The influence of quality of work life on motivation and retention of local government tuberculosis control programme supervisors in South-eastern Nigeria
The influence of quality of work life on motivation and retention of local government tuberculosis control programme supervisors in South-eastern Nigeria
Daniel Chukwuemeka OgbuaborID 0 1
Ijeoma Lewechi Okoronkwo 1
0 Department of Health Systems and Policy, Sustainable Impact Resource Agency, Enugu, Enugu State, Nigeria, 2 Department of Health Administration and Management, University of Nigeria Enugu Campus , Enugu, Enugu State , Nigeria
1 Editor: Nicola Lacetera, University of Toronto, Rotman School , CANADA
Significant gap exists in knowledge about employee-centred human resources practices that address motivation and retention of local government tuberculosis control programme supervisors (LGTBS) in Nigeria. The study examined the role of quality of worklife (QWL) in motivating and retaining LGTBS.
Data Availability Statement: All relevant data are
within the paper and its Supporting Information
Funding: The authors received no specific funding
for this work.
Competing interests: The authors have declared
that no competing interests exist.
Materials and methods
The study was conducted in south-eastern region of Nigeria comprising five states and 95
local government areas. The design was mixed-methods. We used cross-sectional survey
to collect quantitative data on socio-demographic factors, QWL, motivation and retention
from a total sample of LGTBS. The qualitative component involved focus group discussions
(n = 3) with 26 LGTBS. Quantitative data were analysed using exploratory factor analysis,
descriptive statistics, Spearman correlation, Mann-Whitney test, Kruskal-Wallis test and
multiple linear regression. Qualitative data were analysed using a thematic framework
The final 40-item QWL scale was found to be valid and reliable. The LGTBS had high QWL
(M = 5.15, SD = 0.88) and motivation (M = 5.92, SD = 1.08), but low intention to leave their
jobs (M = 2.68, SD = 1.59). Education significantly predicted satisfaction with overall QWL,
work-family balance and work design; but tenure predicted satisfaction with work context.
Work design and work-family balance significantly predicted motivation of LGTBS.
Motivation mediated the relationship between QWL and intention to leave and accounted for 29%
variance in intention to leave. Whereas LGTBS were motivated by responsibility, learning
opportunities, achievement and recognition; they were dissatisfied with lack of flexible work
schedules, involvement in non-TB tasks, long hours at work, limited opportunities for
vacation, resource inadequacy, work-related stigma, lack of promotional opportunities, and
pay disparity and delay.
Addressing work design, work-family balance and working conditions may increase the
motivation and retention of LGTBS and improve human resources for TB at the district level
and performance of the TB control programme.
In Nigeria, the local government area is the basic management unit of the National
Tuberculosis and Leprosy Control Programme (NTBLCP) [
]. The local government tuberculosis
supervisor (LGTBS) coordinates tuberculosis (TB) control activities and oversees all the health
facilities providing TB treatment services in each local government area. By being the link
between the NTBLCP and health facilities and communities, the LGTBS has crucial roles in
TB control including programme management and service delivery. Recently, the
responsibility and workload for LGTBS in Nigeria have been gradually increasing with the expansion of
TB control interventions including TB and human immunodeficiency virus collaborative
activities, public-private mix, community TB care and drug resistant TB . Thus, LGTBS are
the largest cadre of dedicated TB control health workforce in Nigeria [
A well performing health workforce, that is responsive, efficient and effective [
important for infectious disease control [
], Especially at the district level for implementation of
disease control programs and confronting public health challenges [
]. Nevertheless, inadequate
health workforce is still a major impediment to disease-specific control programmes in
lowand middle-income countries, where infectious diseases cause significant mortality, morbidity,
and economic burden [
]. TB control in low-resource countries suffer from low numbers of
healthcare workers, imbalances in staff distribution, poor quality of existing workforce, low
human resource production, effects of human immunodeficiency virus infection, and poor
motivation and retention [
Motivation, described as an individual?s willingness to exert and maintain efforts towards
organisational goals, results from interaction between individuals and their work
environment, and the fit between these interactions and broader societal context [
retention entails preventing people from leaving an organisation to work elsewhere by giving
