“Immuno-modulatory compound from fresh water sponge Spongilla helps fishes to fight against bacterial and fungal infections”


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Development of new antimicrobial drugs is vital, as current finding suggests that resistance producing against microbial drugs is inevitable. As synthetic drugs produces high health and environment risks, natural compound containing immune-modulatory activity isolated from different organisms gaining popularity as they are ecofriendly. Sponges produces variety of bioactive compounds, most among other organisms. However majority of the study focus compounds isolated from marine sponges, freshwater sponges mainly ignore as far. This study screens, extracts bioactive compound isolated from freshwater sponge Spongilla spp. and purify it by help of high performance liquid chromatography (HPLC) and thin layer chromatography (TLC) respectively forming crude compound.
Antimicrobial activity of crude compound against 3 bacterial fish pathogen strains Aeromonas. salmonicida, Flavobacterium. branchiophilum, Pseudomonas spp. or Vibrio spp. and 3fungal fish pathogen stains Exophiala. spp., Aphanomyces. Invadans and Saprolegnia spp. and their minimal inhibitory concentration (MIC) of the compound is evaluate. Its finding may help in designing new antimicrobial drugs against common fish pathogens in aquaculture.

Keywords: Freshwater sponge; Antimicrobial activity; High performance liquid chromatography; Thin layer chromatography; Minimum inhibitory concentration; Aquaculture.


? Bioactive compounds from fresh water sponges and its antimicrobial activities.

• Extraction of bioactive compound from fresh water sponge.
• Purification of bioactive compound and forming crude compound.
• Isolation of bacterial pathogens from infected fishes.
• Isolation of fungal pathogens from fungal infected fishes.
• Antibacterial activity of crude compound against fish pathogens.
• Antifungal activity of crude compound against fish pathogens.
• Minimum inhibitor concentration of crude compound against fish pathogens.



Resistance against disease increasing day by day which lead to increase the necessity of new drugs discoveries. New researches suggests that new drugs isolates from natural sources are so much important for green heath management and to minimizing the toxicological as well as environmental risks produces by synthetic antimicrobial drugs (Prabha Devi, 2013).

Sponges produces many forms of biological active compounds which possess antimicrobial activities. Researchers isolated many compounds from marine sponges as imuno-modulatory compound but identification from freshwater sponge are still lacking.

Extraction of immune-modulatory compound from natural sources i.e. from fresh water sponge and testing its biological activity against fish pathogens may help in discovery of new drug tip its significance in field of biotechnology. Isolation from natural sources may leads lowering the contamination, environment risks and may also lead in reduction of food insecurity as the drug for aquaculture minimize the ratio of fishes to get infected and die. World’s large population is depending on fishes as their food, either develop country like Japan or poor African countries.


• Replacement of exciting antibacterial and antifungal drugs with more effective and natural ones has become main question to address.
• Is fresh water sponges help freshwater fishes to increases its immunity to fight against different bacterial and fungal infections?


Marine sponges contains variety of bioactive compounds which having immunomodulatory activities. Fresh water sponges may also contain these type of bioactive compounds having antibacterial and antifungal activities which may help fresh water fishes to fight against infections and aid them in increasing their immunity.
Aims to find antibacterial and antifungal activities from fresh water sponges.


• From where we can isolate bioactive compound?
From fresh water sponge Spongilla. Spp
(Porifera: Demospongiae: Spongillidae a common variety of freshwater sponge).

• Why fresh water sponges?
Marine sponges are known to produces many metabolites processing various bioactive activities, some are also went for clinical trials. Whereas fresh sponges is less studied group having relatively limited information.

• Will fresh Sponges help more than marine sponges?
Technical problems associated with cultivation and harvesting large amounts of marine sponges. Whereas Fresh water sponges are easy to cultivate and grow and harvest artificially as we can grow them in aquariums.

• What type of bacteria infect fishes? And what disease they cause?
1) Aeromonas. salmonicida causes Furunculosis forms boil-like lesions or may also appear dark in coloration at the base of their fins.
2) Flavobacterium. Branchiophilum causes gill disease, leading to gill proliferation in fishes.
3) Pseudomonas.spp and vibrio.spp can cause frayed fins with hemorrhaging at the base of the fin, sores, lethargy, and swelling of the belly.

• What type of fungus infect fishes? And what disease they cause?
1) Exophiala. spp are ubiquitous yeast and are distinct olive to black-brown color lesions on fishes.
2) Saprolegnia.spp freshwater specie of fungi which causes cottony/woolly, white growth on the skin, or gills, or on fish eggs.
3) Aphanomyces. Invadans causes deep ulcerative orange to red lesions on skin scrapes.

