Margaret Mukwenda Final Corrections

WORKING CONDITIONS AND HEALTH WORKERS’ PERFORMANCE IN
KARUGUTU HEALTH CENTRE IV, NTOROKO DISTRICT
BY
MARGARET MUKWENDA
(16/MPA/00/KLA/WKD/0016)
A DISSERTATION SUBMITTED TO THE SCHOOL OF MANAGEMENT SCIENCE IN
PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE AWARD OF THE
DEGREE OF MASTERS IN PUBLIC ADMINISTRATION OF
UGANDA MANAGEMENT INSTITUTE
NOVEMBER, 2021
DECLARATION
I, Margaret Mukwenda declare that the information contained in this report has been compiled
by me under the guidance of my supervisors, and is submitted with their approval.
Sign Date: 08th/11/2021
MARGARET MUKWENDA
(16/MPA/00/KLA/WKD/0016)
i
APPROVAL
This report has been submitted for examination with my authority as the candidate’s supervisor.
Sign:……………………. Date:……………………..
ASSOC. PROF. MARIA KAGUHANGIRE BARIFAIJO
Sign:……………………. Date:………………………..
DR. GLADYS MUHAMA
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DEDICATION
It is with genuine gratitude and regard that I dedicate this dissertation to my dear children who
have always loved me unconditionally giving me words of encouragement to finish my studies.
I dedicate with special thanks to my wonderful husband who has been a constant source of
support throughout the process and taught me the value of hard work. You mean a lot to me.
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ACKNOWLEDGEMENT
I am deeply indebted to my research supervisors Assoc. Prof. Maria Kaguhangire Barifaijo and
Dr. Gladys Muhama for their patience and valuable guidance throughout the research process.
Without your parental and professional input, this research would have been difficult to elevate
to its current level.
I wish to acknowledge with gratitude the contributions and co-operation made by the
respondents from Karugutu Health Centre IV in Ntoroko District for their willingness to provide
the necessary information when I visited their center during the research process. Without their
cooperation, this study would have been impossible to accomplish.
I would like to also thank my colleagues at Uganda Management Institute, persons who dealt
with secretarial work and those who read through the questionnaires and perfected the draft
report.
I deeply treasure the contributions of all the above persons and I pray that the Almighty God
richly bless them.
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TABLE OF CONTENTS
DECLARATION............................................................................................................................................i
APPROVAL..................................................................................................................................................ii
DEDICATION..............................................................................................................................................iii
ACKNOWLEDGEMENT............................................................................................................................iv
TABLE OF CONTENTS...............................................................................................................................v
LIST OF TABLES.......................................................................................................................................xii
LIST OF FIGURES....................................................................................................................................xiv
LIST OF ACROYMNS...............................................................................................................................xv
ABSTRACT................................................................................................................................................xvi
CHAPTER ONE: INTRODUCTION........................................................................................................1
1.1Introduction...............................................................................................................................................1
1.2Background to the Study...........................................................................................................................1
1.2.1Historical background............................................................................................................................1
1.2.3 Theoretical background........................................................................................................................3
1.2.4Conceptual background.........................................................................................................................4
1.2.5 Contextual background.........................................................................................................................5
1.4 Purpose of the study.................................................................................................................................7
1.5Specific Objectives...................................................................................................................................7
1.6Research Questions...................................................................................................................................7
1.7 Hypotheses of the Study..........................................................................................................................8
1.8Conceptual Framework.............................................................................................................................8
1.9Significance of the Study..........................................................................................................................9
1.10Justification of the Study......................................................................................................................10
1.11 Scope of the Study...............................................................................................................................10
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1.12 Operational Definitions........................................................................................................................11
CHAPTER TWO: LITERATURE REVIEW.........................................................................................12
2.1 Introduction............................................................................................................................................12
2.2 Theoretical Review................................................................................................................................12
2.3 Literature Review...................................................................................................................................14
2.3.1 Infrastructure and Health Workers Performance................................................................................14
2.3.2 Working Equipment and Health Workers Performance.....................................................................15
2.4 Summary of Literature Review..............................................................................................................17
CHAPTER THREE: METHODOLOGY................................................................................................18
3.1 Introduction............................................................................................................................................18
3.2 Research Design.....................................................................................................................................18
3.3 Study Population....................................................................................................................................18
3.4 Sample Size and Selection.....................................................................................................................19
3.5 Sampling Techniques and Procedure.....................................................................................................19
3.6 Data Collection Methods.......................................................................................................................20
3.6.1 Questionnaire......................................................................................................................................20
3.7 Data Collection Instruments..................................................................................................................21
3.8 Validity and Reliability..........................................................................................................................22
3.8.2 Reliability............................................................................................................................................23
3.9 Procedure of Data Collection.................................................................................................................24
3.10 Data Analysis.......................................................................................................................................24
3.10.1 Quantitative Data Analysis...............................................................................................................24
3.10.2 Qualitative Data Analysis.................................................................................................................25
3.11 Measurement of Variables...................................................................................................................25
3.12 Ethical Considerations.........................................................................................................................25
CHAPTER FOUR......................................................................................................................................27
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DATA PRESENTATION, ANALYSIS AND INTERPRETATION....................................................27
4.1 Introduction............................................................................................................................................27
4.2 Response Rate........................................................................................................................................27
4.3 Findings on Background Characteristics...............................................................................................28
4.3.1 Age of the Respondents......................................................................................................................28
4.3.2: Gender characteristics of the Respondents........................................................................................29
4.3.3: Marital status of respondents.............................................................................................................29
4.4 Empirical Findings according to the study objectives...........................................................................31
4.4.1 How infrastructure facilities influence health workers' performance.................................................31
4.6 The extent to which working equipment influence health workers performance..................................35
4.7 How employee rewards influence health workers' performance...........................................................40
CHAPTER FIVE:SUMMMARY, DISCUSION, CONCLUSIONS AND RECOMMENDATIONS 40
5.1 Introduction............................................................................................................................................40
5.2 Summary of key findings.......................................................................................................................40
5.2.2 The extent to which working equipment influence health workers’ performance.............................40
5.2.3 How employee rewards influence health workers' performance........................................................41
5.3 Discussion of the study..........................................................................................................................41
5.4 Conclusion.............................................................................................................................................44
5.5 Recommendation...................................................................................................................................46
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5.6 Limitations of the study.........................................................................................................................48
5.7 Contributions of the study......................................................................................................................48
APPENDICES...............................................................................................................................................i
Appendix 1: Questionnaire for Health Workers.......................................................................................i
APPENDIX II: Interview guide for top administrators.........................................................................iv
APPENDIX III: KREJCIE, R. V, & MORGAN TABLE FOR SAMPLE SIZE................................vii
APPENDIX V: PLAGIARISM REPORT................................................................................................ix
viii
LIST OF TABLES
Table 4.1: Response Rate..............................................................................................................22
Table 4.2: Age of the Respondents................................................................................................23
Table 4.3: Gender of respondents..................................................................................................23
Table 4.4: How infrastructure facilities influence health workers' performance...........................26
Table 4.5: Correlation Matrix for infrastructure facilities and health workers' performance........28
Table 4.6: The extent to which working equipment influence health workers’ performance.......28
Table 4.7: Correlation Matrix for working equipment influence health workers’ performance...31
Table 4.8: How employee rewards influence health workers' performance..................................31
Table 4.9: Correlation Matrix for employee rewards influence health workers' performance......35
Table 4.10: Findings on other rewards and Health Workers' Performance...................................36
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LIST OF FIGURES
Figure 1.1: Conceptual Framework showing the influence of the Working Conditions upon
Health Workers Performance..........................................................................................................6
Figure 4.2: Marital status of respondents......................................................................................24
Figure 4.3: Highest Level of Education the Respondents.............................................................24
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LIST OF ACROYMNS
ACODE Advocates Coalition for Development
CDO Community Development Officer
CVI Content Validity Index
HIV Human Immunodeficiency Virus
HR Human Resource
MOH Ministry of Health
SPSS Special Package for Social Scientists
WHO World Health Organizations
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ABSTRACT
The study aimed at investigating on the relationship between working conditions and health
workers' performance at Karugutu Health Center IV. It was guided by three research objectives
namely; to identify how infrastructure facilities influence health workers' performance, to
determine the extent to which working equipment influence health workers’ performance and to
establish how employee rewards influence health workers' performance at Karugutu Health
Center IV. The study adopted a descriptive cross sectional design where both quantitative and
qualitative methods were used. In this study, a total number of 63 respondents were expected but
54 respondents returned the survey instruments representing a response rate of 94%. The data
was collected using questionnaires and interview, analysis was done using Pearson correlation
coefficient plus content and thematic analysis.
In identifying how infrastructure facilities influence health workers’ performance, results showed
a correlation coefficient of .588** and p=0.000<0.05, a significance level of 0.000 (r=.588). It
therefore means that infrastructure facilities and health workers’ performance were moderately
correlated and statistically significant. The results further indicated that there is a slightly
moderate relationship between working equipment and health workers’ performance which is
statistically significant. The correlation coefficient was .477** and p=0.000<0.05 with a
significance level of 0.000. In establishing the relationship between employee rewards and health
workers' performance, results showed a weak relationship which is statistically significant. The
correlation coefficient was .322* and p=0.000<0.05 with a significance level of 0.000.
Therefore, the alternative hypothesis that was earlier stated in chapter one is rejected and a null
hypothesis is accepted. It was recommended that, there should be a deliberate effort by all health
stakeholders to provide more houses for health workers in Karugutu Health Center IV to address
the issue of inadequate health workers’ housing as well as absenteeism in all its forms. The
management should also focus on availing comfortably furnished offices with leisure activities
during breaks and providing flexible work times (shifts) so as to get deeper harmony in between
free time and work. The management of Karugutu Health Center IV should lobby for the
provision of sufficient personal protective equipment such as waterproof aprons, eye gaggles,
gloves, all necessary personal protective gear for the safety of health workers. The management
should focus on professional development since it makes health workers more killed and
competent to confidently produce higher quality services with motivation.
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CHAPTER ONE
INTRODUCTION
1.1 Introduction
The study investigated about the relationship between working conditions and health workers'
performance in Karugutu Health Centre IV, Ntoroko district. Working condition is an independent
variable, and health workers' performance is a dependent variable. Working conditions may impact
immensely the health workers' performance negatively or positively (Chadrasekar, 2011). Chapter one
presents a background to the study, the problem statement, the purpose of the study, the specific
objectives, the research questions, the hypotheses, conceptual framework, the significance, justification,
scope, and there after operational definitions of different terms and concepts.
1.2 Background to the Study
The background consists of 4 sections which include the historical background, the theoretical
background, the conceptual background, and the contextual background.
1.2.1 Historical background
The World health report 2006 shows that in many countries the salaries of health workers are
below the minimum living wage and that the pay levels of public sector workers are often unfair
compared to others in similar jobs (WHO, 2006). Many scholars, such as Melissa (2017) and
Ruthrock (2017), have revealed that in Europe, working conditions were terrible during the
1900s. Long hours of work were done day and night (12 to 16 hour shifts), poor salaries were
paid to workers, even unhealthy and filthy conditions at workplaces with little to no workers'
rights. In responding to the filthy conditions and poor salaries, some employees intentionally
reduced their dedication to work by breaking machines and others left their jobs and joined
different industries (Kezala, 2018). In New York (1900), the International Ladies Garment
Workers' Union was organized as an attempt to work against the bad working conditions at
workplaces. The 1938 Fair Labor Standards Act defined earnings and required employers to pay
employees for any work carried out over 40 hours. An increase in service delivery improved
efficiency (Melissa, 2017).
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Another author, Kezala (2018), notes that improving working conditions for workers in terms of
workplace safety, health, and hygiene can be an important part of Africa's solution to fighting
poverty. Per Kezala (2018), the quality of healthcare provision was comparatively superb before
Uganda's independence in 1962. In a Professional Code of Conduct, health workers strictly
followed the oath they swore, making service delivery good (Ruthrock, 2019). Health staff
received transport vehicles and houses for lodging, had sufficient wages, pensions, promotions,
and gratuity. They provided services with the heart to serve, treated patients with respect and
dignity, gave them the attention and care that they needed.
Currently in Uganda, different groups of health workers complain of bad working conditions in
form of low wages and pensions, lack of accommodation, transportation, promotion, and also
gratuity. When it comes to Karugutu health center IV, the situation is worrying. Health staff at
the health center is overworked with a large number of patients. This leads to an extended
patient’ waiting time and poor service delivery primarily at Karugutu health center IV
(Mbalibulha, 2015). The above challenges encouraged the researcher to conduct a study at
Karugutu Health Center IV on the relationship between working conditions and the performance
of health workers.
1.2.3 Theoretical background
The study was guided by the theory of Herzberg's motivation or the two factor theory of 1959
which states that there are certain factors in the workplace that cause job satisfaction while a
separate set of factors cause dissatisfaction, all of which act independently of each other (Hyun
and Sungmin, 2009). The Theory is formed from two groups of factors known as the motivation
factors and hygiene factors (Riley, 2005). In the Theory, the company policy and administration,
wages, salaries and other financial remuneration, supervision, interpersonal relations, working
2
conditions and job security are the factors of Hygiene factors. Challenging work, recognition for
one's achievement, responsibility, opportunity to do something meaningful, involvement in
decision making,( sense of importance to an organization) that give positive satisfaction, arising
from intrinsic conditions of the job itself, such as recognition, achievement, or personal growth
(Riley, 2012). It also rests on two assumptions, the first one being; Presence of Hygiene factor
will not cause satisfaction but their absence causes dissatisfaction and the second assumption
states that thepresence of motivational factors causes satisfaction but their absence causes
dissatisfaction (Jeevan, 2015).
In the study of motivation and work satisfaction, Herzberg attempted an empirical approach,
according to Mullins (2010). His work brought attention to the value of job design and the
quality of work as well. He stresses that workers' working conditions should be safe, hygienic,
and fit for purpose. For other companies in the same market, the pay structure should be equal
and competitive (Expert program management, 2018). Herzberg discovered that job satisfaction
factors are related to what a worker does, while dissatisfaction factors are related to the situation
under which he or she works. It is also important to remember that the absence of hygiene factors
induces tension, resulting into poor output due to the absence of motivational factors. Therefore,
it can be inferred that an unhappy worker could be a depressed worker, so poor workers
performance (Mullins, 2010). Herzberg says one need to address the motivating factors
associated with working conditions in a work place so as to create satisfaction. In this study
therefore, working condition is one of the variables, the quality of work is also going to be under
performance. The two-factor theory of Herzberg was used because it addresses workers’
problems by focusing on satisfaction and dissatisfaction factors clearly bringing out issues in the
3
study problem andvariables; working conditions and health workers’ performance at Karugutu
health center IV.
1.2.4 Conceptual background
Many authors give a critical interpretation of working conditions in various ways. Basu (2015)
defines working conditions as a totality of forces, actions and other influential factors that deal
with worker performance practices, whereas Asigele (2012) defines work conditions as demands,
environment and terms of a job that influence staff satisfaction.
He went ahead and stated that to attract and retain talent, organizations may compete by offering
attractive conditions. Working conditions are described as the amount of interrelationships
within an employee, as well as the atmosphere in which he or she works. Opperman (2002),
another scholar, describes working conditions as a combination of the three main sub-conditions:
technological conditions, human conditions, and organizational conditions afterward. The
technical environment relates to instruments, machinery, technological infrastructure and other
physical or technical components. Therefore, this condition is intended to facilitate informal
contact in each workplace to improve the exchange of knowledge and optimal efficiency
(Bushiri, 2014). The researcher, however, studied working conditions in terms of infrastructure,
working equipment, and employee rewards during the study.
In different ways, various researchers describe the performance of health workers. Sinha (2001)
describes the performance of health workers as the ability and transparency of health workers to
achieve organizational objectives or goals through employee productivity.
While Stup (2003) describes the performance of health workers as the use of physical equipment
to do effective work with good performance standards, offers input on performance, taking into
account the reward for the good, the experience, the skills, and the attitude of the standard
4
operating procedures. In this study, the researcher therefore handled health workers' performance
in the form of effectiveness, efficiency and quality of work.
1.2.5 Contextual background
The value of Karugutu health center IV in achieving successful service delivery is the realization
of effectiveness, efficiency and quality of work. Karugutu Health Center IV provides both
outpatient and inpatient care with extensive HIV services to sustain proper delivery of services to
the community (Mbalibulha, 2016). All inpatient and outpatient clients use laboratory facilities,
there after receive treatment. Additionally, health education, immunization services, malnutrition
evaluation, operations, and referral services are also provided by the health center. Despite the
growing number of patients, Karugutu Health Center IV has 60 workers and 6 management
committee members, year in and year out. The facility also partners with Baylor Uganda an
NGO that mainly focuses on handling HIV and TB related issues. Baylor Uganda has a total
number of 5 workers (CDO Report, 2018).
The performance of health workers depends not only on the availability of infrastructure but also
working equipment as well as employee rewards. As per karugutu health center IV, the facility
has a small number of health workers with limited and not well maintained housing for them.
The unreliable supply of laboratory and other equipment in addition to delayed salary payment
affects their performance in form of delayed referral which leads to higher levels of death,
absence from work leading to higher amount of work load, late arrival at work also contributes to
an increase in the patients’ waiting time (CDO, Report 2018). A combination of all the above
provides a signal of health workers’ failure to be effective at work, efficiency not being
maintained and also providing poor quality of work to the patients in addition to inability to
5
meet the health center’ overall goal. Basing on the above statement, the researcher intended to
conduct a study at Karugutu Health Center IV on the relationship between working conditions
and health workers’ performance.
1.3Problem Statement
The Ministry of Health and Karugutu Health Centre IV have made efforts to improve working
conditions by providing good infrastructure in addition to working facilities as well as rewards
for health workers (MOH, Annual Sector Performance Report, 2014). Despite the incentives
granted, workers’ performance has remained below expectation (Mbalibulha. 2015). It takes six
months to learn and understand the proper working of the Health Center when health workers are
hired. Performance is low during this period until the rest of the workers train them so that they
are experienced. The sad part is that, when health workers are appropriate and adaptable to the
Health Center they resort to late attendance, gross absenteeism from work in addition to surfing
the internet for personal pleasure during working hours as well as looking for other
opportunities. This makes it a clear indication of not effectively doing the required work
efficiently, contributing to the production of unreliable quality of work.
The Uganda Local Government Councils Score Card by Advocates Coalition for Development
and Environment (ACODE) for 2009/2010 indicates that problems such as understaffing,
unavailability of drugs and equipment, absenteeism of health workers, and weak accountability
mechanisms persist. Therefore, while the management and control of health center level
programs has been carried out in the long-term institutional arrangements, Karugutu Health
Center IV's functional success depends on the availability of infrastructure, working equipment,
and employee rewards to provide services to the general public in time and efficiently. The
6
above challenges inspired the researcher to conduct a study at Karugutu Health Center IV on the
relationship between working conditions and health workers’ performance.
1.4 Purpose of the study
This study aimed at investigating the relationship between working conditions and health
workers' performance at Karugutu Health Center IV.
1.5 Specific Objectives
i. To identify how infrastructure facilities influence health workers' performance at Karugutu
Health Center IV.
ii. To determine the extent to which working equipment influence health workers’ performance
at Karugutu Health Center IV.
iii. To establish how employee rewards influence health workers' performance at Karugutu
Health Center IV.
1.6 Research Questions
i. How do infrastructure facilities influence health workers' performance at Karugutu Health
Centre IV?
ii. To what extent do working equipment influence health workers' performance at Karugutu
Health Centre IV?
iii. How does employee rewards influence health workers' performance at Karugutu Health
Centre IV?
1.7 Hypotheses of the Study