due attention to the work environment [
]. Intention to leave, defined as individual?s own
estimated probability of leaving one?s current job within the near future [
], is an important
predictor of retention [
]. Job satisfaction, described as the affective orientation that
employees have toward their work [
], mediates the influence of motivation on retention of health
]. Thus, retention is a behavioural consequence of the level of motivation and job
], resulting from satisfaction with working conditions and job characteristics
including work autonomy, clarity of roles, workload management, flexibility, work-life
balance, child care, and support for career and professional development which improve their
wellbeing and performance [
Improving employee wellbeing and organisational performance are the focus of quality of
work life (QWL), defined as the employee?s perceptions of how the working conditions in an
organization can satisfy their important personal needs and work needs while achieving the
organization?s goals [
]. QWL encompasses feelings about job content, physical work
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environment, pay, benefits, promotions, autonomy, teamwork, participation in
decision-making, occupational health and safety, job security, communication, colleagues and managers
support and work-life balance [
]. Organizations with high level of QWL record high
productivity; low turnover and high job satisfaction [
]. Organizations that intend to achieve
high QWL must adopt a socially responsible approach to looking after their employees and
create a good working environment as part of the total reward system .
Studies examining QWL among health workers found low overall QWL [
moderately high QWL [20, 25?27] and high QWL [28, 29]. The findings of relationship of
sociodemographics with QWL varied with contexts in different studies [
18, 22, 24, 25, 30
of work life positively correlated with motivation [22, 29], which in turn, highly correlated
with intention to leave [
14, 22, 31
]. Although QWL negatively correlated with intention to
leave [22, 32?34], QWL influenced intention to leave indirectly through burnout . Yet,
despite the high job demand and increasing complexity of TB control interventions, we found
no study that assessed the relationship between QWL, motivation and intention to leave of
healthcare workers involved in TB control programme. Research on TB control workforce has
been limited to resource availability and basic working conditions [
3, 5, 8, 9, 35?38
instance, lack of staff and insufficient trained staff limited TB control and care and increased
workload of existing staff in many settings [35?38]. In 2006, Nigeria?s TB control programme
fell short of the optimum population-weighted density of 0.5 TB control supervisor per 1000
population resulting in a shortfall of at least 200 TB supervisors . Evidence of
employee-centred human resource practices that address tasks and roles, communication and motivation,
although crucial to wellbeing of LGTBLS and improved TB control, is lacking. Thus, the
NTBLCP must pay attention to the job characteristics and working conditions of local
government (district) supervisors.
The purpose of this study was to examine the role of QWL in motivating and retaining
LGTBS in Nigeria. This information would be useful for evidence-informed human resources
planning for TB control at the district levels. District TB officers working in similar contexts
and health decision makers could use this evidence to develop and implement quality
improvement strategies to create a good working environment for improving the QWL of
district TB officers in resource-poor countries with a similar TB prevalence as that in Nigeria.
Materials and methods
The south-east region in Nigeria comprises 5 states namely Abia, Anambra, Ebonyi, Enugu
and Anambra states delineated into 95 Local Government Areas (districts). The people are
predominantly Igbo, Christians and rural dwellers. There are few minority ethnic groups like
Igala. Within the region, sputum microscopy and TB treatment are provided free of charge in
the publicly owned health facilities. Private health facilities also collaborate with the national
TB control programme.
The study adopted a mixed methods design. The quantitative strand involved cross-sectional
questionnaire survey and the qualitative component, focus group discussion (FGD).
Sampling and sample size
Quantitative. The respondents were all working as LGTBS in the region. We did not need
to calculate sample size in this study since all LGTBS in the region were eligible for inclusion
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and given equal opportunity to participate in the study. However, 92 of 95 LGTBS responded
by filling and returning the questionnaire. Eighty-seven (87) complete questionnaires were
appropriate for analysis, resulting in about 92% net response rate. Three LGTBS were
unavailable during the data collection period.