Considering the importance of green health management in aquaculture and concern about the contamination, toxicological and environmental risks posed by synthetic drugs has led to an increase in the popularity of developing natural products as a source of ecofriendly compounds possessing antimicrobial activities.
In addition, the evolving resistance of microorganisms to existing antibiotics is becoming major issue not only for humans but also for aquaculture. This threat is increasing day by day causing immense economic losses resulting in food insecurity. Hence, replacement of existing antibiotics with more operational and safer ones has become an important subject to discuss.

Sponges are animals which consider one of the most primitive animal on earth, existing from millions of years by surviving major mass extinct. They are belonging to phylum porifera containing pores although their body. They produces variety of bioactive compound as they cannot move lacking physical defenses, highly susceptible predators such as fishes. Thus, it is not surprising that sponges have developed a wide suite of defensive chemicals to deter predators (Anjum, 2016), biofouling, microbial infections, and overgrowth by other sessile organisms (M. F. Mehbub, 2018).

Previously natural products have traditionally been harvested from terrestrial sources, while from sponges and their associates produces approximately 5,300 different natural known compounds (Bibi, 2016). A major contributing factor to this development is the fact that modern technology has made it easier to gain access to the great biodiversity of life found in the oceans (Margey Tadessea, 2008).

Oceans are most primitive, important and unique form of life on the earth. It provides a huge diversity of living organisms inhabiting diverse micro flora. The marine resources are widely studied nowadays because of numerous reasons. One of the reason is, the oceans cover more than 70% of planet surface and among 36 living phyla known yet, 34 of them are found in marine environments with more than 300000 known species of fauna and flora (Bibi, 2016).

Compounds isolated from sponges contains anticancer, anti-inflammatory, antiviral, antibacterial, anticoagulant (Roberta J. Melander, 2016), antitumour (Margey Tadessea, 2008), antifungal (Prabha Devi, 2013), cytotoxic, antidiabetic, antimalarial, antiplatelet, antiprotozoal, antileukemic, anti- tuberculosis, (G. Annie Selva Sonia, 2008) and immunomodulatory activities (Soumalya Mukherjee, 2016). Considering their scope of antibiotic activity against fish pathogenic bacteria, marine sponge extracts are prime candidates as sources of bioactive metabolites (G. Annie Selva Sonia, 2008)

The discovery of penicillin in the mid-twentieth century revolutionized the treatment of infectious disease. Since then, antimicrobial agents have saved the lives and eased the suffering of millions of people. Multi-resistant bacteria threaten to cause new epidemics (Bibi, 2016).

Evidence suggest that development of resistance to any new antimicrobial agents is inevitable (Prabha Devi, 2013). So the evolving resistance has made necessary a search for new antibiotics for human as well as aqua cultural purposes. In the aquatic environment, competition for space and nutrients leads to evolution of antimicrobial defense strategies. This, along with possibly adverse effects on the ecosystem and human health problems, has resulted in restrictions on the use of commercial antibiotics and chemicals in the aquatic environment (G. Annie Selva Sonia, 2008).

Emerging infectious diseases (EIDs) caused by fungi are increasingly recognized as presenting a worldwide threat to food security. This is not a new problem and fungi have long been known to constitute a widespread threat to plant species. However, pathogenic fungi (mycoses) have not been widely recognized as posing major threats to animal health. This perception is changing rapidly owing to the recent occurrence of several high-profile declines in wildlife caused by the emergence of previously unknown fungi (Matthew C. Fisher, 2012). For more than two decades worldwide and fungal infections are amongst the common diseases in hatchery and aquaculture systems leading to the demise of fish population resulting in great economic loss (Prabha Devi, 2013).

Many structurally diverse marine sponge secondary metabolites have been shown to exhibit antibiotic activities against several Gram-positive bacteria including Streptomyces. pyogenes, Staphylococcus.aureus and Bacillus. subtilis. However many of these natural products are in active against Gram-negative bacteria (Roberta J. Melander, 2016).
In most cases development and production of sponge derived drugs is hindered by environmental concerns and technical problems associated with harvesting large amounts of sponges. But now presence of sustainable source of sponge-derived drug candidates could be generated by establishing a symbiont culture or by transferring its biosynthetic genes into culturable bacteria (Anjum, 2016). There are a few examples of marine derived compounds which have successfully reached the market as therapeutic drugs (Margey Tadessea, 2008).

