Training, employee engagement and employee performance: Evidence from Uganda’s health sector

Abstract

The purpose of this study was to investigate the contribution of training and employee engagement on employee performance using evidence from Uganda’s health sector. This study is cross sectional and correlational. Usable questionnaires were received from 150 respondents from four Catholic founded hospitals that is Kamuli Mission Hospital, Buluba Mission Hospital, St. Benedict Mission Hospital and Budini Mission Hospital. Data were analyzed using SPSS. Regression analysis results indicate that training and employee engagement significantly predict employee performance by 44.7% and employee engagement was found to be a major predictor of employee performance as compared to training. Correlation analysis results indicate that there is a significant positive relationship between training and employee performance. Correlation analysis results further indicate that there is a significant positive relationship between employee engagement and employee performance. A partial mediation effect of employee engagement in the relationship between training and employee performance was also established. This research is important to managers, policy makers and Government in improving employee performance in the health sector. Given that this study was cross sectional, monitoring changes in behavior could not be possible. To the researchers’ knowledge, this is the first study to establish the contribution of training and employee engagement on employee performance and at the same time provide an initial empirical evidence on the mediation effect of employee engagement in the relationship between training and employee performance using evidence from Uganda’s health sector.

Keywords:

• training
• employee engagement
• employee performance
• health sector

Public Interest Statement

Employee performance is critical in achieving organizational goals. Employees have interests that are different from those of organizations. Employees will thus prefer those jobs that will give them freedom to perform other tasks that will enable them to satisfy their interests. Once freedom is granted to employees, organizational objectives may never be achieved and yet organizations are bigger than employees. It is thus important to train employees and engage them on a daily basis to enhance service delivery in health centres since health is an important aspect of every human being.

1. Introduction

The phenomenon of employee performance is a multidimensional construct and an extremely vital criterion for determining organizational success or failure. Employees are the blood stream of any business and are the most valuable assets of every organization as they can make or break the organization’s reputation and can adversely affect profitability. Developing countries, such as Uganda are experiencing poor employee performance in the health sector (Lutwama, 2011) and have been greatly attributed to the poor training and minimal engagement of employees. The health workers are accused of absenteeism and untimely provision of services to their clients (Annual health sector performance report, 2012/2013), low productivity, poor attitude toward clients and poor quality of health care services provided to clients (Lutwama, 2011).

Previous studies indicate several determinants of employee performance for example, Bagyo (2013) found out that employee engagement and leadership greatly influence employee performance. Lutwama (2011) contend that there is a significant positive relationship between performance appraisal and employee performance of health workers. Similarly, Elnaga and Imran (2013) established that training is one of the vital human resource management practices that positively affect the quality of the workers knowledge and skills and this results in higher employee performance on job. Kiweewa and Asiimwe (2014) argue that employee training results into substantial productivity and quality performance. Also, Amin, Saeed, and Lodhi (2013) in their study in the education sector of Pakistan found that when employees are trained, their level of knowledge and commitment improve, which ultimately increase their performance on the job. In terms of employee engagement, Ologbo and Sofian (2013) note that engaged employees are aware of the business context in which they work and work with colleagues to improve performance within the job for the benefit of the organization. Similarly, Men (2015) also argues that engaged employees are characterized by energy, absorption, involvement, efficacy, vigor, dedication, enthusiasm and a positive state, which increase their productivity.

Whereas, there is a myriad of studies on employee performance, none of the studies has examined the contribution of training and employee performance, as well as examining employee engagement as a mediator in the relationship between training and employee performance in an African developing country like Uganda in a health sector in a single suite. The desire to establish the contribution of training and employee engagement on employee performance in the health sector of Uganda formed our motivation. This was achieved through a questionnaire survey of 150 respondents (health workers) from Uganda’s hospitals. Results suggest that training and employee engagement contribute 45% of the variance in employee performance.