i. There is a significant positive relationship between infrastructure facilities and health
workers' performance at Karugutu Health Center IV.
7
ii. There is a significant positive relationship between working equipment and health workers'
performance at Karugutu Health Center IV.
iii. There is a significant positive relationship between employee rewards and health workers'
performance at Karugutu Health Center IV.
1.8 Conceptual Framework
When health workers are supported or provided with attractive working conditions, their
performance is determined by effectiveness, efficiency and quality of work (Bushiri, 2014).
The figure below shows the influence of Working Conditions upon Health Workers’
Performance at Karugutu Health Center IV.
WORKING CONDITIONS (I V) HEALTH WORKER’S PERFORMANCE (DV)
Infrastructure
Housing & Furniture
Water & Electricity
Working Equipment
Tool kits Effectiveness
Theatre equipment
Laboratory equipment
Employee Rewards
Efficiency
Base pay
Allowance
Other rewards
Recognition and appreciation
Quality of work
Figure1.1: Conceptual Framework showing the influence of the Working Conditions upon
Health Workers Performance.
Source: Okech (2018) with modifications made by the researcher.
The above figure shows the relationship between working conditions and health workers'
performance. It considers the availability of working conditions in terms of infrastructure,
8
working equipment, and employee rewards that significantly influence health workers'
performance through effectiveness, efficiency and quality of work.
1.9 Significance of the Study
In addition to mobilizing financial, human and capital resources for hospitals in Uganda, policy
makers can use the research results to reinforce management processes.
The results of the research will enable the Ministry of Health to achieve a decent standard of
health for everyone in Uganda and promote a safe and productive life.
Hospital managers will use the results of the study to recognize deficiencies in their work and to
be able to better match the resources available with the defined goals or priorities by careful
preparation, easy decision-making, coordination, transparency, progress in the management of
human resources, consistent communication, ensuring productivity and efficiency in the quality
of service delivery.
The results of the study will also be used as a basis for future researchers who might venture into
a similar field of working conditions and health workers performance.
In addition, the thesis will allow a researcher at the Uganda Management Institute to fulfill one
of the criteria for a Master's Degree in Public Administration award.
1.10 Justification of the Study
There have been performance reviews that made recommendations for improving health
performance. Different problems relating to working conditions and health results, like Karugutu
Health Center IV, have not been resolved, forcing the researcher to conduct the study. Karugutu
Health Center IV was chosen due to the problems facing the local people like absenteeism of
9
health workers and also because the center is often among the low performers in the region
(MOH, Annual Sector Performance Report, 2014).
1.11 Scope of the Study
1.11.1 Geographical scope
Karugutu Health Center IV conducted the research. The health center is located in Karugutu
Town Council, found in the district of Ntoroko, which is about 28 km from Fort-Portal town
along the Bundibugyo-Fort-portal highway.
1.11.2 Content scope
The main study focus was on the working conditions and health workers’ performance at
Karugutu Health Centre IV. Working condition was the independent variable and health workers'
performance was the dependent variable. Working condition was measured in terms of
infrastructure, working equipment, and employee rewards. The health workers’ performance was
also measured in terms of Effectiveness, Efficiency, and the Quality of work.
1.11.3 Time scope
The study time focus was from 2014 to 2017 because it is within that period when the center in-
charge was confronted by over 50 patients about the long time spent at the Karugutu Health
Center (Mbalibulha, 2014). Also, during that period, the center performed poorly by failure to
achieve some of the required key performance indicators in addition to the existence of
unbalanced scorecards and uncompleted performance monitoring charts (MOH, Annual Sector
Performance Report, 2016).
1.12 Operational Definitions
Infrastructure: In this study was referred to as buildings or workspaces, power, water, and others.
10
Working equipment: In this study was referred to as items used in the performance and treatment
of patients' medical procedures, such as tool sets, theatre equipment and laboratory equipment.
Employee rewards: In this study was referred to as basic pay/compensation, allowances, other
rewards like recognition, and appreciation.
Effectiveness: In this study was referred to as effectively using the available tools to achieve the
organizational goal.
Efficiency: In this study was referred to as properly using resources to achieve a given output.
Quality of work: In this study was referred to as the importance of work that a person, team, or
organization provides.
Working conditions: In this study was referred to as infrastructure, working equipment and
employee rewards.
Performance: In this study was referred to as effectiveness, efficiency and quality of work.
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CHAPTER TWO: LITERATURE REVIEW
2.1 Introduction
When health workers are supported with attractive working conditions, their performance
becomes higher compared to when the working conditions are stressful. Working condition is a
very significant factor towards health workers’ performance (Danica, 2013). This chapter
consists of the available Literature basing on the theory, themes from the objectives and a
summarized portion of the reviewed literature.
2.2 Theoretical Review
The study was guided by the Herzberg motivation theory or the two-factor theory of 1959 which
states that there are certain factors in the workplace that cause job satisfaction while a separate
set of factors cause dissatisfaction, all of which act independently of each other (Hyun &
Sungmin, 2009). The Theory is formed from two groups of factors known as the motivation
factors and hygiene factors (Riley, 2005). In the Theory, the company policy and administration,
wages, salaries and other financial remuneration, supervision, interpersonal relations, working
conditions and job security are the factors of Hygiene factors. Challenging work, recognition for
one's achievement, responsibility, opportunity to do something meaningful, involvement in
decision making, is a sense of importance to an organization that gives positive satisfaction,
arising from intrinsic conditions of the job itself, such as recognition, achievement, or personal
growth(Riley, 2012). It also rests on two assumptions, the first one being; Presence of Hygiene
factor did not cause satisfaction but their absence caused dissatisfaction and the second
assumption states that thepresence of motivational factors caused satisfaction but their absence
did not cause dissatisfaction (Jeevan, 2015).
12
Herzberg attempted an empirical approach within the study of motivation and work satisfaction
in (Mullins, 2010) his studies drew attention to the meaning of job design and the quality of jobs.
He stresses that workers' working conditions should be safe, fit for purpose, and hygienic. With
other organizations of the same sector, the wage structure should be equal and competitive
(Expert program management, 2018). Herzberg found out that job satisfaction factors relate to
what a worker does, while dissatisfaction factors relate to the situation in which he or she works.
The lack of hygiene variables creates stress that contributes to poor health (Mullins, 2010).
According to the expectation theory of Vroom in 1964, behavior results from deliberate choices
among alternatives to maximize enjoyment and minimize pain. Vroom realized that the output of
employees depends on individual variables, such as personality, abilities, experience and the
skills, too. In addition, Vroom said that initiative, success, and motivation are related to the
degree of motivation of an individual. The Expectancy, Instrumentality, and Valence variables
were used in his analysis. An increase in effort leads to high output levels in expectation,
meaning that when one works harder, he/she performs better. Performance may be influenced by
the availability of the right tools, the right expertise to do the job, and also the mandatory help to
facilitate the work done (Basu, 2015).
Also, McGregor's (1960) theory Y notes that employees would want to do well at work when
given the correct conditions, and there is a reservoir of talent within the workforce. They believe
a good motivator could be the fulfillment of an honest work. Managers should strive to eliminate
obstacles that hinder self-actualization by employees (Mullins, 2010). Based on the theoretical
analysis above, there is a link between the working situation and the performance of the
employees.
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2.3 Literature Review
2.3.1 Infrastructure and Health Workers Performance
Amir & Shamim (2010) established two elements that contribute to working conditions when
evaluating infrastructure. They are primarily the layout plan of the office and also the comfort of
the office. They further claimed that the physical workplace in a business is organized in order to
accomplish the organization's goal easily. Physical factors in the workplace, such as bad layout
and overcrowding, may cause accidents like hitting objects (Basaza, 2016). The e-bray report
(2014-2020) also agrees with the declaration and adds to it that the presence of an honest chair in
an office makes a worker perform better. The workplace configuration, the amount of contact
and even the degree of comfort of an office have a huge effect on the efficiency of the employees
(Asigele, 2012). The main explanation for low employee numbers, especially in hard-to-reach
areas, could be the lack of accommodation for health workers. In An empirical study conducted
by Achinehutome (2014)revealed that subsidized accommodation scheme for teachers in private
schools in Lagos State creates a sense of belonging and teachers’ emotional attachment to the
school where they teach and employees can benefit from an office water cooler chat(Achinehutome,
2014). Everyone needs time to decompress during the workday, when employees take a break and gather
around an office water dispenser, it allows them to engage with one another which contribute to boosting
morale and productivity. In addition gatherings often improve workplace culture by providing casual
“face time” with supervisors and upper management, while also allowing for the opportunity to
collaborate with workers from other departments. These water breaks give employees ample opportunity
to discover shared interests and hobbies which can improve inclusiveness within an organization.
Employee wellness is worth the investment because it is directly related to employee longevity
and happiness. A simple way to improve the wellbeing of workers is installing a water dispenser
14
in an office since it can greatly enable employees to stay productive, healthy, and engaged for
years at a work place.
2.3.2 Working Equipment and Health Workers Performance
The electronic health reporter's available working equipment literature (2020) states that the
health sector uses specialized medical equipment and drugs to treat patients. It is difficult to scan
quickly when there is no track of the package, and this puts the lives of patients in danger.
The availability of correct quantity and standard of medical equipment and supplies, however,
helps in providing patients with timely service. Their availability leads to accuracy and timely
work results. Asigele (2012) agrees with the above assertion and adds that the availability of the
right instruments helps workers do their job significantly.
This suggests that it is necessary to equip them with the proper gear in order for employees to be
efficient and perform better in today's work environment. Similarly, it is noted that health
workers do not operate without supplies (Eshak, Jidi, & Zakaria, 2015). In bridging the prevalent
holes, such as procurement delays, unreliable amounts, overdue supplier orders, and inadequate
records, the availability of sufficient resources can only be sorted out.
2.3.3 Employee rewards and Health Workers Performance
Employee rewards include non-wage compensation and regular wages or salaries, according to a
report administered by Dengejeho (2014). Lambert (2016) notes that, incentives for workers
have a direct effect on employee efficiency, his findings were in line with the real fact that
employees consider jobs where their prominence or value is expressed by financial and non-
financial compensation. In a report by Geldenhuys, Laba, & Venter (2014) on meaningful
employment, dedication to work and organizational participation in the African nation, identified
15
that psychological importance, job dedication, and employee performance have a positive
relationship.
A research by Bernadine (2007) based on the impact of cash on the output of employees. It was
clearly discovered that money motivates action over efficiency, especially when it appears to be
equal, equitable, and offers rewards that the employee genuinely values. Therefore, since
individuals are a strong resource for a company, they have to be empowered so that they are
committed to work and easily achieve the goals that are already set. In a related study, Kepner
(2016) emphasizes that employee rewards are key to arousing workers performance. The
monetary incentives include profit sharing, project bonuses, stock options, and also warrants,
scheduled bonuses and additional paid vacation time. They have traditionally helped maintain a
positive motivational environment for a variety of workers. In Kepners’ study, monetary
incentives focused on salary advance and wages. As per Amah & Chukwuigwe (2017) basing on
a benefit research determined that piece rates, commission trips, bonuses, stock options, and
others offered by employers including health, life, and dental insurance, retirement plans,
maternity leave or child care provision could give a big impact towards the performance and
commitment of the employees.
According to the World Health Organization report of 2006, changes in payment systems may
show promising results, performance-related pay contributes positively or negatively to
performance in terms of improved or low productivity. However, it may need to be
complemented with a quality assurance mechanism that keeps health workers and managers
responsible for their performance and ensure better quality of care.
16
2.4 Summary of Literature Review
Working conditions, in principle, is seen as an output motivator. It means securing, sustaining
and improving the labor force's timeliness, reliability and productivity, leadingto improved
performance.
A clear-cut finding amongst the assorted scholars was that efficiency is positively influenced by
good working conditions. As there are some areas of disagreement, the final picture painted is
that efficiency will be improved if Karugutu Health Center IV adopts the above-mentioned
working conditions.
The literature review, however, had some gaps which deserved attention. Eshak, Jidi, &Zakaria
(2014) examined the link between motivation and the output of employees and needed more
study since they had only used a questionnaire but recommended using another method of data
collection and population size for better results.
The sample used in that analysis was 125, drawn from a population of 650. Therefore, 63
samples out of a population of 71 were chosen during this study. As only a questionnaire tool
was used in the literature, this study added on an interview guide. Secondly, as an example, most
studies had been carried out outside Uganda for an extended period of time. Technology in India,
Tanzania, Kenya, Ghana, the United States of America, and other countries has changed making
the previous findings unparalleled. The earth's movement forces triggered by the heavy rain also
rendered the old research not accurate since running water washes away health centers.
17
CHAPTER THREE: METHODOLOGY
3.1 Introduction
This chapter outlines the approach that was used to investigate the relationship between working
conditions and health workers’ performance. The chapter also covered the research design used,
the study population, the sample size and sample selection, sampling techniques and procedures,
methods of data collection, the instruments for data collection, the data collection procedures, the
methods for data analysis, measurement of variables, and key ethical considerations.
3.2 Research Design
A descriptive cross-sectional survey was used to gather data from a cross-section of respondents
(Sekaran, 2003)since it captures data at a selected point in time a cross-sectional design also
increases versatility. It was also carried out on representative population samples, and ethical
concerns seldom occur (Amin, 2005). Groves, Fowler, Couper, Lepkowski, Singer, &
Tourangeau (2009) demonstrated that when investigating research issues, a triangulation of data
collection methods increases data reliability.
The study applied a triangulation technique that incorporated both qualitative and quantitative
methods. By using a triangulation process, the researcher preferred to elaborate or build on the
results. A qualitative approach included the non-numerical presentation of data, while a
quantitative approach presented research results in numbers (Creswell, 2009).
3.3 Study Population
During this study, the target population was 71 people, meaning 60 health workers (including the
support team), 6 management committee members of Karugutu Health Centre IV and 5 workers
of Baylor Uganda. A population is the aggregate of objects or persons with one or more
characteristics in common that are of interest to the researcher (Amin, 2005).
18
3.4 Sample Size and Selection
A sample size of 63respondents was selected from a population of 71 health workers,
management committee members, and BaylorUganda staff found atKarugutu Health Center IV.
These health workers have the expertise necessary for the research, and their efforts directly
contribute to the Health Centre's objectives and goals. Using the Sample Size Table by Krejcie
and Morgan (1970 pp. 607-610) in Appendix III, the sample size of 63 was selected.
Table 3.1: Category, Study Population, Sample Size and Sampling Technique
Category Study Population Sample Size Sampling Techniques
Health workers and Baylor 65 57 Simple random
Uganda Staff
Management committee 6 6 Purposive
Total 71 63
Source: Ntoroko District HR Manual (2015)
3.5 Sampling Techniques and Procedure
Simple random technique was used to select health workers of Karugutu health center IV and
those of Baylor Uganda for the study. According to Creswell (2009), the technique ensured that
each member of the population had an equal chance of being chosen to generate the sample.
More accuracy, clarity, and objectivity are given by simple random sampling. A sample frame
serves the purpose of providing the researcher with a method that can answer questionnaires to
select participants from the target population.
In this research, purposive sampling was employed while sampling the management committee
members. Purposeful sampling, according to Amin (2005), is known as judgmental sampling.
19
Based on the researcher's expertise and awareness of the participants, purposeful sampling was
used to pick participants for the interview and therefore an interview guide was used.
3.6 Data Collection Methods
Two methods of data collection, combined with documentary analysis were used to ensure the
validity of results (Brewer & Hunter, 2006). These are the interview and a questionnaire.
3.6.1 Questionnaire
Data from sampled health workers of Karugutu health center IV and Baylor Uganda was
obtained using a questionnaire. The method was used because it is simple to apply to multiple
respondents within a short period of time (Creswell, 2013). Questionnaires were also useful for
the collection of confidential data from respondents. The questionnaires were self-administered
by the health workers of Karugutu Health Center IV and Baylor Uganda.
3.6.2 Interview
Data from the management committee members was collected using an interview. Interviews
identified events and perceptions of phenomena among respondents (Kothari, 2004). In addition,
an interview is described by Junker & Pennink, (2010), as a conversation between an interviewer
and an interviewee aimed at collecting data on a topic. Face-to-face and telephone interviews
were carried out. Interviews were conducted face-to-face with physically available interviewees,
while telephone interviews were conducted with interviewees who were not physically available
but willing to produce the requisite knowledge.
Both face to face and telephone interviews ensured that quality data was obtained or collected
quickly. Questions in the interviews were both structured and semi-structured. Interviews were
used in conjunction with Somekh & Lewin, (2005), since they have the value of looking for
more knowledge, clarification and capture of interviewees' facial expressions. Interviews often
20
allow certain topics excluded from another instrument to be revisited that are critical in the
analysis.
3.7 Data Collection Instruments
3.7.1 Questionnaire
The first instrument used during this study was a standardized questionnaire. The questionnaire
was developed using the constructs defined from the literature review (Debois, 2019). Per Amin
(2005), formulated problems are easier to investigate because they are in a type that is
immediately used. A questionnaire contained a series of questions to which respondents had
restricted choices for answers (Kothari, 2004). The questionnaire was used based on the
assumption that variables such as the beliefs, opinions, attitudes, and feelings of respondents
cannot be observed under research. The respondents agreed on the dates when to collect the
completed questionnaires after the researcher thoroughly clarified inquiries to prevent doubts.
The questionnaire questions were well formulated to ensure that data collected is accurate and
reliable(Amin, 2005). The shape and layout of the Likertscale style was followed in the
questionnaire since it is the easiest scale for a structured/quantitative questionnaire. Appendix I
include a copy of the format of a questionnaire that the researcher used.
3.7.2 Interview Guide
An interview guide was used to gather information from the management committeesince they
hold key information about the health center that cannot be obtained from other people. Using
the frameworks described within the literature review, an interview guide was developed.
Interviews were correct methods to be used to discuss sensitive subjects in order to create a
favorable atmosphere for respondents(Groves, Fowler, Couper, Lepkowski, Tourangeau, &
Singer, 2009). Interviews were used because they had the value of ensuring a demand for
21
knowledge, clarification and capture of the interviewees' facial expressions (Ragin, 2007). An
interview guide is also detailed with valuable questions which helps the researcher to managethe
flow of information (Amin, 2005). The interview guide consisted of unstructured questions and
therefore helped to discuss all the variables set out in the conceptual framework.
3.8 Validity and Reliability
3.8.1 Validity
Validity is the quality of being correct or true in measuring research instruments (Amin, 2005).
Before administering the tools, validity checks were performed throughout the study to
determine if the query items could catch the expected responses. The researcher consulted
experts to determine the content validity index (CVI) for each item. For the instrument to be
recognized as valid, a minimum CVI of 0.7 is considered (Amin, 2005). The CVI was
determined using the formula below:
CVI = Number of items declared valid
Total number of items
The tools were given to the experts (supervisors) to assess the importance of each item within the
instrument to the goals in order to qualitatively evaluate validity. The scale of each object was as
follows: very important (4), somewhat relevant (3), somewhat relevant (2), and not relevant (1).
Table 3.2: Results of content validity for research tools
Dimensions No of Items Relevant CVI