Multi drug resistant Staphylococcus. aureus (MRSA) formerly particularly problematic in places such as hospitals and nursing homes, is now found in commonly-used places. Scientists have isolated an extract from a sponge found in Antarctica, tested it on MRSA biofilm and found that it eliminate more than 98 percent of MRSA cells. The highly-resistant MRSA infection (USF, 2016). Several strains were identified for their potent antifungal activity, and for both antifungal and antibacterial activities (University, 2018).

Benthic marine invertebrates (Sponges) were found to be a promising source of novel bioactive compounds against human and fish pathogenic bacteria and fungi (Margey Tadessea, 2008). Freshwater poriferans are relatively a less studied group with limited scientific information (Soumalya Mukherjee, 2016). Spongilla. Spp (Porifera: Demospongiae: Spongillidae a common variety of freshwater sponge) is distributed in seasonal ponds and lakes.


Collection and Laboratory Acclimation of Spongilla. Spp:
Protocol is design according to (Margey Tadessea, 2008) and (Prabha Devi, 2013) Spongilla. Spp shallow water sponge will manually collect from the water bodies. Sponges will carefully remove from jetty pylons with a scraper, kept wrap in plastic bags, and will immediately transport to the laboratory. Associated macro organisms (mainly algae and polychaetes) will remove from the biological material before lyophilisation. Samples of Spongilla. Spp will then identify by Polymerase chain reaction (PCR), pool, lyophilize and separately frozen at -20 o C.

Extraction of Bioactive Compound from Sponge:
Extraction protocol as describe by (Margey Tadessea, 2008), (Prabha Devi, 2013) and (G. Annie Selva Sonia, 2008) frozen sponge sample will thaw and extract exhaustively with acetone (Prabha Devi, 2013) or extract thrice with distilled methanol and the pooled organic solution made from each species will filter by suction through a Buchner funnel line with Whatman No. 1 filter paper. (G. Annie Selva Sonia, 2008). Solvent will remove by rotary evaporator. The free aqueous extract thus obtain will transferred into a separating flask and fractionate sequentially using Diethyl Ether (DE) follow by Butanol (Bu) to obtain the DE-fraction and the Bu fractions respectively (Margey Tadessea, 2008). The crude extracts will now screen for antibacterial and antifungal activity.

Pathogens Collection:
Pathogen collection as describe by (Prabha Devi, 2013) Fish pathogens will isolate from infected fish. Isolation will carry out using standard techniques. Briefly, one gram wet weight of the fish sample from the infected region will rinse thrice in sterile fresh water and homogenize it by using a sterile mortar and pestle in 5ml sterile freshwater.

For Bacterial Pathogens:
Serial dilutions (up to 4 dilutions) will make and spread plated on Luria agar (M. F. Mehbub, 2018) as standardize growth media due to the simplicity and accessibility of its formulation. Plates will incubate at 26°C for 2-3 days. The isolates will repeatedly sub-cultured until pure bacterial isolates will obtain and then store on Luria broth until use.

For Fungal Pathogens:
Serial dilutions (up to 4 dilutions) will make and spread plated on Sabourauds dextrose agar (SDA, Hi Media) containing 50 mgml-1 of antibiotic chloramphenicol to inhibit bacterial growth. Plates will incubate at 26°C for 2-3 days. The isolates will repeatedly sub-cultured until pure fungal isolates will obtain and then store on SDA slants until use. (Prabha Devi, 2013)

Metabolite Purification High Performance Liquid Chromatography (HPLC):
Protocol is set as per (M. F. Mehbub, 2018) and (Prabha Devi, 2013) to assess sponge metabolite profiles, and HPLC analyses will perform as per protocol defined by (M. F. Mehbub, 2018). At constant flow rate, 100 mg of freeze-dried sponge tissue was extracted three times, powdered sponge tissue was transferred to a new tube and dissolved with 1 ml methanol in an ultrasonic tank for 5 min with high energy setting, centrifuged and the pellet retained after transferring the supernatant.
The pellet was extracted twice and the combined crude extracts and finally dissolved with 1 ml methanol. This crude extract was filtered through a 13 mm 0.2 µm Syringe Filter and added to a 2ml tube with glass insert. Then, 50 µl of this filtered solution was injected into the HPLC system described above. The peaks will observe at 200 to 800nm wavelength range.