This study is important in the following ways. First, the study contributes to the existing literature by examining the contribution of training and employee engagement on employee performance and also testing the mediation effects of employee engagement in the relationship between training and employee performance. Second, policy makers and management of healthcare centres/hospitals may have to engage their employees by allocating to them more tasks as this improves their performance. It is also important that training of healthcare workers is done frequently and possibly in each year. Lastly, society must appreciate that once their relatives join the health sector or any other sector concerned with provision of services, training and employee engagement are paramount.

The rest of the paper is organized as follows. The next section is literature review where hypotheses are developed, Section 3 is the methodology employed while Section 4 is results. Section 5 is discussion of results and finally summary and conclusion.

2. Literature review

Employee performance is the ability of an employee to achieve a specified task measured against predetermined standards of accuracy, completeness, cost and speed (Sultan, Irum, Ahmed, & Mehmood, 2012).

2.1. Training and employee performance

The concept of training has gained more popularity in human resources due to its positive association with employee performance (Kiweewa & Asiimwe, 2014). Training is an aspect of capacity building in any organization that is carried out to improve staff performance and to enable an organization meet her objectives (Tahir, Yousafzai, Jan, & Hashim, 2014). Training is a type of activity, which is planned, systematic and its results enhance the level of skills and knowledge that are necessary to perform work effectively (Sultana, Irum, Ahmed, & Mehmood, 2012). Training is mainly concerned with the improvement and upgrade of the skills and knowledge of the employees, which ultimately adds into the job performance (Azeem, Rubina, & Paracha, 2013). Training is one way of increasing an individual’s productivity. In the training process, employees acquire technical skills, interpersonal skills and solid knowledge in order to perform their jobs efficiently and effectively at the workplace and lack of ongoing training programs leads to lower performance of employees (Nawaz, Masoodul, & Saad, 2014). Training not only develops the capabilities of the employee but sharpen their thinking ability and creativity in order to take better decision in time and in more productive manner (Elnaga & Imran, 2013). Training also enables employees to deal with the customer in an effective manner and respond to their complaints in a timely manner (Amin et al., 2013). Therefore, in order to prepare workers to do their job as desired, organizations provide training so as to optimize their employee’s potential (Kiweewa & Asiimwe, 2014). Most of the firms, by applying long-term planning, invest in building new skills, knowledge and changing the attitudes of their workforce, enabling them to cope with the uncertainties that they may face in future, thus improving employee performance (Elnaga & Imran, 2013). In one of the accounting related scholarly works by Bananuka, Mukyala, and Nalukenge (2017), it was noted that when employees are not motivated to work and not supported to further their careers, it is perceived as a challenge by internal auditors and this has an effect on their performance. Bananuka et al. (2017) further documents that once internal auditors are not trained, it is perceived as a challenge to the internal audit and these challenges have a negative impact on their role performance.

Training programs are basically categorized into two that is on the job and off the job trainings (Sultan et al., 2012). According to Sultan et al. (2012), employees who undergo on the job training are said to be better performers as compared to their counter parts who undergo off the job training. This is attributed to the vast job experience, which increases in the both skills and knowledge. However, a complementary relationship was found between receiving on the job training and receiving off-the-job training. Previous studies provide evidence that there is a strong positive relationship between training and employee performance for example, Elnaga and Imran (2013) established that, training is one of the vital human resource management practices that positively affects the quality of the workers knowledge and skills, and this results in higher employee performance on the job. According to Hameed and Waheed (2011), a well-trained and highly motivated employee may work with less supervision because of the skills and confidence they possess and thereby reduce cost of supervision. The impact of well-trained and highly responsible workforce is capable of improving company’s efficiency through their cordial relationships with customers (Amin et al., 2013). It can be argued that training improves employee performance only when it is properly done and through proper identification and selection of trainees, timely scheduling of trainings and based on the gaps identified in the areas of knowledge, skills, abilities and change of attitude of the concerned staff. By doing so, training generates benefits for the employee, as well as for the organization by positively influencing employee performance through the development of employee knowledge, skills, ability and behavior (Amin et al., 2013; Sultan et al., 2012). From the foregoing discussion, it can be hypothesized that:

