Diversity issues in Nigeria ’ s healthcare sector : implications on organizational commitment . A cross-sectional study

Workplace diversity is increasingly gaining the attention of Background healthcare organizations, especially in developing countries like Nigeria. However, little is understood from existing literature about how workforce diversity affects employees’ satisfaction and organisational commitment in the workplace. Consequently, this paper showed the direct and mediating relationships between diversity of workforce, job satisfaction and employee commitment to the organization. : Copies of the structured questionnaire have been given to 133 Methods public healthcare employees in Nigeria’s Ministry of Health in Lagos state. Statistical analysis for the study included descriptive measures and multi-variate analysis, using structural equation modelling. : Outcomes from statistical analysis supports direct and mediating Results relationships between the research variables. Gender and ethical diversity had significant influences on job satisfaction at r = 0.35 (p < 0.05) and r = 0.28 (p < 0.05) respectively. The following mediating relationships were also statistically confirmed: job satisfaction related with affective commitment (r = 0.41, p < 0.05) and normative commitment (r = 0.26, p < 0.05). : Based on the results of the statistical analysis, the study Conclusions concludes that there is a relationship between diversity of employees and job satisfaction, diversity of employees and organizational commitment and the influence of work satisfaction on organizational commitment.


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Introduction Workforce diversity has a significant impact on the work behaviour and attitudes that employees exhibit in the work environment 1 . Diversity of employees depicts a scenario in which different people bring their unique backgrounds, perspectives, values and benefits to the organization 2 .
Assessing diversity among employees is strategic to effectively managing the organization's human resources and can improve the organizational commitment and satisfaction of employees 3 . Furthermore, diversity in the workforce improves better decision-making, greater creativity, innovation and greater competitiveness [4][5] . Workforce diversity has grown from focusing solely on human demographic characteristics; like race, gender and age, to a much broader meaning that encompasses the whole range of human, physical and cultural differences 6 , and this could influence their levels of job satisfaction.
In the work of Jex 7 , job satisfaction is described as the positive affection of an employee towards the job. According to Shuck et al. 8 , employee satisfaction itself has a direct and indirect influence on individual and organizational performance, including the commitment of employees to work. Job satisfaction, for example, is the best predictor of employee turnover. More so, having a committed workforce is important for achieving organisational performance. Therefore, it is important to produce a committed workforce that would show organisational commitment.
Today's workplace consists of different employees with unique and varied features 9,10 . Although, existing literature have discussed workforce components as a determinant of employee commitment 11 . However, the current literature does not sufficiently explained the employees feelings about diversity in their working environment, and whether diversity in the workforce results in dissatisfaction or lack of engagement, especially within the public health sector of developing economies like Nigeria. Despite that most researchers, such as Osibanjo et al. 12 have been focusing on explaining concepts that enhance understanding of workforce diversity, little is understood about how workforce diversity affects employees' satisfaction and organisational commitment in the workplace. Studies on the influence of diversity in the workforce on the satisfaction of employees and the organizational commitment in the public health sector in Nigeria are rare in existing literature 13 . This paper therefore aims to examine the influence of diversity in the workforce on organizational commitment and employee satisfaction among selected public health workers in Nigeria, based on the following four hypotheses.   Public healthcare employees in Nigeria's Ministry of Health, are important for this research because of the increased awareness of the diverse workforce of the Ministry. Hence, it is imperative that such diversity is properly managed in ways that avoid negative impact on employee satisfaction and commitment to the organization 15,16 . Furthermore, due to the important roles that the Health sector undertake for the population and the overall well-being of any country, this research is considered essential to maintain employee interest and motivation in the provision of quality services 17 . Simple random sampling technique was adopted. This technique allowed every member of the population to be a respondent by selecting the respondents without any form of partiality. Thus, given the total population if public health workers in the Lagos State Ministry of Health, the 133 respondents were selected at random without any form of bias and were administered the copies of the questionnaire during working hours. Employees who turned down the proposal to participate in the survey were respectfully eliminated from the research process, and a replacement was determined by the same random selection process. The following inclusion and exclusion criteria applied:

Inclusion criteria:
• Participants had to be employees of the organisation • Participants must be literate, able to read and write English • Participants must be accessible Exclusion criteria: • Members of casual staff The copies of questionnaire were self-administered to respondents and retrieved within the space of eight weeks, based on the request of the respondents.