Thin Layer Chromatography (TLC):
This step is design according to protocol design by (M. F. Mehbub, 2018) and (Prabha Devi, 2013) to further elaborate the nature of the metabolites produced, we used TLC. A slurry of the Diethyl Ether (DE) fraction in silica gel was prepared by dissolving the crude extract in minimum quantity of DE and dried under nitrogen. This dry slurry was loaded onto a silica gel glass column and initially eluted with hexane followed by increasing concentration of diethyl ether in hexane. Next elution was performed using chloroform followed by increasing concentration of methanol in chloroform and finally eluted with methanol. Like fractions were combined on the basis of TLC and the combined fractions were subjected to bioassay screening against pathogenic bacteria and fungi. Separation on TLC may be detected under a UV lamp at 254 or 366 nm wavelength range.

Biological Activity:
Antimicrobial activities for the crude fractions and the pure compound against fish pathogens will determine by agar disc diffusion method. Briefly, paper discs of 6mm diameter will impregnate with 25 µg of the crude extract and 10 µg of the pure compound dissolve in diethyl ether. The zone will then measure in millimeter and scored as (– no activity; + mild activity; ++ moderate activity; +++ Significant activity; and ++++ strong activity). Positive and negative control will also use.
For bacterial pathogens discs will place on Mueller Hinton Agar (MHA) plates possessing a lawn of the different strains to be test. The cultures will incubate for 24 hours at 37°C and for fungal pathogens discs will place on Potato Dextrose Agar (PDA) plates possessing a lawn of the different strains to be test. The cultures will incubate for 48 hours at 27°C to obtain maximum growth in the culture media so as to visualize the clear zone of growth inhibition around each discs. Experiment repeat thrice to know the reproducibility of results

Minimum Inhibitory Concentration (MIC):
Minimum Inhibitory Concentration (MIC) is defined as the lowest concentration of the pure compound that inhibits visible growth of the microorganism around the disc. MIC values of crude compound against test pathogens will determine according to the Kirby and Bauer disc diffusion method. The discs load with the compound will prepare in the same way as described above. Each of the pathogen will inoculated in different plate.
For antibacterial MIC inoculum of 250µl solution will spread over each MHA agar plate surface and incubate it for 24h for 37°C and for antifungal MIC inoculum of 250µl solution of each fungi pathogen spread over the surface on potato dextrose agar and plates will incubate for 48-72 h at 28°C. An array of the discs containing different concentrations (µg/ ml) of the compound will place on the plates to determine the MIC values of the compound. Dried discs will use as negative control discs and standard drug will use as positive control. MIC will determine in triplicate.


• Collection and laboratory acclimation of Spongilla. spp and its identification through PCR can take up to 3 months according to availability of reagents.

• Bacterial and fungal fish pathogens collection can be start along with Spongilla collection. As we have to collect three Bacterial and tree fungal pathogens, it can be done within 3 months after Spongilla identification.

• After identification of Spongilla, we have to wait until pathogens collection. After collection we will thaw and then extract bioactive immune-modulatory compound. Extraction of bioactive compound from sponge can be done within two week.

• Metabolite Purification by HPLC and TLC both can be done within 3 months, forming pure crude compound.

• Antibacterial and antifungal biological activity of crude compound done in systematic repeat manner in order to get authentic results. This step can be done in 3 month.

• To find out minimum inhibitory concentration of crude compound only for those against which it give antimicrobial activity, will be done in a month.

• Thesis writing can be done within 3 month after complete whole research work.


1.0 Introduction

1.1 Aim

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The aim is to conduct an in in-depth analyzes of the Role of Human Resources in Organizational Performance while analyzing case studies of the Global Significance of Human Resources in Health Care Sector

1.2 Research Objective

• Identify the significant roles of HRM within an organizations
• Recommend applicable HR strategies to manage workforce
• Evaluate the impact of HR strategies within an organization
• Identify issues in employee management which HR faces
1.3 Research Questions

• Has HR changes the way people are seen in the Health sector globally
• Are the issues raised still present in the health sector
• Has the roles of HR changed over the years
• To what extent can HRM improve the performance of the health sector
1.4 Rationale

• To identify and analyse how major trends in health care sector influence the nature of HRM
• To explain the importance of aligning an organization’s HRM and business strategy
• To evaluate the importance of HRM strategies
• To apply HRM models and theories
1.5 Overview