HI: Training is positively associated with employee performance

2.2. Employee engagement and employee performance

Employee engagement has been conceptualized in different ways, for example, according to Men (2015), it is the positive attitude held by the employees toward the organization and its values. The level of employee performance is highly determined by the level of commitment an employee has toward their organization and its values (Selvarasu & Sastry, 2014). An engaged employee is aware of business context and works with colleagues to improve performance within the job for the benefit of the organization (Ologbo & Sofian, 2013). According to Men (2015), engagement is characterized by energy, absorption, involvement, efficacy, vigor, dedication, enthusiasm and a positive state which are described as catalysts for employee performance. According to Shantz, Alfes, Truss, & Soane, (2013), engaged employees have a positive attitude and have work-related state of mind characterized by vigor, dedication, and absorption and these make the employees psychologically present at work, which minimizes their possibility to do work related mistakes and errors. Gichohi (2014) explains that there is positive relationship between employee engagement and employee performance through increased commitment and this is because, engaged employees experience positive emotions which broadens their thinking, leading them to become more attentive and absorbed in their work. (Shantz et al., 2013).

The organization takes care of employees through the simultaneous implementation of empowerment and training; employees show more engaged behavior to their work, leading to better performance outcomes in the workplace (Ariani, 2013). In other words, employees receiving various benefits like training and resources from the organization would be more likely to feel obliged to repay the organization through greater work engagement and in turn, display better attitude and behavior (Otieno, Wangithi, & Njeru, 2015). Employee motivation is enhanced through training and empowerment and this leads to better organizational performance (Nawaz et al., 2014). Amanda, Kerstin, Catherine, and Emma (2013) argued that through training, employee engagement is increased by promoting a positive attitude characterized by vigor, dedication and absorption. It further fosters Job satisfaction and commitment to an organization since employees will feel that they are part and parcel of the organization and this will lead to increased performance (Ariani, 2013). Training enhances the psychological state of involvement, commitment, attachment, mood, which impacts an individual’s performance. This could be in form of effort or observable behavior, including pro-social and organizational citizenship behavior (Sanneh & Taj, 2015). People who are highly engaged in an activity feel excited and enthusiastic about their role, say time passes quickly at work, devote extra effort to the activity, identify with the task and describe themselves to others in the context of their task. This therefore means that engaged employees are interested in the success of an organization and also identify with this success (Rashid, Asad, & Ashraf, 2011). Employee engagement can therefore be a predictor of employee performance since it leads to positive behavior, such as taking personal initiative, organizational citizenship behavior and employee effectiveness (Otieno et al., 2015).

According to Nawaz et al. (2014), employees show engaged behavior when they are given training and empowerment hence engagement is related to putting effort in work and being persistent while facing difficulties. That is, employees dedicate their physical, cognitive and emotional resources to work roles by having high levels of energy, being enthusiastic about having high levels of energy, being enthusiastic about their work and being fully engrossed in their work engagement leading to high-performance work practices, extra customer services or creative behavior of employees (Otieno et al., 2015). Accordingly, it appears that when the organization takes care of employees through training, employees show more engaged behavior to their work, leading to better performance outcomes in the workplace. (Nawaz et al., 2014). It is now imperative to hypothesize as follows;

H2(a): Employee engagement is positively associated with employee performance

H2(b): Employee engagement mediates the relationship between training and employee performance

3. Methodology

3.1. Research design, population and sample

This study is cross-sectional and correlational. Cross sectional research design is a type of observational study that analyzes data collected from a population, or a representative subset, at a specific point in time (Bananuka, Nkundabanyanga, Nalukenge, & Kaawaase, 2018; Mukyala, Bananuka, Basuuta, Tumwebaze, & Bakalikwira, 2017; Saunders, Lewis, & Thornhill, 2007; Sekaran, 2003). The study population comprised of 268 health workers in the four mission hospitals (Kamuli Mission Hospital, Buluba Mission Hospital, St. Benedict Mission Hospital and Budini Mission Hospital). A sample of 157 health workers was determined using Krejcie and Morgan table of 1970. 150 usable questionnaires were received representing a response rate of 95%. According to Bakalikwira, Bananuka, Kaawaase, Musimenta, and Mukyala (2017), a high response rate is likely if a questionnaire is employed to elicit views from respondents. The other reason for the higher response rate is the several callbacks made by the researchers on the respondents and also the ample time given to the respondents to fill the questionnaire. Stratified sampling was used to select the respondents from every hospital in order to ensure that all hospitals are represented. Simple random sampling was then used to pick final respondents in each of the hospitals.