Qualitative. We purposively selected 26 focus group participants from among survey
respondents. The LGTBS must have worked in the NTP for at least one year and willing to
participate in the FGD. Participants were recruited from LGTBS attending workshops in Enugu,
Nigeria. To ensure maximum variation, each group included both male and female gender
participants from different States with varying level of education and tenure.
Data collection tool and data collection
Quantitative. A pre-tested, self-administered questionnaire was used to collect data on
the socio-demographic characteristics and QWL of LGTBS during their quarterly review
meetings in 2016. The questionnaire was divided into four sections. Section A: sought information
on state, gender, age, marital status, education and tenure in the TB control programme.
Section B: was on quality of work life. To measure QWL and its dimension (work design, work
context, work-family balance and work relevance), this study adapted questions from validated
questionnaires used in previous studies [29, 39, 40]. Section C consisted of three questions that
assessed the motivation of LGTBS sourced from an earlier study . Section D also
comprised three questions that assessed the intention to leave of LGTBS sourced from a previous
study . The draft questionnaire consisted of 54 QWL items and 3 items on motivation
scored on a 7-point Likert scale (strongly disagree = 1, disagree = 2, somewhat disagree = 3,
undecided = 4, somewhat agree = 5, agree = 6, strongly agree = 7).
The data collection tool (S1 Appendix), which was designed in English, was validated for
content by two health management experts, one from the University of Nigeria Enugu
Campus and the other, from the NTBLCP. The comments of the experts were helpful in rephrasing
some questions. The questionnaire was also pre-tested on 10 LGTBS working in south-south
Nigerian states to check for clarity and its completion time. The questionnaire was easy to
understand and took about 30 minutes to complete.
Qualitative. We conducted three (3) focus group discussions (FGDs) with 26 TB
supervisors to gain deep understanding of the quality of worklife factors influencing their motivation.
Each focus group comprised 8 to 10. The FGDs were held at a venue and a time chosen in
consultation with the participants. FGDs were conducted using discussion guide developed based
on the dimensions of quality of worklife (S2 Appendix). Discussions, which lasted about 90
minutes, were held in English language and audiotaped with participants? consent. Data
collection was stopped after the third FGD when data saturation was reached and no new
information emerged .
Quantitative. Data from the questionnaires were entered, cleaned and analysed using
SPSS version 20. Exploratory factor analysis (EFA) using principal component analysis (PCA)
with varimax rotation was used to examine the similarity of the factor structure between the
QWL scale and data collected . The suitability of data for factor analysis was checked using
Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy and Bartlett?s test of sphericity.
Since KMO statistics ranges between 0 and 1 and values greater than 0.5 are considered
adequate, a KMO value of 0.6 was used as cut-off for sampling adequacy in this study . The
criterion for factor extraction was eigenvalues greater than 1.0. Communalities were used as
the criterion for item deletion before rotation, whereas item loading was used as the standard
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for item deletion after rotation. Since communalities commonly ranged from 0.4 to 0.7 and
item loading 0.5 represents adequate item loading , a value of 0.5 was used as the cut-off
for item deletion before and after rotation in this study . Cronbach?s alpha was used to
assess the reliability of the extracted factors for each dimension and the overall QWL scale.
Univariate analyses of quality of work life (QWL), motivation and intention to leave were
done using descriptive statistics (mean, standard deviation, frequencies and percentages).
Bivariate analysis of association of quality work life, motivation and intention to leave with
socio-demographic characteristics of LGTBS was done using non-parametric tests
(MannWhitney test and Kruskal-Wallis test). Correlation between variables were done using
Spearman correlation coefficient. We used multivariable linear regression to establish the predictors
of QWL, motivation and retention of LGTBS. Statistical significance was set at alpha 0.05 level.