There is a changing trend in the impact of HRM where employees are now seen are an integral part of the organization. There is an effective strategy in HRM created to align with the organizational strategy. HRM strategy about creating long-term goal, objective and mission that is suitable for the organization. In HRM there are several books that define the concept differently
Torrington, Derek and Hall Laura (2014) define “HRM is concerned with all aspect of how people are employed and managed in organization”. It important organizations are employs the right staff and these staffs are treated well through effective management strategy which can lead to organization growth.
HRM performance provides a platform for organization to grow financially, enhances their skills, and motivate staff. This is where organization retains the right staff by recruiting staff that fit the organization culture and strategy. Most organizations have a skill based system normally called talent management. Organizations have to deploy a job for staff that meets the strategy requirement of that role. In cases where this is not meet there should be training in place to improve productivity and increase staff retention.
There are different functions/roles that deploy in HRM according to the Torrington Derek and Hall Laura (2014) that includes: strategic HRM, human capital management, knowledge, organization development, resourcing, performance management, learning and management, reward management, employee relations and employee well-being”.
There are different roles that HRM plays as discussed previously, this will now be discussed in details briefly and then reviewed later in the chapter, firstly we need to define and describe each HRM function are:
1. Strategic HRM: Torrington, Derek and Hall Laura (2014) “This is an approach that defines how the organization’s goals will be achieved through people by means of Hr strategies and integrated HR policies and practices”. Strategic HRM is about continues planning, better values, committed and motivation that can lead to a competitive edge.
2. Human capital management: Torrington, Derek and Hall Laura (2014)”is concerned with obtaining analyzing and reporting on data which informs the director of value-adding people management strategic investment and operational decisions at corporate level and at the level of Front-line management”. Organization can be informed on where the assets are and how it can lead to a competitive edge. The asset can be social, organization and intellectual.
3. Knowledge management: Torrington, Derek and Hall Laura(2014) “is any process or practice of creating, acquiring, sharing and using knowledge, wherever it resides, to enhance learning and performance in organization”. It about making sure that information flows effectively and efficiently for the right personnel.
4. Resourcing(Human planning recruitment and selection and talent management):
Focus on improving employee recruitment, retention, performance, and potential. It’s all about making sure that employees are committed.
5. Performance management:
It’s the communication about management and employee with regards to ensuring that the organization’s goals set are met by the employee.
6. learning and management:
It about ensuring that skill and knowledge is improved within the organization through the use of the term called procurement, which involves training and cost-effective approach.
7. Reward management:
It an approach that focuses on rewards strategy and practice which results in acknowledge of an employee for the exceptional performance through pay increase and fair treatment.
8. Employee relations and employee well-being:
The focus is to create a positive relationship between the employee and employer through advice and knowledge sharing within the relationship which can lead to employee commitment and engagement
1.6 Identify issues in employee management which HR faces

The issues will be discussed in the literature review in more details, as for now, the facts have to describe. There are different issues in Hr employee management globally that include the following below:
• Recruiting new staff: It is important that the right employees are recruited and trained to adapt to the roles quickly. It is not just about one aspect when recruiting.
• Retention: Staff can be retained by providing them with different HR schemes such as a reward system and effective training.
• Training: It is important that staffs are trained well so they can increase the productivity of the organization. If staff are not well trained this cause slow down in productivity.
• Health and safety: Staff must be kept informed about the health and safety in the organization. It is an important aspect of the staff commitment.
• Work diversity: There must be rules in place to ensure that staff are not treated badly and are respected.
• Globalization: It is where organization are set up multi-nationally and should operate to deal with different issues such as laws and tradition
• Advancement in technology: Organization needs to keep up with the changing trend in technology such as the HRM system and payroll system.
• Management of information: information need to updated, reliable and should be useful for the particular purpose within the organization.
The chapter below that we will be covered includes the following-
1. Literature Review
2. Methodology
3. Results / Findings / Discussion
4. Conclusions and Recommendations?
2.0 Literature review