3.2. The questionnaire and variables measurement

We administer self-administered questionnaires with closed ended questions on a 5-point Likert scale. Questionnaires have previously been used by previous scholars within the behavioral discipline targeting a large audience especially of 30 respondents and above (see Bakalikwira et al., 2017; Bananuka et al., 2017, 2018; Kiweewa & Asiimwe, 2014; Lutwama, 2011; Mukyala et al., 2017) Questionnaires may contain close ended questions and open ended questions. According to Sudman and Bradburn (1982), open ended questionnaires encourages respondents to give their opinion fully and with as much nuance as they are capable. However, this approach was not applicable. This study utilizes a questionnaire with close ended questions since it is aimed at calculating the mean ratings of the extent of agreement with the statements given. The questionnaire was developed after reviewing existing literature on training, employee engagement and employee performance. Training was operationalized using the measures, such as off the job training and on the training (Elnaga & Imran, 2013; Sultan et al., 2012). Employee engagement was measured using items adopted from the works of Men (2015) and these include vigor, absorption and dedication. Employee performance was measured using measures adopted from (Lutwama, 2011) and these include availability, responsiveness, productivity and competence.

3.3. Validity and reliability

Field (2009) defines content validity as evidence that the content of a test corresponds to the content of the construct it was designed to cover. Field (2009) defines reliability as the ability of a measure to produce consistent results when the same entities are measured under different conditions. Validity of the instrument was obtained through the development of the scales with the help of experts in the field using the content validity index (CVI). CVI and Cronbach’s (1951) α were used to test the validity and reliability of the scales as measures of the study notions. The questionnaire was given to practitioners and experts in the subject area for validation. CVI of all the study variables was above 0.8 while Cronbach’s reliability index for study variables was above 0.7 and this means that the instrument was reliable.

3.4. Data analysis

Data were checked to identify missing values and any inconsistencies in responses given by the respondents. Simple frequency runs were made to screen the data so as to identify missing values using series of means value replacement method (Field, 2009). The identified values were a result of omissions made by respondents and constituted less than 1% of the data; thus considered inconsequential (Little & Rubin, 2002) to suppress the standard deviation (Field, 2006; Mundfrom & Whitcomb, 1998). The fact that missing values were as a result of omissions and unrelated to other values or variables, met the criteria of data missing completely at random (Little & Rubin, 2002). Having cleaned the data, demographic characteristics were computed using Statistical Package of Social Sciences and this was followed by correlation analysis to establish associations between the predictor and the outcome variables. The multiple regression approach was used to ascertain the predictive potential of the predictor variables of the outcome variable.

4. Findings

4.1. Demographic characteristics

Usable questionnaires were received from 150 respondents. Of the 150 respondents, 32% were male whereas 68% were female. This has an implication that mission hospitals basically employ more females as compared to the male. Regarding the age bracket of the respondents, 31% belonged to 25–29 years age group and this was followed by 29% in the age group of 40 years and above. Eight percent were in the 34–39 age group. The age bracket of 18–24 and 30–34 each represented 16% of the entire sample size. This implies that majority of the respondents are youth with minimum experience in the profession, which also impacts on their performance. Also, half (54.7%) of the respondents have attained certificate level of education, 28.7% diploma, 8% degree, 3.3% masters and 1.3% Post Graduate Diplomas. This implies that due to low levels of education of majority of the respondents it necessities training in order to spur their performance. Respondents were asked about how long they have been in healthcare service. The study results show that out of the 150 respondents, 36.7% had been in the hospital for a period between 2 and 5 years, these were followed by those above 10 years accounting for 24.7% and last in that order were those who had spent a period of 6–10 years. On the issue of professional experience, 42% of the respondents were found to have working experience of period between 2 and 5 years, 33.3% had working experience of above 10 years, and lastly were those who had working experience of less than a year (6.7%).