Measures and variables
Data was captured using a questionnaire developed for this study based on evidence from the literature (see extended data 18 ). Workforce diversity (including gender, education, religion, ethnicity, experience, income and position) items were developed based on Glazer et al. 19 , work satisfaction (described as by the extent to which employees felt positive affection towards their job) items based on Jensen et al. 20 were developed and workforce commitments (including affective, continuance and normative) items based on Changa et al. 21 and 22 Hanaysha et al. 22 were developed.

Ethical consideration
The questionnaire was administered to respondents based on their willingness to participate in the research exercise. The participants in the study were also assured of confidentiality and anonymity, such as not reflecting their names in the questionnaire. The study received verbal approval for execution as a satisfactory requirement from the organization and the employees.

Validity and reliability of research instrument
In this research, internal consistency method, using Cronbach alpha measurement was adopted to ensure reliability of the research items. It is widely accepted that the score of 0.7 above indicates the reliability of the instrument. The SPSS (Social Science Statistical Package) was used to test the reliability of the research instrument. The reliability statistics that was obtained for the instruments used for this study was 0.747. Instrument validity was ascertained through content validity.

Statistical analysis
The statistical analysis for this study was performed using SPSS software (version 22) and AMOS (version 23). The analysis of data was carried out using descriptive statistics and structural equation modelling (SEM) to show the relationships between workforce diversity, job satisfaction and organizational commitment.

Results
In terms of demographics of the respondents, 64 (48.1%) were male while 69 (51.9%) were female. The age distribution among respondents was as follows: the majority of respondents (68) were between 18 and 34 years of age, 45 respondents between 35 and 44 years of age, 13 respondents were between 45 and 54, and 7 were 55 or above years (Table 1 and underlying data 23 ). Analyses revealed varying levels of direct and mediating relationships among the research variables. Specifically, gender and ethical diversity had significant influences on job satisfaction at r = 0.35 (p < 0.05) and r = 0.28 (p < 0.05) respectively. Direct relationships were also statistically established between workforce diversity and organizational commitment in the following ways: gender diversity and affective commitment (r = 0.26, p < 0.05), normative commitment (r = 0.05, p < 0.05); education diversity and normative commitment (r = 0.12); experience diversity and continuance commitment (r = 0.20, p < 0.05). A direct inverse relationship was established between religion diversity and continuance commitment (r = -0.14, p < 0.05).
The following mediating relationships were also statistically confirmed: job satisfaction related with affective commitment (r = 0.41, p < 0.05) and normative commitment (r = 0.26, p < 0.05). The results of these data support existing research results 21,26 .

Discussion and Conclusion
Researchers like Ashikali et al. 27 , Ibidunni et al. 26 and Hanaysha et al. 28 demonstrated that diversity in the workforce promotes creativity, innovative problem solving and productivity. Also, Moon 28 confirmed that large organizations use various teams intentionally to solve problems and employed people from a diversity races, ethnicities and experience to shape perspectives in the organization 29,30 .
Although arguments for diversity are naturally attractive and somewhat popular, there is little empirical evidence that diversity in the workforce can be used to increase employee engagement, especially in developing economies such as Nigeria. Whether employee diversity influences organizational engagement is an empirical issue that has not been properly tested in Nigeria in the public sector context. This study therefore contains evidence to fill this gap. The results of this study show that gender is the most sensitive factor in the diversity that influences Nigeria's commitment to public health workers. Gender diversity is associated with the affective and normative aspects of the commitment of employees 31,32 . These two dimensions of commitment reflect the degree to which employees are emotionally committed to their productivity at work 26,33 . The promotion of gender equality at work must therefore be seen as a strategic way to increase the commitment of public health workers in Nigeria.
Our results demonstrate that the diversity of the workforce has a significant impact on the satisfaction and commitment of Nigerian public health professionals. Based on the results of the statistical analysis, the study concludes that there is a relationship between diversity of employees and job satisfaction, diversity of employees and organizational commitment and the influence of work satisfaction on organizational commitment. Therefore, this study has important implications for directing policymakers to ensure that the demographic diversity among public health workers is treated as a strategic part of employee selection. This in turn significantly influences their levels of job satisfaction and commitment to the organization. This project contains the following extended data:

Data availability
• RESEARCH QUESTIONNAIRE.pdf (Study questionnaire) Data are available under the terms of the Creative Commons Zero "No rights reserved" data waiver (CC0 1.0 Public domain dedication).

Grant information
Authors of this research work would like to appreciate Covenant University Management for providing sponsorship to the publication of the research in this journal.
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.