Infrastructural facilities 05 04 0.8
Working equipment 08 07 0.875
Employee rewards 13 12 0.923
Health worker performance 06 05 0.833
Average % (CVI) 0.857
22
Table 3.2 presents an overall CVI average of 0.857 and each variable represented by; 0.8, 0.875,
0.923 & 0.833 respectively. Each variable had a CVI that is above 0.7, imply that the tool was
valid since it was appropriately answering / measuring the objectives and conceptualization of
the study. According to Mugenda & Mugenda (2003), the tool can be considered valid when it’s
CVI value is 0.7 and above which is the case for all the four variables provided above.
3.8.2 Reliability
Reliability, a measure of the internal consistency and stability of the instrument was determined
by both pretesting and Cronbach’s α coefficient. About 10 questionnaires were pretested to
ensure consistency of the responses. On the other hand, the researcher obtained Cronbach Alpha
coefficient values for each construct and variable from the field results to guide data cleaning
until the coefficients are over and above the 0.7 threshold upon which it can be concluded that
the results used are reliable (Nunnally and Bernstein, 1994). The reliability of instruments was
established using Cronbach Alpha Coefficient which tests internal reliability and the average
reliability test result for research was 0.84 which is recommended as given below in 3.3.
Table 3.3: Reliability test results of research instruments.
Study variables Cronbach’s Alpha