4.2. Correlation analysis results

We present correlation analysis results in Table 1. We use Pearson correlation coefficient to establish relationships among the study variables. Pearson correlation coefficient was adopted for this study as it is a parametric statistic and requires interval data for both variables (Field, 2009) and to test its significance, normality is assumed. Parametric statistics assumes that the sample data comes from a population that follows a probability distribution based on a fixed set of parameters. Results in Table 1 indicate that there is a significant positive relationship between training and employee performance (r = .542**, p < .05) and thus HI is supported. This implies that a positive change in training will lead to a positive change in employee engagement. It should also be noted that both on the job training and off the job training are independently associated with employee performance. Furthermore, correlation results show that there is a significant positive relationship between employee engagement and employee performance (r = .624**, p < .05) and thus H2(a) is supported. This implies that a positive change in employee engagement will lead to a positive change employee performance. When employees are dedicated and vigorous their performance in terms of productivity, responsiveness and availability will increase.

Table 1. Zero order correlations

	1	2	3	4	5	6	7	8
Training (1)	1
On job training (2)	.766**	1
Off job training (3)	.883**	.375**	1
Employee engagement (4)	.521**	.456**	.419**	1
Vigor (5)	.447**	.380**	.367**	.923**	1
Absorption (6)	.457**	.337**	.413**	.897**	.744**	1
Dedication (7)	.438**	.510**	.260**	.710**	.587**	.413**	1
Employee performance (8)	.542**	.594**	.349**	.624**	.555**	.468**	.635**	1

Source: Primary data

4.3. Regression analysis results

The results in Table 2 reveal that training and employee engagement have a significant contribution on employee performance (β = .298, p < 0.05), and (β = .469, p < 0.05 respectively), implying that Training and Employee engagement are significant predictors of employee performance. From the results above, a unit change in training will bring about a 0.298 change in employee performance. On the other hand, a unit change in employee engagement will bring about a 0.469 change in employee performance. Further still, the model was found to be well specified and the model’s predictive power is 44.7%, an indication that other than training and Employee engagement, there are other factors that impact on employee performance. Employee engagement was found to be the most influential at explaining employee performance (β = .469, p < 0.05) as compared to training (β = .298, p < 0.05).

Table 2. Regression model

Model		Unstandardized coefficients		Standardized coefficients		Sig.
		B	Std. error	Beta	T
	(Constant)	1.641	.219		7.566	.000
1	Training	.228	.055	.298	4.172	.000
	Employee Engagement	.390	.059	.469	6.563	.000
R = .674 R^2 = .454 Adjusted R^2 = .447 F Statistic = 61.123

Source: Primary data.

4.4. Testing mediation effects

The other hypothesis this study was that employee engagement mediates the relationship between training and employee performance. Mediation tests were thus conducted to be sure that the conditions suggested by Baron and Kenny (1986) are met. According to Baron and Kenny (1986), mediation occurs if the following conditions are met:

• Variations in the independent variable significantly account for variance in the presumed mediator;

• Variations in the mediator significantly account for variance in the dependent variable;

• Variations in the independent variable significantly account for variance in the dependent variable;

• The effect of the independent variable on the dependent variable significantly reduces when the mediator is included in the equation.

All the above-mentioned conditions were met. The MedGraph program, a modified version of Sobel test was used to compute the Sobel z-value and the significance of the mediation effect of employee engagement on the relationship between training and employee performance. The results are summarized in Figure 1.

