survival associated with drug-resistant TB outbreaks among PLHIV (WHO, 2012).
Therefore all HCWs allocated in the hospitals and Primary health care clinics who deal with TB patients, contacts should be well informed regarding these guidelines and they must be guided by these guidelines throughout their practice, in order to prevent the HCWs spreading the disease and contracting the disease while on duty (MOHSS, 2010).
Inadequate TB treatment regimens leading to the lower levels of success and the higher rates of default or failure have long been considered driving factors for drug- resistant TB. However, over time, dynamics of factors responsible for drug-resistant TB have changed with about 40% of MDR-TB patients having a history of defaulted or failed treatment, and about 30% of them as new cases without previous treatment history (WHO, 2011). Furthermore, recent studies show even higher proportions (about 50%) of new MDR-TB cases among people who never been treated for TB before, demonstrating direct transmission of drug-resistant strains (WHO, 2011). In addition, patients, who were previously treated for TB, acquire drug-resistant tuberculosis through transmission rather than as a consequence of non-adherence to the previous treatment. When transmission happens in healthcare setting it is considered as nosocomial (WHO, 2011).
Rising demand from countries for guidance on TB transmission prevention and their need to understand policy gaps in TB Infection Prevention Control (IPC) led to the development of TB IPC by WHO in 2009. The document defines TB IPC as “a combination of measures aimed at minimizing the risk of TB transmission within populations, founded on early and rapid diagnosis and management of TB patients” and includes evidence-based recommendations on TB infection control in healthcare facilities, congregate settings and households (WHO, 2009). According to WHO (2009), there is evidence that implementation of IPC measures, including administrative and environmental controls; personal protection through use of N95 face masks reduces transmission of TB in healthcare facilities. Important contributing factors of nosocomial transmission as delayed diagnosis, unrecognized multi-drug resistance, inadequate isolation and infection control practices, poor ventilation and air circulation, are addressed in the WHO document. Importantly, TB IPC was neglected for many years and has been recognized as a priority issue that should be incorporated into country-level policy.
• Statement of the Problem
Nigeria adopted a national TB infection prevention and control policy since 2010, but the incidences of TB continue growing which raise concerns about the effectiveness of healthcare-related TB IPC policy implementation. The effectiveness of healthcare-related TB IPC policy implementation simply implies organizational performance of the healthcare facilities. Effective TB IPC should be customized to the specific setting and should use an evidence-based approach.
Several general and strategic management scholars have identified organizational processes and employee skills development as key determinants of organizational performance (Dumas et al., 2013;
However, there is a lack of research in this regard in the Nigerian public healthcare context. The implication of this is that, in the context of Nigerian healthcare facilities, the link that is thought to be existent between these aspects is rather assumed than proven empirically. This dearth of empirical research led to the following question: what is the influence of organizational processes and employee skills development on the effectiveness of Tuberculosis Infection Control Policy in public healthcare facilities in Akwa Ibom state? Thus, this study seeks to lessen the literature gap by addressing the question above.
• Research Questions
• What is the level of effectiveness of Tuberculosis Infection Control Policy in public healthcare facilities in Akwa Ibom state?
• What is the impact of organizational processes on the effectiveness of Tuberculosis Infection Control Policy in public healthcare facilities in Akwa Ibom state?
• What is the influence of employee skills development on the effectiveness of Tuberculosis Infection Control Policy in public healthcare facilities in Akwa Ibom state?
1.4. Research Aim and Objectives
The aim of this research was to understand the effect of organizational processes and employee skills development on the effectiveness of Tuberculosis Infection Control Policy and barriers in public healthcare facilities. Thereby, guiding as instrument for public healthcare facilities managers and policy-makers for the development of appropriate policies and programmes to enhance the effectiveness of Tuberculosis Infection Control Policy in public healthcare facilities. To attain this core research aim, the following objectives of the study needed to be realized:
• To determine the level of effectiveness of Tuberculosis Infection Control Policy in public healthcare facilities in Akwa Ibom state;
• To assess the impact of organizational processes on the effectiveness of Tuberculosis Infection Control Policy in public healthcare facilities in Akwa Ibom state; and
• To gauge the influence employee skills development on the effectiveness of Tuberculosis Infection Control Policy in public healthcare facilities in Akwa Ibom state.
1.5 Research Hypothesis
• H1: A positive association exists between organizational processes and the effectiveness of Tuberculosis Infection Control Policy in public healthcare facilities in Akwa Ibom state.
• H2: There is a positive relationship between employee skills development and the effectiveness of Tuberculosis Infection Control Policy in public healthcare facilities in Akwa Ibom state.
• Significance of the Study
This study will have considerable contribute to the body of knowledge in tuberculosis infection prevention and control. It will deliver a notional support on the impact of organizational processes and employee skills development on the effectiveness of Tuberculosis Infection Control Policy in public healthcare facilities. Thus, it will be of substantial interest to public healthcare managers and policy-makers. In addition, the research findings will reveal opportunities for comparable studies in this under-researched field. It is thus significant to future researchers.
In addition, the research findings might reveal opportunities for comparable studies in this under-researched field. It is thus significant to future researchers.
• Limitations of the Study
Inherently, the study design has some limitations. Given that only employees of public health facilities in Akwa Ibom state were included, the outcomes cannot be generalised to all other public health facilities in and/or outside Nigeria. The inherent limitations of a survey research design also apply to this study; participants’ reluctance to disclose information that they consider sensitive or confidential is expected.
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