Infrastructural facilities 0.745
Working equipment 0.986
Employee rewards 0.876
Health worker performance 0.765
Average Cronbach Alpha coefficient for variables 0.843
23
Through the use of SPSS, the researcher undertook to judge and determine the coefficient of
reliability of the research instrument. A reliability of 0.8 was considered relevant since a pretest
study was carried out by the researcher on 20 respondents and found 0.827 of 32 items.
3.9 Procedure of Data Collection
The research proposal was approved and an introductory letter was got from Uganda
Management Institute. Research instruments were fine-tuned and tested. Permission was sought
from the In-charge to conduct the study in Karugutu Health Center IV and was granted in form
of a letter. There after an informed consent was sought from the respondents and appointments
were made. The researcher collected data on the study subject from Karugutu Health Center IV.
Questionnaires were administered to the respondents and agreed on a timeline within which to
complete and return. Interviews at the line appointment dates were also carried out (Creswell,
2009).
3.10 Data Analysis
3.10.1 Quantitative Data Analysis
The researcher determined the positivity or negativity path (Noel, 2018). SPSS was used to
organize data into frequencies and percentages, as units of measurement and descriptive statistics
were used to classify the population sampled. In SPSS Version 21 of the computer program, data
was entered for analysis. The responses obtained were summarized in form of graphs and tables
that were analyzed and discussed. This procedure made it easy for the reader to match and
understand the findings. The research provided an analysis of the viewpoints and perceptions of
working conditions and health worker’s performance.
All the research objectives were addressed in the report. This required editing of data, simple
occurrence of answers where completeness of data was checked. On learning that they are
24
incomplete, few instances were discarded. All negative scale objects were reverse-coded;
missing values were checked for objects that were intentionally not ticked or in error and were
discarded. The researcher then produced descriptive statistics and inferential statistics
(correlations & regressions).
3.10.2 Qualitative Data Analysis
According to Education (2020), qualitative data analysis included writing or categorizing the
sum of raw data. The method involved reducing huge quantities of information into distinctive,
significant patterns from which meaningful knowledge and logical patterns were drawn. Based
on each research objective of the report, qualitative data was analyzed thematically. For easy
review, alldata collected was classified and summarized (Creswell, 2009). The researcher made
general summaries and appropriately included identification of trends, inconsistencies,
experiences, and also explanations for their occurrences.
3.11 Measurement of Variables
Codes and labels were applied to emerging themes for qualitative data to help in the capture of
responses for better management and analysis of the entire study, while a Likert Scale was used
to quantify quantitative data variables which is calculated using a 5-point scale of 5 to 1 by
strongly agreeing-5, agree-4, not sure-3, disagree-2, strongly disagree-1 as directed by(Amin,
2005). A Likert scale is a rating scale used to assess opinions, attitudes or behaviors of
respondents.
3.12 Ethical Considerations
All emails and contacts remained anonymous, as well as names of respondents since the
researcher used number codes. The privacy of respondents and their responses were maintained
25
by choosing to perform interviews in areas where respondents believed that their privacy was
secure. Information collected from them was used only for academic purpose.
Participants were given clear details on what the studywas about and guaranteed that their
agreement to participate was openly and willingly coerced. Sekaran-consistent (2003),
Participant consent is obtained through a letter or form outlining what the study entails, including
the protocols that participants may expect to follow, and describing how their confidentiality is
guaranteed. Signing of each participant's mutual informed consent was assurance that
participants did not appear to be compelled to participate in the study but did so voluntarily.
By identifying all the works cited, the researcher ensured that intellectual property rights are
observed, and no plagiarism of the work by other writers was carried out. This implied that the
researcher properly understood the work done by other authors without any misrepresentation.
Using Turnit in tool, the researchers’ work was subject to an originality test.
26
CHAPTER FOUR
DATA PRESENTATION, ANALYSIS AND INTERPRETATION
4.1 Introduction
This chapter presents the findings, analysis and interpretations to the findings. The findings are
presented according to the objectives of the study. The study investigated on the relationship
between working conditions and health workers' performance at Karugutu Health Center IV,
Ntoroko district. The study was specifically premised on the following research objectives;to
identify how infrastructure facilities influence health workers' performance, to determine the
extent to which working equipment influence health workers’ performance and to establish how
employee rewards influence health workers' performance at Karugutu Health Center IV.
4.2 Response Rate
Presentation of tabulated data according respondent’s response rate
Table 4.4: Response Rate
Category Study Sample Sampling Instrument Actual Response