Figure 1. Testing employee engagement as a mediator in the relationship between training and employee performance

Results in figure reveal that when employee performance was regressed on training, turned out (β = 0.412, p < 0.05) to have a significant effect on employee performance and thus H2(b) is supported. On introducing employee engagement, the effect of training remained constant though there was a change of 0.114 in the beta to (β = 0.298, p < 0.05). The finding implies a possibility of partial mediation effect of employee engagement on the relationship between training and employee performance which finding is confirmed by the sobel test (z = 4.920644, p < 0.05). A ration index (i.e indirect effect/total effect) of 27.7% given by (0.114/0.412*100) was computed, this indicates that 27.7% of the effect training on employee performance goes through employee engagement, while the 72.3% is direct effect. Conclusively, employee engagement reduces the strength of the relationship between training and employee performance.

5. Discussion

The present study results indicate that training and employee engagement are significant predictors of employee performance in the health sector as shown in the regression analysis model. The regression analysis results are further supported by the correlation analysis results. The correlation analysis results indicate that there is a significant positive relationship between training and employee performance, which implies that a change in training in terms off the job and on the job training would cause a change in employee performance in terms competence, responsiveness and productivity. Therefore a decline or improvement in training would cause a significant decline or improvement in employee performance in Uganda’s health sector. These results conquer with Nawaz et al. (2014), who argued that in the training process, employees acquire technical skills, interpersonal skills and solid knowledge in order to perform their jobs efficiently and effectively at the workplace. On the other hand, Elnaga and Imran (2013) argues that training not only develops the capabilities of the employee but sharpen their thinking ability and creativity in order to take better decision in time and in a more productive manner while Amin et al. (2013) believes that training enables employees to deal with the customer in an effective manner and respond to their complaints in a timely manner. Therefore, most of the previous studies provide evidence that there is a strong positive relationship between training and employee performance. Elnaga and Imran (2013) established that training is one of the vital human resource management practices that positively affects the quality of the workers knowledge and skills and this results in higher employee performance on the job. However, Amin et al. (2013) and Sultan et al. (2012) argued that training improves employee performance only when it is properly done; through proper identification and selection of trainees, timely scheduling of trainings and based on the gaps identified in the areas of knowledge, skills, abilities and change of attitude of the concerned staff. By so doing, training generates benefits for the employee, as well as for the organization by positively influencing employee performance through the development of employee knowledge, skills, ability and behavior.

Furthermore, correlation results showed that there is a significant correlation between employee engagement and employee performance in the health sector. This implies that when Employees are engaged, their performance will increase. These results are in agreement with many findings of other researchers for example, Ologbo and Sofian (2013) argued that an engaged employee is aware of the business context in which he or she works and works with colleagues to improve performance within the job for the benefit of the organization. Also according to Men (2015), engagement is characterized by energy, absorption, involvement, efficacy, vigour, dedication, enthusiasm and a positive state which are described as catalysts for employee performance. This does not deviate from Gichohi (2014) who explained that there is positive relationship between engagement and employee performance through increased commitment. This is because engaged employees experience positive emotions which broadens their thinking, leading them to become more attentive and absorbed in their work. Otieno et al. (2015) argues that employee engagement can therefore be a predictor of employee performance since it leads to positive behavior, such as taking personal initiative, organizational citizenship behavior and employee effectiveness.

Regarding the mediating role of employee engagement, the study revealed that when employee engagement was introduced in the relationship between training and employee performance, the effect of training remained constant though there was a change. However, since the relationship was not reduced to zero, this implies that employee engagement partially mediates the relationship between training and employee performance. This is in line with Otieno et al. (2015), who argued that when employees receive various benefits like training and resources from the organization, the employee would be more likely to feel obliged to repay the organization through greater work engagement and in turn, display better attitude and behavior. This also agrees with Shantz et al. (2013), who argued that through training, employee engagement is increased by promoting a positive attitude; develop work-related state of mind characterized by vigor, dedication, and absorption. Training fosters job satisfaction and commitment to an organization since employees will feel that they are part and parcel of the organization ultimately leading to increased performance. Also, Nawaz et al. (2014) believed that when the organization takes care of employees through training, employees show more engaged behavior to their work, leading to better performance outcomes in the workplace especially in the hospitals.