Qualitative. A thematic framework approach involving coding, mapping and organising
the data under themes and interpretation was used to analyse the data . Verbatim
transcription of FGDs were prepared and imported into NVivo 11 software. Two persons coded
the data using a codebook. The main themes were deduced from the dimensions of quality of
worklife. The sub-themes were generated, inductively, by reading the transcripts and reflected
job characteristics affecting motivation of TB supervisors. Inter-coder differences were
resolved by consensus. The findings were validated during TB supervisors? quarterly review
meetings. We used excerpts and illustrative quotes to ground our findings in the data.
Triangulation. We analysed each data set from the quantitative and qualitative
components separately and triangulated the findings at interpretive level to offset the weakness of
each data collection method and enrich the findings from both sources .
Ethical clearance was obtained from the Health Research Ethics Committee of the Ministry of
Health, Enugu State Government, Nigeria. Written, informed consent was obtained from each
participant. Completed questionnaires and audiotapes were kept confidential and stored in a safe place.
The validated QWL scale consisted of 40 items (with 11 ?work design, 19 ?work context, 2 ?
work-family balance, and 8 ?work relevance). The Kaiser-Meyer-Olkin (KMO) measure of
sampling adequacy was 0.608 (X2 = 1936.132, ? = 0.000). Fourteen items were deleted from
the initial QWL questionnaire; 9 for low communalities and 5 because of inadequate loading
(Table 1). Overall, the reliability of the resultant 40-item QWL questionnaire was 0.875. The
reliability coefficients of the work design, work context, work-family balance, and work
relevance dimensions were 0.774, 0.812, 0.673, and 0.724 correspondingly.
Eighty-seven LGTBS returned valid questionnaires appropriate for analysis, indicating 92%
net response rate. Most respondents were age 40 years (mean age = 46.55 years), married
and have worked in TB programme for an average period of about 15 years. About 60% of the
LGTBS possess at least a bachelors? degree (Table 2).
The mean scores (standard deviation) of overall QWL, work design, work-family life
balance, work context and work relevance were 5.15 (0.88), 4.82 (1.74), 4.62 (1.11), 5.78 (0.64)
and 4.77 (1.08) respectively. The mean score of motivation and intention to leave were 5.92
(1.05) and 2.68 (1.59) correspondingly. In the bivariate analysis (Table 2), motivation differed
significantly by marital status. Overall QWL, work-family balance and work design differed
significantly by education. Overall QWL, work-family balance, work design, work relevance,
motivation and intention to leave differed significantly across states.
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Reason for deletion
Quality of work life and its dimensions are positively inter-related (Table 3). Education was
negatively associated with work-family balance (r = -0.271, ? < 0.05), work design (r = -0.286,
? < 0.01) and overall quality of work life (r = -0.317, ? < 0.01). Tenure was negatively
correlated with gender (r = -0.251, ? < 0.05), but positively correlated age (r = 0.439, ? < 0.01) and
state (r = 0.234, ? < 0.05). Motivation was positively correlated with marital status (r = 0.251,
? < 0.05), work design (r = 0.571, ? < 0.01), work relevance (r = -0.471, ? < 0.01), overall
quality of work life (r = -0.471, ? < 0.01), but negatively correlated with intention to leave (r =
-0.365, ? < 0.01). Intention to leave was also negatively associated with work design (r =
-0.266, ? < 0.05), work context (r = -0.214, ? < 0.05) and overall quality of work life (r =
-0.242, ? < 0.05).
Education predicted overall quality of work life (? = -0.554, ? value < 0.05), work-family
balance (? = -0.919, ? value < 0.05) and work design (? = -0.670, ? value < 0.05); whereas
tenure predicted work context (? = -0.242, ? value < 0.05) as in Table 4. Motivation of LGTBLS
was predicted by work-family balance (? = -0.199, ? value < 0.05) and work design (? = 0.514,
? value < 0.05), which accounted for about 38% variance in motivation (Table 5). However,
overall quality of work life and dimensions of quality of work life did not predict intention to
leave. Motivation predicted intention to leave (? = -0.704, ? value < 0.05) and accounted for
about 29% variance in intention to leave (? < 0.05).