population size technique Response rate (%)
Health 65 57 Simple Questionnaire

workers of random
Karugutu
HC IV &
Baylor
Uganda staff
57 54 94%
Management 6 6 Purposive Interview 5 83%
of Karugutu sampling guide
HC IV
Total 71 63
Source: Primary Data (2021)
From table 4.4 above, out of the 57 questionnaires administered, 54 were returned correctly
27
filled representing 94%. Out of 6 targeted members of the management committee, 5 were able
to be interviewed implying a response rate of 83%. The overall response rates were considered
good enough since it was over and above the 50% as recommended by (Amin, 2005).
4.3 Findings on Background Characteristics
This section presents findings on demographic characteristics of the respondents as presented
below.
4.3.1 Age of the Respondents
The study looked at age distribution of the respondents by using a frequency distribution. The
results obtained are presented in Table 4.5 below;
Table 4.5: Age of the Respondents
Age bracket Frequency Percentage
19-29 years 16 30
30-39 years 15 28
40-49 years 19 35
50 years and above 04 07
Total 54 100
From the above Table 4.5, the majority of respondents who took part in the study were between
40-49 years making a total percentage of 19(35%), 16(30%) were between the age of 19-29
years, those between 30-39 years were 15(28%), and those that were above 50 years were
04(07%). This implies that the data provided was reliable since it was generated from different
respondents with different age brackets.
28
4.3.2: Gender characteristics of the Respondents
The gender characteristics of respondents investigated for this study findings are presented in
Table 4.6 below;
Table 4.6: Gender of respondents
Category Frequency Percentages
Male 28 52
Female 26 48
Total 54 100
Source: Primary Data (2021).
Table 4.6 shows that majority of the respondents were male 28(52%) and female were 26(48%).
The implication of this finding was that no matter the disparity in percentage of males and
females who took part in the study, at least views from both males and females were captured
which is too vital in making a critical analysis on the working conditions and health workers’
performance in Karugutu Health Center IV. This made the study findings fairly representative
and therefore, enabled generalization of results.
4.3.3: Marital status of respondents
Figure 4.2 below shows the marital status of respondents interviewed during the study;
29
Widowed
2%
Single Married
46% 52%
Results from the figure above indicate that majority of the respondents were married 28(52%),
singles were 23(46%) whereas 01(02%) of the respondents were widowed and none of the
respondents had divorced respectively. This indicated that all categories of respondents in
reference to marital status were represented in this study.
4.3.4: Education level of respondents
The respondents were also asked to indicate their education levels and findings were as
illustrated in the Figure 4.3 below;
30
60
50
40
30 Frequency
Percentage
20
10
0
Degree Certificate Masters Diploma Others
So
urce: Primary Data (2021)
Figure 4.3: Highest Level of Education the Respondents
Findings in Figure 4.3 above indicates that majority of the respondents were diploma holders
29(53%), certificate holders were 23(43%), bachelors’ holders were 01(02%), masters level
01(02%) and others 00%. These results indicate that the respondents had good qualifications and
the right skills and knowledge to deliver services as required. Besides, the respondents were able
to read, interpret and understand the questions in the questionnaire and gave relevant responses.
Relatedly, there were a reasonable number of attendants who had attained high education
qualifications necessitating consideration of their qualification in the determination of basic pay
to motivate employees with higher education and effectively perform their duties.
4.4 Empirical Findings according to the study objectives
4.4.1 How infrastructure facilities influence health workers' performance
The items on infrastructure facilities were structured basing on the objectives of the study. Items
were measured on a five-point Likert scale where code 1 = Strongly Disagree, 2 = Disagree, 3 =
31
Not sure, 4 = Agree and 5 = Strongly Agree. The data is presented and analyzed basing on 05
items which are statistically tabulated and presented in the table below with the frequencies and
percentages according to the responses collected.
Table4.4: How infrastructure facilities influence health workers' performance
Items SD D N A SA Mean Std.Dev
The wards are sufficient for the 52% 09% 20% 07% 09% 2.24 1.24
number of health workers (28) (05) (11) (04) (05)
The offices are sufficient for 11% 09% 15% 39% 26% 3.63 1.17
the number of health workers (6) (5) (8) (21) (14) 1
The theatres are large enough 52% 19% 11% 22% 15% 2.15 .854
for the purpose. (28) (10) (06) (12) (08)
There are a number of 26% 21 00% 07% 46% 3.80 1.65
buildings still under (14) (11) (00) (04) (25)
construction
The buildings in the hospital 67% 15% 06% 13% 07% 1.79 1.20
are well maintained (35) (08) (03) (07) (04)
Source: Primary Data, (2021)
As to whether the wards are sufficient for the number of health workers, respondents’ responses
indicated that cumulatively, 52%strongly disagreed, 09% disagreed, 11% were not sure 07%
agreed and 09% strongly agreed. The mean = 2.24 indicated that majority of the respondents
disagreed that wards are not sufficient for the number of health workers. The standard deviation
was 1.24 indicating that those respondents had deviating responses.
A key informant revealed that;
32
Karugutu health center IV has only two wards for example the general ward and
maternity ward. Patients like children, male and female would have been provided with
different wards but someone who treats for example males does it when children and the
female patients are observing everything in a compacted general ward.
Relatedly, respondents had this to say on whether the offices are sufficient for the number of
health workers, 11% strongly disagreed, 09% disagreed, 08% not sure, 39% agreed and 26%
strongly agreed. The mean = 3.63 indicated that offices are sufficient for the number of health
workers. The standard deviation was 1.17 indicating those who had deviating responses. The
findings are supported by the key informant who said;
They have offices attached to every building at the health center.
With respect to whether the theatres are large enough for the purpose, 52% strongly disagreed,
19% disagreed, 11% not sure, 22% agreed, and 15% strongly agreed. The mean = 4.15 which
indicates that majority of the respondents strongly disagreed with the statement.
The health center has one small theatre which makes work difficult when there is more
than one patient that needs emergency contributing to unnecessary referral of patients to
the distant hospitals outside the district making the center unreliable for proper patient
care.
As to whether there are a number of buildings still under construction, 26% strongly disagreed,
21% disagreed, 00% not sure, 07% agreed and 46% strongly agreed. The mean = 3.80 meant that
respondents agreed that there are a number of buildings still under construction. The standard
deviation was 1.65 explaining deviating responses.
33
There is a building supposed to be for children issues that has failed to be completed due
to delays in the release of funds from the government which consists of a lot of
bureaucratic processes and procedures.
With respect to whether the buildings in the hospital are well maintained, 67% strongly
disagreed, 15% disagreed, 06% were not sure, 13% agreed, 07% strongly agreed. The mean =
3.79 which corresponded to strongly disagreed indicated that majority of the respondents
disagreed with the statement.
A key informant stated that;
Most of the buildings at the health center are old with cracks; some latrines are beyond
repair and are out of use though still there. They are breeding areas for cockroaches at
the center.
Testing hypothesis one
Table4.5: Correlation Matrix for infrastructure facilities and health workers' performance
Infrastructure Health Workers'

Facilities Performance
Infrastructure Pearson Correlation 1 .588**
Facilities Sig. (2-tailed) .000
N 54 54
Health Workers' Pearson Correlation .588** 1

Performance
Sig. (2-tailed) .000
N 54 54
**. Correlation is significant at the 0.01 level (2-tailed). Source: Primary Data (2021)
34
The coefficient was .588** and p=0.000<0.05 and the significance level was 0.000(r=.588). The
result depicts a moderate correlation between infrastructure facilities and health workers'
performance which is statistically significant. Therefore, the alternative hypothesis that was
earlier stated in chapter one (there is a significant positive relationship between infrastructure
facilities and health workers’ performance at Karugutu Health Center IV) is rejected and a null
hypothesis (there is no relationship between infrastructure facilities and health workers’
performance at Karugutu Health Center IV) is accepted. This implies that, infrastructure facilities
have to be improved so that health workers are satisfied.
4.6 The extent to which working equipment influence health workers performance
The (08) items on working equipment were structured basing on the objectives of the study.
Items were measured on a five-point Likert scale where code 1 = strongly Disagree, 2 =
Disagree, 3 = Not sure, 4 = Agree and 5 = strongly Agree. The items are statistically tabulated
and presented in table 4.7 below with the frequencies and percentages according to the responses
collected.
Table 4.6: The extent to which working equipment influence health workers’ performance
35
Items SD D N A SA Mea Std.
n Dev
The health equipment used are 04% 09% 00% 13% 74% 4.26 5.64
fairly good (00) (07) (40)
(02) (05)
The health equipment needed is 22% 11% 07% 37% 22% 3.18 1.43
available (20) (12)
(12) (6) (04)
The health equipment is always 15% 13% 06% 56% 11% 3.89 1.24
checked before use (03) (30)
(08) (07) (06)
There is a policy in place for 17% 09% 13% 35% 26% 3.89 4.27
use of equipment (07) (19) (14)
(9) (5)
The hospital beds are enough 15% 43% 07% 13% 22% 3.17 1.32
(07)
(08) (23) (04) (12)
The tool kits issued to mothers 09% 48% 00% 15% 28% 3.44 1.21
and patients are adequate
(05) (26) (00) (08) (15)
The hospital laboratory is well 20% 52% 04% 17% 09% 2.00 1.32
equipped (07) (05)
(11) (27) (02)
The health equipment needed 09% 20% 13% 17% 41% 3.85 1.21
are always bought
(05) (11) (07) (09) (22)
36
With respect to whether the health equipment used are fairly good, 04% strongly disagreed, 09%
disagreed, 00% not sure, 13% agreed and 74% strongly agreed. The mean = 4.26 which
corresponded to agreed indicated that majority of the respondents agreed that the health
equipment used are fairly good and 1.43 standard deviation indicated those respondents who
deviated from the response.
Responses to the question as to whether the health equipment needed are available, 22% strongly
disagreed, 11% disagreed, 07% were not sure, 37% agreed and 22% strongly agreed. The mean =
3.18 indicated that health equipment needed are available. The standard deviation was 1.43
showing those who deviated from the responses.
The hospital is stocked to a fair level with personal protective gear, although there are
some staff that have an attitude of I don’t care when it comes to using them. Still some
gears such as gumboots, gurgles and plastic aprons are lacking.
As to whether the health equipment is always checked before use, the respondent’s responses
indicated that 15% strongly disagreed, 13% disagreed, 06% were not sure, 56% agreed, 11%
strongly agreed. The mean = 3.89 indicated that the majority of the respondents agreed that the
health equipment is always checked before use.
Responses to the question as to whether there is a policy in place for use of equipment, 17%
strongly disagreed, 09% disagreed, 13% not sure, 35% agreed and 26% strongly agreed. The
mean = 3.89 indicated that the majority of the respondents agreed that there is a policy in place
for the use of equipment.
With respect to whether the hospital beds are enough 15% strongly disagreed, 43% disagreed
07% were not sure, 13% agreed and 22% strongly agreed with the statement. The mean = 2.17
37
indicated that the majority of the respondents disagreed with the statement.In relation to this,
akey respondent stated that;
In most cases many mothers after giving birth sleep on the ground due to lack of enough
beds which blocks way for others and also hinders cleaners from accessing areas
required to be cleaned.
As to whether the tool kits issued to mothers and patients are adequate, 09% strongly disagreed,
48% disagreed, 00% were not sure, 15% agreed and 28% strongly agreed. The mean = 2.44
meant that the majority of respondents disagreed with the statement. A key respondent stated
that;
Tool kits are not always enough and mothers are advised to buy from the nearby
pharmacies since it is one of the requirements at the health center when one is in labor.
With respect to whether the health center laboratory is well equipped, 20% strongly disagreed,
52% disagreed, 04% were not sure, 17% agreed, 09% strongly agreed with the statement. The
mean = 2.00 which corresponded to disagree with the statement. As per this, a key respondent
stated that;
Equipment sometimes take long to be repaired due to bureaucratic processes of resource
mobilization, this negatively affects staff because their work is halted when there is
breakdown. The few equipment translates into poor output. Some tests/ procedures are
completely equipment based for example measuring patients vital cannot be done without
equipment like a BP machine.
Responses to the question as to whether the health equipment needed is always bought, 09%
strongly disagreed, 20% disagreed, 13% were not sure, 17% agreed, and 41% strongly agreed.
38
The mean = 3.85 indicated that the majority of the respondents agreed that the health equipment
needed is always bought.
Testing hypothesis two
Table4.7: Correlation Matrix for working equipment and health workers’ performance
Working Health Workers
Equipment Performance
Working Pearson Correlation 1 .477**
Equipment Sig. (2-tailed) .000
N 54 54
Health Workers Pearson Correlation .777** 1
Performance
Sig. (2-tailed) .00
N 54 54
**. Correlation is significant at the 0.01 level (2-tailed)
The correlation coefficient was .477**. The results indicate that there is a slightly below
moderate relationship between working equipment and health workers’ performance which is
statistically significant. Therefore, the alternative hypothesis that was earlier stated in chapter
one (there is a significant positive relationship between working equipment and health workers’
performance at Karugutu Health Center IV)is rejected and a null hypothesis( there is no
relationship between working equipment and health workers’ performance at Karugutu health
Center IV) is accepted. This therefore means that availability of working equipment does not
39
necessarily guarantee good health workers’ performance but a very important requirement at the
Health Center and can easily make health workers dissatisfied.
4.7 How employee rewards influence health workers' performance