After reviewing a few literatures this is the points that were made. Firstly all of the literature that was read said and made the point about motivation, which is useful in employee retention.
Motivation as an enabler
In the past motivation was not well appreciated in hr within the health sector according to human resources and the success of health sector written by Tim Martineau. He adds that the health sector did not understand how HR would improve productivity and therefore HR was ignored as resources by the management. Human resources management in Healthcare sector a conceptual study written by K.Naga Sundari, Prof. V. Narasimha Rao argue further that there is a problem with staff engagement and top management support in HR planning. Human resources in the health sector: an international perspective Javier Martínez ; Tim Martineau argues that planning and managing staff resources are an important tool to effective HR in the health sector globally. Poor motivation is seen as the cause of the problem faced by management not taking the process seriously. Motivation can be achieved where the management roles can be changed or adjusted to fit into the hr roles that can be useful while dealing with HR queries from staffs. It should be reflected in the job description. Javier Martínez ; Tim Martineau in the Human resources in the health sector: an international perspective adds that the job description should show skills and competencies that include proper training and effective Hr development in the health sector.
Also, technology will play a part in the management of staff by the manager in the health sector where hr software are integrated to assess the need of staff and assess how they can be enabled to do better at their roles. It is important that management motivate their staff which can lead to job satisfaction which in turn ensures there is high staff retention in the health sector. Most of the Literature that was reviewed covered the motivation and they argue that a health sector without highly motivated staff will end with poor quality of work which would lead to performance issues. It talked about ways of overcoming performance issues such as creating performance appraisal, better pay rate and increase in the recruitment of quality staffs that are willing to stay. Although they talked about motivation in the literature reviewed it did not go into detail about what motivation was and the impact on the health sector. Based on the review it has not changed the way staff are treated in the health sector, it is still a problem, for example looking at NHS, we can see that it struggle to recruit staffs that are right for the roles and even staff that are recruited struggle to cope or stay in the health sector. Motivation will always be a problem in the health sector as seen in the literature reviewed covered. HRM is an important way of managing staffs and the future is bright if this resource is well integrated into the health sector.
Poor investment in HR
There was poor investment in HR due to the complexity of the health sector and hr combined together. Both hr is a complex on its own and health sector is same; combing both makes it difficult to see the impact of HR in the health sector. Some of the literature covered saw this as a problem with HR and health sector. None of the literature said that hr professional (expert) can sort these problems out. It was a problem with the literature that was covered. One thing that was mentioned in the literature was that hr investment is the future. There is not enough said about investment in HR and how this can change hr in the literature in the health sector that was covered this is loophole in this sector. Human resource management in the sector a conceptual study written by K.Naga Sundari1 , Prof. V. Narasimha Rao2 and Javier Martínez ; Tim Martineau in the Human resources in the health sector: an international perspective also says that lack of time and resources is a major issue in HR as management. This is due to the fact that management finds the process complex as mentioned earlier in the review and they feel that they can be doing other management roles rather than HR Duties. The importance of human resources management in health care: a global context Stefane M Kabene and Carole Orchard, John M Howard, Mark A Soriano, and Raymond Leduc further adds it is a complex relationship between HR and health sector. It further argues that the cost of hr is due to the complexity of area and the combination of the health sector and hr together. Staff performance issue was mentioned in most of the literature covered during the review. In review the literatures the conclusion is that staffs don’t perform well because there is not enough investment in the hr in terms of training the staff, performance review and recruitment of the right staffs that can do the job effectively and efficiently. Low Pay by health sector is seen by Javier Martínez & Tim Martineau in the Human resources in the health sector: an international perspective as the main investment issues that health sector need to address and overcome to retain and attract the right type of staff. Staffs are more likely to move away from their existing job in one health sector for a better job as covered by Javier Martínez & Tim Martineau in the Human resources in the health sector: an international perspective. There are loop-hole in the literature review covered this includes the lack of discussion of the Strategic HRM. It is due to the fact that this alone is a complex issue and aligning the Strategic HRM with the organizational strategy is a very complex activity and takes time and effort. When we look at the literature review, there is a lot of discussion on the issues of investment, but it did not take it in depth. It lacks discussion on technology and how it can improve the HRM with the health sector. From the review of the textbook covered it mentioned technology as an enabler of change in the organization. When it compares to the literature review, there is a problem because all the literature reviewed. It did not mention the rewards system and better training facilities. Investment in the HRM is a slow process and it will take time to take off, it just requires encouraging and gaining the support management to embrace the impact that technology in the health sector. As investment in hr increases so does that the performance existing staff and recruitment of the right staff in the health sector. When reviewing the literature there is evidence that there are clear changes taking in term of investment, more need to be done to facilitate this change. Health sector needs to recognize the impact of HRM and what investment can do in this sector. There need to be more literature written on this area and how investment can help. Technology and staff should be at the heart of everything the health sector do. If this can be achieved than the health sector will do better at staff retention.
Knowledge staff