clocking out? (P7, FGD3) at the Local Government health department interrupted their daily
work schedules. Some LGTBS are involved in other health programmes, which interfere with
their TB work and increased their workload. Yet, some LGTBS relied on NTBLCP policy that
?on no condition will TB supervisor be assigned any other work apart from TB? (P8, FGD1) to
get exemption from non-TB tasks. Despite expansion of the TB control programme, most TB
supervisors lack programme management team. Furthermore, most LGTBS are also TB service
Work family balance. TB supervisors noted that high workload and long working hours
deprive them time to attend to family needs and leave them exhausted after work. The
NTBLCP seemed to have a culture of sending impromptu invitations for trainings and
meetings, which ?leaves LGTBS little time to meet family obligations before leaving for such
meetings? (P5, FGD1). It was particularly more challenging for female supervisors to combine
family needs and demanding TB programme responsibilities. Yet, LGTBS work for several
years without vacation. As observed by one LGTBS, ?the work is demanding in the sense that I
have been in the programme for twelve years. Could you imagine, for twelve years, I have not
gone on leave? (P1, FGD2).
Work context. Safe and healthy working environment, resource availability, career
development and growth, and social integration were key themes related to the work context.
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LGTBS stated that most TB treatment centres have inadequate facility design to support TB
infection control, which exposes people to the hazard of contracting TB. Infection control
measures have been limited to training of some TB staff, cough etiquette and respiratory
hygiene and natural ventilation. As pointed by one LGTBS, ?we need standard operating
procedure [for TB infection control] because one of our TB supervisors died because of TB of the bone
after retirement and another TB service provider right now is having TB of the bone? (P7,
LGTBS stated that TB supervisors do not receive managerial support and allowances from
the local government and management of some hospitals. ?They (policymakers) don?t regard
health workers. We are on our own. . . . Yes, if we go, they will tell us that we should go and meet
the NGOs that are supporting the programme? (P6, FGD3). LGTBS agreed that ?government
need to be actively involved rather than leaving the funding to the partners. What if the partners
are not with us again?? (P4, FGD2). LGTBS mentioned that lack of functional motorcycles
hinders supervision of TB program. LGTBS described the experience as traumatizing, ?when your
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motorbike gets old, but you can?t get a replacement? (P3, FGD3). In 3 states, the ban on use of
motorcycles within the capital city limits TB control activities. Despite the waiver on publicly
owned motorcycles, the enforcement officers still impounded LGTBS?s motorcycles (P6, FGD1).
LGTBS stressed the need for government to provide them means of transport or funding for
LGTBS mentioned that irregular and interrupted drug supply adversely affected quality of
TB services. It was found that a logistics partner, contracted to distribute TB drugs, scarcely
involved LGTBS, drug distribution is often delayed, and drugs meant for an entire local
government are sent to one health facility. Yet, when there is issue in these health centers, maybe,
stock-out, we are the one that will bear the brunt (P1, FGD2). LGTBS argued that the ?logistics
partner receive adequate funding for the distribution of drugs; and if funds are equally made
available to supervisors, they will do exactly what the partner were meant to do, and do it better?
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LGTBS stated that delayed promotion, embargo on government-sponsored in-service
trainings and trainings that are not linked to conversion and promotion limited their career
development and growth. A LGTBS remarked, ?We have been to Zaria (National TB Training
School), but it is not recognized. They cannot use that certificate to promote you? (P3, FGD2).
Even when LGTBS obtained study leave without pay or chose part-time studies, at the
completion of the training, conversion may be granted but the candidate?s grade level may be stepped
LGTBS stated that social interaction between TB supervisors and other staff of the Local
Government is poor due to stigma associated with TB. A LGTBS observed, ?Once my
colleagues see me, they just call me, ?TB!? My name has been changed to TB? (P5, FGD1). The TB
supervisors explained that stigma associated with TB resulted in poor attention to TB control
programme by decision makers, stigmatization of LGTBS by co-workers and refusal of health
workers to be posted to TB programme.