The items on employee rewards were structured basing on the objective of the study. Items were
measured on a five-point Likert scale where code 1 = Strongly Disagree, 2 = Disagree, 3 = Not
sure, 4 = Agree and 5 = Strongly Agree. (13) Items statistically tabulated and presented in the
table below consist of frequencies and percentages according to the responses collected.
Table4.8: How employee rewards influence health workers' performance
Items SD D N A SA Mean Std. Dev
My salary is released on time 48% 33% 00% 11% 07% 1.48 1.76
(26) (18) (00) (06) (04)
I am on the government pay 40.7% 31.4% 9.2% 5.5% 12.9% 2.58 1.42
roll
(22) (17) (05) (03) (07)
The salary I get is enough 31.4% 44.4% 5.5% 07% 11% 1.13 2.03
(17) (24) (03) (4) (06)
I can afford a good standard 46.2% 38.8% 00% 5.5% 07% 2.22 1.23
of living with my salary
(25) (21) (00) (03) (04)
The salary I receive is a 38.8% 31.4% 18.5% 8.2% 11% 2.14 1.45
consolidated figure
(21) (17) (10) (00) (6)
I am paid for the extra 7.4% 55.5% 00% 14.8% 22.2% 1.39 1.24
responsibilities I have
40
(4) (30) (00) (08) (12)
I receive allowances for 42.5% 26.6% 00% 18.5% 09 % 2.41 1.30

various duties under taken.
(23) (16) (00) (10) (5)
I have access to salary 46.2% 33.3% 00% 00% 20.3% 1.29 1.40
advance
(25) (18) (00) (00) (11)
The salary advance is given 38.8% 44.4% 00% 00% 16.6% 2.00 1.21
on time
(21) (24) (00) (00) (9)
I receive my allowances on 51.8% 18.5% 11% 22% 15% 2.15 .854
time (28) (10) (06) (12) (08)
I am given housing 25.9% 35.1% 00% 07% 31.4% 3.80 1.65
allowance (14) (19) (00) (04) (17)
I am given transport 67% 15% 06% 13% 07% 1.79 1.20
allowance (35) (08) (03) (07) (04)
My allowance is equal to 20% 52% 04% 17% 09% 2.00 1.32

other health workers (07) (05)
(11) (27) (02)
With respect to whether salary of the health workers is released on time, 48% strongly disagreed,
33% disagreed, 00% not sure, 11% agreed and 07% strongly agreed. The mean=1.48 indicated
that majority of the respondents disagreed that salary of the health workers is not released on
time. The standard deviation was 1.76. This implies that some employees are not satisfied with
the time taken to receive their salary.
41
Responses to the statement as whether I am on the government pay roll 40.7% strongly
disagreed, 31.4% disagreed, 9.2% were not sure, 5.5% agreed and 12.9% strongly agreed. The
mean = 2.58 indicated that the majority of the respondents disagreed with statement. A key
informant stated that;
Sometimes it is hard to be put on the pay roll since when they apply for jobs they are
being asked to pay a lot of money and they end up working as volunteers since they are
not able to raise the required fees.
Responses to the statement as to whether the salary I get is enough, 31.4% strongly disagreed,
44.4% disagreed, 5.5% were not sure, 07% agreed and 11% strongly agreed. The mean = 1.13
indicated that the majority of the respondents disagreed with the statement. This implies that the
health center pays less and health workers are likely to be less motivated compared to their
colleagues from other similar organizations. In relation to this, akey respondent stated that;
We earn hand to mouth money which makes it hard for us to develop.
As to whether I can afford a good standard of living with my salary, 46.2% strongly disagreed
38.8% disagreed, 00% not sure, 5.5% agreed, 07% disagreed. The mean = 2.22 indicated that the
majority of the respondents disagreed with the statement. The standard deviation was 1.23
showing deviating responses from the statement.
With respect to whether the salary I receive is a consolidated figure, 38.8% strongly disagreed,
31.8% disagreed, 18.5% not sure, 8.2% agreed 11% strongly agreed. The mean = 2.14 which
corresponded that majority of the respondents disagreed that the salary they receive is not a
consolidated figure. This implies that the health center pays less and its health workers are likely
42
to be less motivated. It can be concluded that employees may become dissatisfied and this could
affect their performance.
Responses to the statement as to whether I am paid for the extra responsibilities, 7.4% strongly
disagreed, 55.5% disagreed, 00% of the respondents were not sure, 14.8% agreed whereas 22.2%
of the respondents strongly agreed with the statement. The mean = 1.39 indicated that the
respondents disagreed with statement. A key informant stated that;
When payment is less, workers feel like looking for other jobs that are highly paying or
even join agriculture and business.
With respect to whether I have access to salary advance, majority of the respondents 46.2%
strongly disagreed with the statement, (33.3%) agreed with the statement, 00% of the
respondents were not sure, whereas 20.3% strongly agreed. The mean = 1.29 which
corresponded to those who disagreed with the statement. The standard deviation 1.40 showed
deviating responses from the statement.
As to whether the salary advance is given on time, cumulatively the larger percentage 44.4%
disagreed with the statement, 38.8% strongly disagreed, 00% were not sure, 16.6% of the
respondents strongly agreed with the statement. The mean = 2.00 meant that salary advance is
not given on time.
With respect to whether I receive my allowances on time, 51.8% strongly disagreed with the
statement, 18.5% disagreed, 11% were not sure, 22% agreed with statement and 15% strongly
agreed with the statement. The mean = 2.15corresponded to disagree indicating that the majority
of the respondents’ allowances are not received on time. The findings above are supported by a
key informant who said;
43
Due to delayed payment of allowances, they are forced to borrow money from banks and
in case payment is done the banks automatically cut off the money which is not good
since borrowing becomes continuous.
With respect to whether I am given housing allowance, 25.9% strongly disagreed, 35.1%
disagreed, 00% not sure, 07% agreed, and 31.4% strongly agreed. The mean = 4.15corresponded
to those that disagreed with the statement. These findings are in harmony with Bond and
Galinsky, (2006) who stated that some organizations give housing allowances or provide housing
facilities and other supplementary assistances to their workers as a demonstration that they view
the investment valuable for purposes of enhancing workers’ efficiency.
With respect to whether I am given transport allowance, 67% strongly disagreed, 15% disagreed,
06% were not sure, 13% agreed, 07% strongly agreed. The mean = 1.79 corresponded to
majority of those who disagreed with the statement.
A key informant stated that:
Most of the health workers walk long distances from their areas of residence to the health
center and from the health center back home which forces them to reach at the work
place late and also go back early. Those who are able use bodabodas but not on a daily
basis. There is no reliable means of transport for health workers at Karugutu health
center IV.
With respect to whether allowances are equitably paid to all staff, 20% strongly disagreed, 52%
disagreed, 04% were not sure, 17% agreed, 09% strongly agreed with the statement. The mean =
2.00 which corresponded to agreed indicated the majority of respondents disagreed that
allowances are not equitably paid to all staff.
44
Responses to the statement as to whether the salary of the health workers is released on time09%
strongly disagreed, 20% disagreed, 13% were not sure, 17% agreed, and 41% strongly agreed.
The mean = 3.85 indicated that the majority of the respondents agreed with the statement. A key
respondent stated that;
Sometimes health workers receive their salaries late which affect their performance
mostly when they spend a day without having lunch and try going away to look for other
alternatives to sustain their living hence absconding from duties.
Testing hypothesis three
Table4.9: Correlation Matrix for employee rewards and health workers' performance
Employee Rewards Health Workers'