Human resources management in Healthcare sector a conceptual study written by K.Naga Sundari , Prof. V. Narasimha Rao argue that knowledge staff, skilled staff are key to the organizational or growth. If you recruit the right stuff that is well trained and knowledge is likely to improve the performance of the health sector according to this literature review covered. This literature was the only one that covered the concept of flexibility in the hr and how important is the health sector. It mentioned that staff flexibility can lead to high staff retention. Human resources management in Healthcare sector a conceptual study written by K.Naga Sundari , Prof. V. Narasimha Rao also argues that valuable works force and manageable workforce is key to HR success in the health sector within the global sector. Most the literature reviewed talked about the keeping staff to who can be trained and also retrain other staff. It is a challenge as this is why we need HR as a tool to deal with this issue. Globally finding the right staff is an issue as demonstrated in the case study which covered NHS, health sector in African and another part of the world according to case study covered in the literature. There are issues of size, health care distribution, training, migration and Demographic which focus on ages as a major reason according to the importance of human resources management in health care: a global context Stefane M Kabene and Carole Orchard, John M Howard2, Mark A Soriano and Raymond Leduc. Most of the literature discussed the issue of recruiting the right staff that is knowledgeable and well trained to do the job within the health sector. HRM plays an important role in the health sector which can lead to better results in the performance of staff in their roles. One thing that was mentioned was the importance of knowledge management and transfer of this knowledge from across the board. Most of the literature reviewed talked about the power of knowledge in the health sector. With an effective knowledge, we can find the right staff and have HRM strategy that can be useful in the health sector. It is not always easy to find the right staff according to the literature reviewed and something we need the expert to deliver this approach and so doing integrate this with the HRM strategy. Not much has changed in the use of knowledge management in the health sector according the literature reviewed. Management does not have time to assimilate knowledge, they would prefer spending their time doing other management roles.
But there was a point made in human resources issues and implications for health sector issue which argue that having the right no of staff may not lead to success right away. It said that the key is commitment and right staff quality and that skill and commitment was an important asset to the health sector. The literature continues with the point that lack of training, care worker to do the job and behaviours of staff was a drawn back to the commitment of staff in the health sector. It could lead to staff lose and low staff morale. This point is further strengthened in the literature entitled “Human resources in the health sector: an international perspective Javier & Tim Martineau” add that It is the staff behaviour which includes staff not turn up for work on time, increased workload which is as result of lack of staff and finally bad attitude which resides from staff not able to deal with the job. Therefore commitment is a key aspect of staff retention. It was the only literature covered, that add that committed model organizational involvement, emotional identity, staff considering leaving cost and staff staying benefit was key to high staff retention and staff commitment to the health sector when hr is integrated. One of the areas it covered finally was the HRM practice was includes socialization among staff that has a personality trait that match and can works well together, It also mentioned performance management as a key asset that will allow staff work well together and final point was the job staff practice. Reward system and performance appraisal can keep the best staff and improve underperforming staff. It mentioned that staff can stay if there is promotion and effective training. This leads to commitment from staffs. Human resources management in Healthcare sector a conceptual study written by K.Naga Sundari , Prof. V. Narasimha Rao, and Argue that there should be a HR strategy that is clear and defined this means that the facts need to be laid out effectively. It also talks about the issues of having HR department that staffs can queries for hr effectively and efficiently. Furthermore human resources in the health sector: an international perspective Javier Martínez & Tim Martineau talks of the main problems with hr in the health sector is the delivery of services and care planning issue. The importance of human resources management in health care: a global context Stefane M Kabene and Carole Orchard, John M Howard, Mark A Soriano and Raymond Leduc further adds that knowledge, skills and motivation are key to staff delivery of service. Having reviewed different literatures the assumption is that the only way that the issues can be controlled to find the committed staffs who believe HR has a role to play in the health sector. Human resources in the health sector: an international perspective Javier Martínez & Tim Martineau that an effective staff objective that is well defined and well-organised lead to an increased staff performance. Most of the literature reviewed talked about commitment as an enabler of change and it argue that that with committed staff, the health sector can have high staff retention. It would need the support of committed management who know how to motivate staffs. The main loophole with the literature review covered is it did not look in depth at motivation. This is still a problem with the management and staff as a whole. This is because staff morale is down and staffs do not stay on in the health sector due to poor management. NHS is one case study reviewed and the findings are clear, it has low staff retention. The roles of management have changed over the year in the health sector, It is not clear from the literature reviewed how it has changed but in the textbook, covered there were changes that need to be made by the health sector. The following includes the changes that need to be made: It needs a reward system to encourage staff to stay, performance review, better trained staffs that are committed and are willing to stay the course. Commitment would always a problem for staff and management. There is no quick fix to the problem and it takes time to implement the process.
Review of case study
There were case studies explored by the literature, preferred human resources and the success of health sector written by Tim Martineau because it looks in details at how HR is deployed in the health sector in that particular organization. The first point in the case study was the issues of retraining staff, adjusting the staff roles to suit the need of the health sector was also mentioned and finally the fact quality staffs needs to be recruited. The second case study made the point that structure changes need to be made to suit the health sector, staff also need to be re-profiled and a database be to be created to suit this process and would cost a lot in integrating this changes. Finally, case study about NHS said that staff performance needs to be addressed, new pay structure need to review and integrated into the organization and the final point was the fact that skilled staff needs to deployed correctly to bring about increased performance.