Work relevance. Adequate and fair compensation, and job significance and recognition
emerged as key themes related to work relevance. Most TB supervisors agreed that their
compensation ?cannot be quantified with the work we do? (P8, FGD3) due to disparity in salary
scale, delay in payment, under-payments (salary cuts), and outright non-payment of staff
salaries. As one LGTBLS observed, ?one can?t go home every day feeling happy, especially when one
compares one?s salary with what those of one?s colleagues in the ministry receiving consolidated
health salary take home? (P3, FGD1). LGTBS held the view that ?workers are even neglected as
the disease condition itself? (P1, FGD3). Nonetheless, positive clinical outcomes for their
patients give LGTBS sense of accomplishment and improve their quality of worklife. ?Even
though the government does not pay us adequately,. . . we feel happy and fulfilled whenever we
see our patients recovering? (P9, FGD1).
The study revealed that the final QWL scale with 40 items was loaded on four dimensions. The
extracted components were labelled work design, work-family life balance, work context and
work relevance. Content-related validity was assured by the process of item generation which
involved adaptation from literature and review of tool by experts to improve the content
coverage and relevance to local context. Construct validity of the QWL scale was confirmed by
adequate factor loading of the four components, which exceeded 0.5 cut-off [29, 42]. The QWL
scale and its four dimensions also showed a good internal consistency with observed
reliabilities within the acceptable range. Therefore, the 40-item QWL scale was found to be a valid and
reliable measure of the QWL of LG TB supervisors in this study.
The overall quality of work life among TB supervisors in south-east Nigeria was found to be
high which is consistent with results from previous studies [28, 29], but contrasts low overall
QWL found in other settings [
]. The dimensions of QWL varied from moderate
(work-family life balance, work design and work relevance) to high QWL (work context),
which is similar to the findings from other studies [20, 25?27]. The finding that work design
had the lowest mean score may be due to high workload, lack of program team, lack of
opportunities for flexible working schemes, participation in non-TB services and involvement in
frontline TB service delivery by most TB supervisors. With increasing complexity of TB
control interventions, it is imperative to improve autonomy and control at work, clarify roles of
LGTBS, encourage LGTBS to build and work with program teams, and ensure compliance
with the policy excluding TB supervisors from non-TB tasks.
The study revealed that education inversely and significantly predicted satisfaction with
overall QWL, work-family balance and work design which is similar to findings among
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hospital employees in Iran . Although gender was not predictive of quality of worklife, we
expected the contrary given that evidence from focus groups indicated that female supervisors
seemed to have more challenges than their male colleagues balancing family obligations and
increasing demand at work. It might be that with more education, TB supervisors increasingly
demand autonomy and control of their work and flexible work schedules that bridge
organisational and employee interests and balance work and family life.
The study finding that tenure inversely and significantly predicted satisfaction with the
work context is consistent with results from a previous study [
], but differs from evidence
elsewhere [24, 27]. Four factors from the qualitative sub-study could explain this finding. As
the length of stay in TB control programme increases, LGTBS show higher concern for safe
and health working environment especially concern for TB infection control; accumulate
experiences with weak political commitment and resource inadequacy; detest negative
organisational climate and stigmatising work environment; and worry about frustrating promotional
opportunities. Job enrichment strategies focusing on safe and healthy environment, resource
availability, social integration, management and leadership, and opportunities for career
growth might improve the work context of LGTBS.