Performance
Employee Pearson Correlation 1 .322*

Rewards Sig. (2-tailed) .007
N 54 54
Health Pearson Correlation .322* 1

Workers’
Performance
Sig. (2-tailed) .000
N 54 54
*. Correlation is significant at the 0.05 level (2-tailed). Source: Primary Data (2021)
The result in Table 4.11 shows that correlation coefficient is .322*, meaning that there is a weak
relationship between employee rewards and health workers' performance which is statistically
significant. Therefore, the alternative hypothesis that was earlier stated in chapter one (there is a
significant positive relationship between employee rewards and health workers’ performance at
Karugutu Health Center IV) is rejected and a null hypothesis (there is no relationship between
45
employee rewards and health workers’ performance at karugutu health Center IV) is accepted.
Therefore availability of employee rewards does not necessarily guarantee good health workers’
performance but need to be improved so that health workers are satisfied.
Table 4.10: Findings on other rewards and health workers' Performance
Items SD D N A SA Mean Std.Dev
Study leave can be granted to 30% 44% 07% 6.6% 14.8% 2.24 1.24
me if I am going for further (16) (24) (4) (02) (08)
studies
I am covered under health and 15% 65% 00% 09% 11% 1.15 .854
group insurance (8) (35) (00) (5) (6)
I am provided with transport 16.6% 35% 5.5% 13% 30% 2.63 1.17
allowance (09) (19) (3) (07) (16)
I am provided with an official 09% 74% 04% 04% 09% 2.80 1.65
uniform (5) (40) (2) (2) (05)
I am provided with recreation 18.5% 53.7% 00% 13% 14.8% 2.79 1.20
facilities (10) (29) (00) (07) (08)
Staffs doing studies receive 09% 48% 00% 15% 28% 3.44 1.21
100% tuition (05) (26) (00) (08) (15)
Results in Table 4.10 shows that30% of the respondents strongly disagreed that study leave
cannot be granted when going for further studies, 44% of the respondents disagreed with the
statement, 07% being not sure while 6.6% agreed with the statement and 14.8% strongly agreed.
The findings therefore show that responses of the respondents were not similar as the standard
46
deviation was 1.24. The mean was 2.24 showing that majority of the respondents disagreed that
study leave cannot be granted to go for further studies. This is corroborated with interview
results where one respondent stated that;
Most of the health workers at karugutu health center seem to be contented with their
qualifications and therefore going for further studies could be for very few members. It is
not known whether a study leave can be granted or not.
With the statement I am covered under health and group insurance, 15% of the respondents
strongly disagreed with the statement, 65% of the respondents disagreed with the statement 00%
of the respondents were not sure, 09% of the respondents agreed with the statement and 11% of
the respondents strongly agreed with the statement. The mean was 1.15 showing that majority of
the respondents disagreed that there was no health and group insurance. A key respondent stated
that;
Most of the health workers are not informed about health and group insurance.
On the statement I am provided with transport allowance, majority of the respondents disagreed
with the statement, 16.6% of the respondents strongly disagreed with the statement,35% of the
respondents disagreed with the statement and 5.5% were not sure. A minority of the respondents
comprising of 13% agreed with the statement and 30% strongly agreed. The mean was
2.63showing that majority of the respondents disagreed that transport allowance is not given.
Results in Table 4.10 also shows that 09% of the respondents strongly disagreed that they are
not provided with an official uniform,74% of the respondents disagreed with the statement and
04% of the respondents were not sure. A smaller percentage of 04% respondents agreed with the
47
statement that they are provided with official uniforms while09% strongly agreed. The mean of
2.80 indicates that respondents are provided with official uniforms.
In relation to the above, a key respondent stated that;
Majority of the health workers don’t have uniforms. It is therefore not easy for the
patients to identify them and at the same time affects health workers’ morale and
involvement in group activities carried out by the health center.
For the statement I am provided with recreation facilities, 18.5% of the respondents strongly
disagreed with the statement and 53.7% of the respondents disagreed to with the statement. The
standard deviation was 1.2 showing that respondents had differing opinions about the
statement.00% of the respondents were not sure, 13% of the respondents agreed and 14.8% of
the respondents strongly agreed that they were provided with recreation facilities. The mean was
2.79 showing that majority of the respondents were in disagreement with the statement. This is
supported by the interview results where one respondent stated that;
This is the first time of hearing about recreation facilities and therefore don’t know
anything about it.
As per I receive 100% tuition when going for studies, 09% of the respondents strongly disagreed
that they don’t receive 100% tuition, 48% of the respondents disagreed with the statement.
Minority of the respondents,00% were not sure, 15% of the respondents agreed with the
statement and 28% of the respondents strongly agreed with the statement. The standard deviation
was 1.21 showing differing responses from respondents with a mean of2.44 showing that
48
majority of the respondents had mixed reactions on whether staffs doing studies receive 100%
tuition.
49
CHAPTER FIVE
SUMMMARY, DISCUSION, CONCLUSIONS AND RECOMMENDATIONS
5.1 Introduction
This study investigated about working conditions and health workers’ performance in Karugutu
Health Centre IV, Ntoroko district. This chapter presents a summary, discussion of findings,
conclusions and recommendations made by the study in line with the research objectives.
5.2 Summary of key findings
The result showed a correlation coefficient of.588** and p=0.000<0.05 and the significance level
was 0.000 (r=.588). The result depicts a moderate correlation between infrastructure and health
workers' performance which is statistically significant. Therefore, the alternative hypothesis that
was earlier stated in chapter one (there is a significant positive relationship between
infrastructure facilities and health workers' performance at Karugutu Health Center IV) is
rejected and a null hypothesis (there is no relationship between infrastructure facilities and health
workers’ performance at Karugutu Health Center IV) is accepted. This implies that working
conditions have to be improved so that health workers are satisfied.
5.2.2 The extent to which working equipment influence health workers’ performance
The result showed a correlation coefficient of.477** which means a slightly below moderate
relationship between working equipment and health workers’ performance that is statistically
significant positive relationship between working equipment and health workers' performance at
Karugutu Health Center IV) is rejected and a null hypothesis (there is no relationship between
working equipment and health workers’ performance at Karugutu Health Center IV) is accepted.
40
This therefore means that availability of working equipment doesn’t necessarily guarantee good
health workers’ performance but basically an important requirement at the health center and can
easily make health workers dissatisfied.
5.2.3 How employee rewards influence health workers' performance