In the context of the health sector in Uganda, training of employees will improve service delivery. Bakalikwira et al. (2017) noted that health is a concern to everyone and thus accountability is critical. Those charged with governance should then improve their accountability by rendering quality services to the population. The only way to provide service delivery is through training employees since training equips employees with skills and knowledge. Further, employees should not be left redundant. In Uganda’s hospitals, there is always shortage of staff but the available staff should be engaged so that they are motivated. From the results of this study, it is evident that training and employee engagement improves employee performance in Uganda’s health sector. Further to note is that employee engagement mediates the relationship between training and employee performance in the health sector.

6. Summary and conclusion

This paper aimed to find out the contribution of training and employee engagement on employee performance using evidence from Uganda’s health sector. This was achieved through a questionnaire survey of 150 health workers in catholic founded hospitals in Uganda. Regression results indicate that training and employee engagement contribute up to 44.7% of the variance in employee performance. Further, correlation analysis results indicate a positive association between (1) training and employee performance and (2) employee engagement and employee performance. Also, results indicate that there is a partial mediation whereby employee engagement mediates the relationship between training and employee performance.

Since the research findings show that there is as significant positive relationship between employee engagement and performance, managers should not develop policies, procedures and take decisions in isolation from employees but involve them, this will make them obliged to fulfil organizational goals through becoming dedicated. On the job training is recommended to managers because this was found out to be more associated to employee performance as compared to off the job training. Therefore, in case managers wish to train employees they should give on the job training the first priority.

Like any other study, this study is not without limitations. This study was cross sectional and employed questionnaires with closed ended questions. It is thus probable that changes in behavior over time is not monitored. Further, close ended questions limit a respondent’s freedom to fully express his or her opinion. There is therefore need for future research to employ a mixed methods design to gain an in-depth understanding of the subject matter. Future researchers may wish to conduct interviews to ascertain the determinants of employee performance or carry out a meta-analytic study in the same area since the current study predictor variables only account for 44.7% of the variance in employee performance. Also, given that this study concentrated on Uganda’s health sector, there is need for further research in other sectors within and outside Uganda especially among government hospitals and other private hospitals. In the presence of all the above limitations, this study results remain useful in a number of ways. First, the study contributes to the existing literature by examining the contribution of training and employee engagement on employee performance and also testing the mediation effects of employee engagement in the relationship between training and employee performance. Second, policy makers and management of healthcare centers/hospitals may have to engage their employees by allocating to them more tasks as this improves their performance. It is also important that training of healthcare workers is done frequently and possibly in each year. Lastly, society must appreciate that once their relatives join the health sector or any other sector concerned with provision of services, training and employee engagement are paramount.

Additional information

Funding

The authors received no direct funding for this research.

Notes on contributors

Kasimu Sendawula

Kasimu Sendawula is an Assistant Lecturer in the Department of Marketing and Management, Makerere University. He holds a degree of Master of Science in Entrepreneurship and Bachelor of Entrepreneurship and Small Business Management of Makerere University. His research interests are in the areas of Sustainable Entrepreneurship, Islamic Banking and Corporate Governance.

Saadat Nakyejwe Kimuli

Saadat Nakyejwe Kimuli is a Lecturer in the Department of Entrepreneurship, Makerere University Business School. She is a PhD student at the ICT University. Her research interests are in Sustainable Entrepreneurship, Strategic Management and Corporate Governance.

Juma Bananuka

Juma Bananuka is a Lecturer in the Department of Accounting, Makerere University Business School. He holds a degree of Master of Science in Accounting and Finance and Bachelor of Commerce of Makerere University. His research interests are in the areas of Corporate Reporting, Auditing, Taxation and Islamic banking.

Grace Najjemba Muganga

Grace Najjemba Muganga is a Teaching Assistant in the Department of Accounting, Makerere University Business School. She holds a degree of Bachelor of Commerce of Makerere University.