Even though no socio-demographic factors significantly influenced work relevance, its
inverse relationship with education and tenure suggests that with more education and longer
tenure, perception of work relevance diminishes among LGTBS. Insights from the FGDs
reveal that despite not being adequately remunerated, a sense of accomplishment improves
work relevance of LGTBS. Additionally, LGTBS perceive their job as not well unrecognised by
government and the public. To improve work relevance of LGTBS, it is imperative that LGTBS
receive adequate and fair pay and their contributions to the NTP and society at large
The motivation of LGTBS in south-east Nigeria was found to be high, which is consistent
with result from a previous study [
]. Furthermore, the study revealed that work design and
work-family balance predicted motivation among LGTBS, which is consistent with existing
16, 17, 22, 33
]. In this study, LGTBS were satisfied with factors arising from intrinsic
conditions of their job namely autonomy and control at work, responsibility, learning
opportunities in TB control programme, achievement of positive clinical outcomes for their patients,
and acknowledgement and recognition from cured patients. Whereas extrinsic conditions
such as the supervisory practices and support from health development partners and NTBLCP
enhanced their motivation, LGTBS were dissatisfied with organisational policies including
limited opportunities for vacation, involvement in non-TB tasks, long hours at work, lack of
flexible work schedules, impromptu invitation to workshops and non-replacement of
motorcycles. Improving motivation of LGTBS must address these extrinsic factors, which seem to
limit the work design and disrupt TB supervisors? work-family balance.
We found that motivation mediated the relationship between quality of worklife and
intention to leave and accounted for about 29% variance in intention to leave among LGTBS. Boma
and Laschinger also found that whereas QWL correlated negatively with intention to leave,
QWL influenced intention to leave indirectly through burnout . In this study, over 70% of
the LGTBS have been tenured for over ten years in the NTBLCP. The high level of motivation,
which reflects TB supervisors? satisfaction with the total work environment may explain their
low intentions to leave the NTBLCP. However, efforts to improve motivation and retention of
LGTBS must pay attention to the dimensions of quality of worklife, which focus on
organisational requirements to achieve employee wellbeing, since needs satisfaction resulting from
workplace experiences contribute to job satisfaction [
Our study was based on context-specific, valid and reliable QWL scale and provides
baseline values for QWL scores and its relationship with motivation and intention to leave among
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LGTBS in Nigeria. Notwithstanding that the questionnaire survey provides only a snapshot of
TB supervisors? perceptions at the time of the study, the qualitative insights into the intrinsic
and extrinsic conditions that motivate LGTBS enriched the findings. Also, generalisation of
results may be limited by the scope of the study as only one of the six geopolitical zones in
Nigeria was involved. Future studies in other geopolitical zones are needed to compare
findings across settings. Equally, LGTBS may have provided some socially desirable answers to
some questions in the questionnaire but triangulation of the quantitative and qualitative
findings increased the validity of the study.
This study has examined the levels of QWL and how QWL influences motivation and
intention to leave among local government TB supervisors in south-eastern region of Nigeria. The
findings reveal that LGTBS have high QWL and motivation, but low intention to leave their
jobs. Whereas education predicted satisfaction with overall QWL, work-family balance and
work design; tenure (years of work experience) predicted satisfaction with work context. Our
study established that motivation mediated the relationship between QWL and intention to
leave. Motivation was predicted by work design and work-family balance. So, to increase the
motivation and retention of LGTBS, health decision makers should collaborate with LGTBS to
improve TB supervisors? workload management, work stress, work autonomy, flexibility,
work-family balance and working conditions.
S1 Appendix. Questionnaire.
S2 Appendix. Focus group discussion (FGD) guide.
We acknowledge the assistance of staff of German Leprosy and TB Relief Association in
Nigeria, who helped in the questionnaire administration during the TB control programme review
meetings in the study area.
Conceptualization: Daniel Chukwuemeka Ogbuabor, Ijeoma Lewechi Okoronkwo.
Formal analysis: Daniel Chukwuemeka Ogbuabor.
Investigation: Daniel Chukwuemeka Ogbuabor.
Methodology: Daniel Chukwuemeka Ogbuabor.
Project administration: Daniel Chukwuemeka Ogbuabor.
Software: Daniel Chukwuemeka Ogbuabor.
Supervision: Ijeoma Lewechi Okoronkwo.
Validation: Daniel Chukwuemeka Ogbuabor.
Writing ? original draft: Daniel Chukwuemeka Ogbuabor.
Writing ? review & editing: Daniel Chukwuemeka Ogbuabor, Ijeoma Lewechi Okoronkwo.
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