The result showed a correlation coefficient of .322*. This indicates that there is a weak
relationship between employee rewards and health workers' performance which is statistically
significant positive relationship between employee rewards and health workers' performance at
Karugutu Health Center IV)is rejected and a null hypothesis (there is no relationship between
employee rewards and health workers’ performance at Karugutu Health Center IV) is accepted.
This implies that provision of employee rewards may not necessarily guarantee health workers’
performance but can make them dissatisfied.
5.3 Discussion of the study
The results showed a correlation coefficient of.588** and p=0.000<0.05 and a significance level
of 0.000 (r=.588). This depicts a moderate correlation between working conditions and health
workers' performance that is statistically significant. Therefore, the alternative hypothesis that
was earlier stated in chapter one (there is a significant positive relationship between
infrastructure facilities and health workers' performance at Karugutu Health Center IV) is
rejected and a null hypothesis (there is no relationship between infrastructure facilities and health
workers’ performance at Karugutu Health Center IV) is accepted. This implies that working
conditions have to be improved to satisfy heath workers.
41
The study findings above are in agreement with Amir and Shamim (2010) who established two
elements that contribute to working conditions when evaluating infrastructure. They are
primarily the layout plan of the office and also the comfort of the office. They further claimed
that the physical workplace in a business is organized in order to accomplish the organization's
goal easily.
Physical factors in the workplace, such as bad layout and overcrowding, may cause accidents
that hit objects, for example. The e-bray report (2014-2020) also agrees with the declaration and
adds to it that the presence in an office of an honest chair will make a worker perform better.
Physical factors, such as building space, are closely linked to employee efficiency. The
workplace configuration, the amount of contact and even the degree of comfort of an office have
a huge effect on the efficiency of employees (Asigele, 2012). The main explanation for low
employee numbers, especially in hard-to-reach areas, is the lack of accommodation for health
workers.
The results showed a correlation coefficient of .477**. This indicates that there is a slightly
below moderate relationship between working equipment and health workers’ performance that
is statistically significant. Therefore, the alternative hypothesis that was earlier stated in chapter
one (there is a significant positive relationship between working equipment and health workers'
performance at Karugutu Health Center IV) is rejected and a null hypothesis (there is no
relationship between working equipment and health workers’ performance at Karugutu Health
Center IV) is accepted. This therefore means that availability of working equipment may not
necessarily guarantee good health workers’ performance but basically an important requirement
at the Health Center and can easily make health workers dissatisfied.
42
This finding agrees with the finding of Simon (2010) that there was a significant detrimental
effect from wearing the suit for both measures of performance. However, the finding is contrary
to the findings of most previous scholars. For instance, Abad et al. (2013) revealed that providing
workers assigned to serious and likely hazardous tasks with safety glasses, helmets, boots,
gloves, masks, jumpsuits and shoes led to significant improvements in safety, performance and
workforce productivity. Similarly, Agbola (2012) revealed that organizations which fraught with
unavailability of essential safety equipment had adverse effects on employees and organizational
performance. Likewise, Dumondor (2017) showed that Safety and health facilities had a positive
significant effect on employee performance. Also, Pourmoghani (2004) revealed that the effect
of gloves and goggles were significant across all platforms towards performance. In the context
of Karugutu health center IV, to a higher extent personal protective equipment did not relate to
performance of health workers.
The result showed a correlation coefficient of .322*. This shows a weak relationship between
employee rewards and health workers' performance that is statistically significant. Therefore, the
alternative hypothesis that was earlier stated in chapter one (there is a significant positive
relationship between employee rewards and health workers' performance at Karugutu Health
Center IV) is rejected and a null hypothesis (there is no relationship between employee rewards
and health workers’ performance at Karugutu Health Center IV) is accepted. This therefore
means that availability of employee rewards may not necessarily guarantee good health workers
performance but an important requirement at the health center and can make health workers
dissatisfied.
43
Basing on the discussion of findings above, financial rewards are very instrumental for any
organization that is committed to workers’ motivation. Financial rewards are those factors within
the job environment that are capable of eliciting better job performance from the worker. These
rewards are offered to the worker by the employer. Workers engage in work activities in
response to rewards or commands as noted by Houston (2009).
These findings were in line with the real fact that employees consider jobs where their
prominence or value is expressed by financial and non-financial compensation. In a report by
Geldenhuys, Laba, and Venter (2014) on meaningful employment, dedication to work and
organizational participation in the African nation, identified that effectiveness, efficiency and
quality of work have a positive relationship.
5.4 Conclusion
According to the research findings, the researcher learnt that buildings at the health center are not
enough to accommodate all staff. Much as most health workers have offices at the health center,
they are not attractive and of lowstandard due to lack of proper maintenance as required. Health
workers were found to be still struggling to have even the most moderate housing for residence.
In this study, it was concluded that an improvement in the provision of health workers’ housing
may lead to a significant increase in health workers’ performance since they will be able to
report early for work and also leave at reasonable hours without struggling to find ways of
getting back home. However, there is lack of evidence on how addressing housing conditions
for health workers can increase health workers’ performance. Relatively, the insufficient number
of wards at the Health Center limits health workers from effectively providing good quality care
to patients as well as the Health Center’s failure to achieve the required targets.
44
Secondly, Karugutu Health Center IV has only one small theatre which increases a lot on the
patients’ waiting time to be worked on. For health workers to perform effectively in saving
human life, they need to be supported with more theatres at the health center to prove their
efficiency at work.
During the study, the researcher learnt that, Karugutu Health Center IV is fairly equipped and
before use, the equipment is always checked to provide accurate procedures and prescriptions to
patients. However, equipment is not equally distributed in all departments of the health center
mainly in the laboratory which gives room for higher chances of using guess work. Lack of
personal protective equipment hinders health workers’ performance and also contributes a lot
towards absenteeism. This is especially when health workers lack sufficient waterproof aprons,
eye gaggles, access to all necessary personal protective equipment, health and safety devices or
tools. Health workers under good protection measures work without fear of contracting deadly
diseases from patients (WHO, 2006); the motivation to work hard is high hence resulting into
better quality care to the clients.
In addition to the above, the researcher learnt that beds in the wards at Karugutu Health Center
IV are not enough. This therefore hinders health workers from providing efficient services to In-
patient clients hence leading to an increase in workload as well as unethical behavior such as the
illegal generation of financial income from patients.
Employee rewards are an important factor that may motivate health workers to work effectively
and efficiently to provide good quality care (WHO, 2006). As per this study, the researcher learnt
that, the salary of health workers at Karugutu Health Center IV is not enough and always
45
released late. This makes it hard for them to afford a good standard of living. Low salaries being
a push factor may lead to increased absence of health workers to earn extra income and also
affect their motivation to provide good quality work to the clients. Many health workers in the
public sector adopt a coping strategy to deal with the low income earned from their jobs by for
example requesting informal payments from patients, pilfering drugs as well as referrals to their
own private service (WHO, 2006).
5.5 Recommendation
To increase health workers’ performance, it is recommended that the ministry of health policy
makers, implementers and managers should pay much attention to the provision of health
workers’ housing at Karugutu Health Center IV. This will help health workers to report early and
also leave the center at reasonable hours. Time wasted on walking for long distances will be
channeled to work and increase on dedication. Most workers reach the center already tired due to
walking and with low morale for work which negatively affect their performance. When the
issue of inadequate health workers’ housing is solved consequently health workers’ absenteeism
in all its forms will also be no more.
Secondly, much as most health workers have offices, the management of Karugutu Health
Center IV should focus on making them comfortable and attractively furnished with leisure
activities during breaks and providing flexible work times (shifts) as well as drinking water in
addition to rest rooms so as to get deeper harmony in between free time and work.
46
The management of Karugutu Health Center IV should provide sufficient personal protective
equipment. Such equipment should include waterproof aprons, eye gaggles, all necessary
personal protective equipment, health and safety devices and tools. There is need for a sufficient
budget to be allocated on health and safety since health workers are the ones that make a health
center move forward, their lives are so versatile and cannot be replaced once perished.
The study recommended that, since government aims at improving lives of its citizen therefore, it
has the role to play to make sure that everyone at the workplace is protected from any harm
which may relate to the working condition or operation at the place by setting good and
favorable conditions for the health workers.
Periodic monitoring and evaluation basically on the equipment should be considered vital so that
repair and replacement do not take long. Similarly, the government should put in place a system
where requests are placed whenever there’s lack of equipment so that the responsible body can
deliver them in time at a given Health Center.
Karugutu Health Center IV should revise the salary structure so that workers are motivated by
providing them with fringe rewards such as paid allowance on leave, medical insurance, etc. It
was realized that the permanent and pensionable employees have an “I don’t care” attitude
towards producing results because they know their jobs are secure. It is recommended therefore
that the Karugutu Health Center IV adopts a contract based system of employment so that
renewal is as a result of good performance.
The body that govern health centers in the country should revise the payment structure so that
staff in hard to reach areas are paid highly compared to those in towns to motivate them since
47
they undergo a lot of complications. This will attract different people with good skills and
experience.
The management should establish a shared identity with the health center through having end of
year parties so as to increase on the workers’ commitment, consulting recognized workers to
identify individual interests and also offering best performers praise and compliments. The
management should incorporate motivation in their human resource planning, since motivation
has the potential of increasing health workers’ performance.
5.6 Limitations of the study
The study consisted of some limitations including uncooperative behavior of some respondents,
others were un-approachable coupled with reluctance to give information limited the researcher
in this study. However, the researcher mitigated this by assuring the respondents that the study
was only for academic purpose and showed them a student identity card as proof.
Lack of reports and limited documentation at the health center hindered the researcher from
getting enough information about working conditions and health workers’ performance at
Karugutu Health Center IV. Therefore there is need for further research to be carried out from a
different geographical scope mainly focusing on the relationship between employee rewards and
workers’ performance.
5.7 Contributions of the study
The findings of the study could be useful in various ways;
Provide resource information to academicians, policy makers, and researchers for better policies
and could influence service delivery in the health sector within Uganda and other countries with
similar settings.
48
The study helped substantiate Herzberg’s two factor theory and how it could be applied in
managing health workers’ performance in Karugutu Health Center IV.
The study has also helped in developing operational interventions necessary to stimulate and
enhance the performance of health workers in Karugutu Health Center IV.
This study despite the foregoing limitations has clearly brought out the relationship between
working conditions and health workers’ performance in a Health Center IV such as Karugutu. It
has been found out in this study that, lack of good working conditions without any reasonable
doubt grossly impairs health workers’ performance in Karugutu Health Center IV. And as a
result, the health workers are likely to suffer from chronicle lack of effectiveness, low levels of
efficiency as well as producing poor quality of work.
49
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APPENDICES
Appendix 1: Questionnaire for Health Workers
Dear respondent,
I am Margaret Mukwenda a student of Masters in Public Administration at Uganda Management
Institute, Kampala. I am carrying out research to generate data on Working Conditions and
Health Workers’ Performance in Karugutu Health Center IV, Ntoroko District. You have
been sampled to take part in the study. The information you provide is going to be strictly for
academic use but not against you or your office. The information obtained from you will be
confidentially kept. Your name is not necessary on this questionnaire therefore you are requested
not to write it. Please fill the questionnaire and return to me.
Thank you for your cooperation.
SECTION A BIO-DATA
Please tick the most appropriate option to you.
Age group 19-29 30-39 40-49 50 Above
Sex Male Female
Marital status Married Single Widowed Divorced
Highest Level of Masters Bachelors Diploma Certificate Others Specify
Education
i
Instructions from statement 1 tick the number that best indicates your opinion on the
statements using the following scale.
Scale 5 4 3 2 1
Strongly Agree Agree Not sure Disagree Strongly disagree
SECTION B
1. INFRASTRUCTURE
1 The wards are sufficient for the number of health workers 5 4 3 2 1
2 The offices are sufficient for the number of health workers
3 The theatres are large enough for the purpose.
4 There is a number of buildings still under construction
5 The buildings in the hospital are well maintained
2. WORKING EQUIPMENT
6 The health equipment used are fairly good 5 4 3 2 1
7 The health equipment needed are available
8 The health equipment is always checked before use
9 There is a policy in place for use of equipment
10 The hospital beds are enough
11 The tool kits issued to mothers and patients are adequate
12 The hospital laboratory is well equipped
13 The health equipment needed is always bought
ii
3. EMPLOYEE REWARDS
5 4 3 2 1
14 My salary is released on time
15 I am on the government pay roll
16 The salary I get is enough
17 I can afford a good standard of living with my salary
18 The salary I receive is a consolidated figure
19 I am paid for the extra responsibilities I have
20 I receive allowances for various duties under taken.
21 I have access to salary advance
22 The salary advance is given on time
23 I receive my allowances on time
24 I am given housing allowance
25 I am given transport allowance
26 My allowance is equal to other health workers
4. OTHER REWARDS
5 4 3 2 1
27 Study leave can be granted to me if I am going for further studies
28 I am covered under health and group insurance
29 I am provided with transport allowance
30 I am provided with an official uniform
31 I am provided with recreation facilities
32 I can receive 100% tuition when going for studies
iii
APPENDIX II: Interview guide for top administrators
1. How does hospital space affect the performance of health workers in the Health Centre
with reference to office space, casualty space, theatre space and treatment space?
2. How does maintenance of the available buildings affect the performance of health
workers in the Health Centre?
3. How does the number of wards and office space affect the performance of health workers
in the Health Centre?
EQUIPEMENT
4. How does the available health equipment affect the performance of health workers in the
Health Centre?
5. How does maintenance of the available health equipment affect the performance of health
workers in the Health Centre?
6. How does the number of equipment affect the performance of the health workers in the
Health Centre?
EMPLOYEE REWARDS
7. How do employee rewards given to health workers affect their performance at work?
8. How does salary paid to health workers affect their performance at work?
9. How does accommodation and other allowances given to health workers affect their
performance at work?
HEALTH WORKERS’ PERFORMANCE
10. How is feedback on health workers’ performance provided?
11. How do you obtain feedback from the public on service delivery?
12. How do you measure timely accomplishment of tasks?
13. How do you measure the quality of work produced?
14. How do you monitor health workers’ attendance on duty?
iv
APPENDIX III: KREJCIE, R. V, & MORGAN TABLE FOR SAMPLE SIZE
N S N S N S N S N S
10 10 100 80 280 162 800 260 2800 338
15 14 110 86 290 165 850 265 3000 341
20 19 120 92 300 169 900 269 3500 246
25 24 130 97 320 175 950 274 4000 351
30 28 140 103 340 181 1000 278 4500 351
35 32 150 108 360 186 1100 285 5000 357
40 36 160 113 380 181 1200 291 6000 361
45 40 180 118 400 196 1300 297 7000 364
50 44 190 123 420 201 1400 302 8000 367
55 48 200 127 440 205 1500 306 9000 368
60 52 210 132 460 210 1600 310 10000 373
65 56 220 136 480 214 1700 313 15000 375
70 59 230 140 500 217 1800 317 20000 377
75 63 240 144 550 225 1900 320 30000 379
80 66 250 148 600 234 2000 322 40000 380
85 70 260 152 650 242 2200 327 50000 381
90 73 270 155 700 248 2400 331 75000 382
95 76 270 159 750 256 2600 335 100000 384
APPENDIX IV: FIELD LETTER

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APPENDIX V: PLAGIARISM REPORT
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WORKING CONDITIONS AND HEALTH WORKERS’ PERFORMANCE IN

KARUGUTU HEALTH CENTRE IV, NTOROKO DISTRICT

A DISSERTATION SUBMITTED TO THE SCHOOL OF MANAGEMENT SCIENCE IN

PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE AWARD OF THE

DEGREE OF MASTERS IN PUBLIC ADMINISTRATION OF

UGANDA MANAGEMENT INSTITUTE

by me under the guidance of my supervisors, and is submitted with their approval.

Sign Date: 08th/11/2021

ASSOC. PROF. MARIA KAGUHANGIRE BARIFAIJO

DR. GLADYS MUHAMA

have always loved me unconditionally giving me words of encouragement to finish my studies.

to its current level.

cooperation, this study would have been impossible to accomplish.

richly bless them.

CHAPTER ONE: INTRODUCTION........................................................................................................1

1.2Background to the Study...........................................................................................................................1

1.2.3 Theoretical background........................................................................................................................3

1.2.5 Contextual background.........................................................................................................................5

1.4 Purpose of the study.................................................................................................................................7

1.7 Hypotheses of the Study..........................................................................................................................8

1.9Significance of the Study..........................................................................................................................9

1.10Justification of the Study......................................................................................................................10

1.11 Scope of the Study...............................................................................................................................10

CHAPTER TWO: LITERATURE REVIEW.........................................................................................12

2.2 Theoretical Review................................................................................................................................12

2.3 Literature Review...................................................................................................................................14

2.3.1 Infrastructure and Health Workers Performance................................................................................14

2.3.2 Working Equipment and Health Workers Performance.....................................................................15

2.4 Summary of Literature Review..............................................................................................................17

CHAPTER THREE: METHODOLOGY................................................................................................18

3.2 Research Design.....................................................................................................................................18

3.3 Study Population....................................................................................................................................18

3.4 Sample Size and Selection.....................................................................................................................19

3.5 Sampling Techniques and Procedure.....................................................................................................19

3.6 Data Collection Methods.......................................................................................................................20

3.7 Data Collection Instruments..................................................................................................................21

3.8 Validity and Reliability..........................................................................................................................22

3.9 Procedure of Data Collection.................................................................................................................24

3.10 Data Analysis.......................................................................................................................................24

3.10.1 Quantitative Data Analysis...............................................................................................................24

3.10.2 Qualitative Data Analysis.................................................................................................................25

3.11 Measurement of Variables...................................................................................................................25

3.12 Ethical Considerations.........................................................................................................................25

4.2 Response Rate........................................................................................................................................27

4.3 Findings on Background Characteristics...............................................................................................28

4.3.1 Age of the Respondents......................................................................................................................28

4.3.2: Gender characteristics of the Respondents........................................................................................29

4.3.3: Marital status of respondents.............................................................................................................29

4.4 Empirical Findings according to the study objectives...........................................................................31

4.4.1 How infrastructure facilities influence health workers' performance.................................................31

4.7 How employee rewards influence health workers' performance...........................................................40

CHAPTER FIVE:SUMMMARY, DISCUSION, CONCLUSIONS AND RECOMMENDATIONS 40

5.2 Summary of key findings.......................................................................................................................40

5.2.1 How infrastructure facilities influence health workers' performance.................................................40

5.2.3 How employee rewards influence health workers' performance........................................................41

5.3 Discussion of the study..........................................................................................................................41

5.3.1 How infrastructure facilities influence health workers' performance.................................................41

5.3.3 How employee rewards influence health workers' performance........................................................43

5.4.1 How infrastructure facilities influence health workers' performance.................................................44