3.0 Research Methodology

3.1 Why Research Methodology

The Methodology allows the collection, analyses, and presentation of data using a particular research method. This is of great importance during the research process. It allows the researcher to look at the data that is on display by using a target audience to create the finding which will be discussed later in the finding chapter.
3.2 Research purpose

The goal of the research is to assess the roles of human resources in organizational performance using a different research approach. It would involve using case study, and other resources to assess the global significance of human resource in healthcare sector.
3.3 Outline of intended research activities

In the research methodology there are activities that would be covered as we carry out the research and this includes the following:
• Data Collection
• Research approach
• Research justification methodology
• Sample approach
• Analytical tools
• Difficult faced in research design
• Ethical issues faced
• Ethical issues overcome
3.4 Data collection

There has to be a way that we can collect data from the relevant sources, it important that we consider the target audience for this particular research. The target audience for this research is mainly health care personnel and their performance. Due to the complexity of the subject area, we need to keep the target audience easy to assess.
There are two ways of collecting data that includes primary and secondary data collection. Primary data collection uses research resources such as interview and questionnaire while secondary data collection includes case study, e-book, books, journal, project, and other sources. For the purpose of this research, the focus will be on the secondary data collection not primary data collection and this is due to limited resources to carry out this research. Interpreting the data will require detailed analysis of different sources to ensure that it matches, can be used generate new ideas, relevant, useful, and timely and it is consistent in during the research process.
There is an issue of accessing the data this is due to the fact that gathering health sector data within the hr is not an easy task. It is a very specific and complex area to find data and write about. The Validity of data may not always be accurate as the data may change over time and it may mean adopting a new research to find that data that is required. It may mean doing more research and making sure the data matches and this is less inconsistent. The Generalizability of finding should focus on the making sure that the data found is clear, useful and can be integrated into another set in a different organization in the health sector. It must focus on the areas in question and embedded into a new or existing environment.
3.5 Limitation of research design

Time restriction: Due to the complexity of area it takes time to find the data that is required to present the finding. It is important that we find data through the use of secondary data collection in this context. Having the correct research strategy is key to finding the right data. It is important that we reduce and be more specific in the research area we are investigating as time is of the essence.
Deadline restriction: As the deadline is short, it requires particular attention to the right type of information. As mentioned earlier information collected must be up to date and relevant. This will allow the researcher to gather information easily and present it with ease.
Data analysis: This could be a problem with finding the right data to analysis requires a lot of checklists to make the right decision. It requires the use of data that are relevant, useful and allow you to make a conclusion. Sometimes researchers do not always find the right data and make end up finding the wrong data and analyzing this data, it may be because the research design is not fit for the purpose.
Sources of information: In this research, there will need to collect and analyze data using the secondary sources of data. The primary sources may not be used due to the time restriction and complexity of data. The major problem with using data collection that involves primary approach is that its time consuming, expensive and need permission to collect the data. In the complexity, the best option would be secondary data collection. This is due to the fact that it’s cost effective and does not require permission to access data.
Analytical tool: In the research design for the purpose, there will be no tool use to analyses the data, due to the type of research in question. This limits the process of finding data as the focus would be only collecting and analyzing data without using analytical tools. Instead, the use of data collection would involve using different research tools such as Google, e-book and e-journal.
There are a few difficult faced while designing the research process as this affects, this includes the following:
• It is hard to make sure that topic aligns with the research design as it takes time to do this.
• It takes time to conduct an effective research process and this requires patience and the right data.
• It hard to use choose which research group areas it requires continues the effort to gather this information from the group.

3.6 Sample Approach

The motivation for choosing the target sample or population mentioned earlier is due to the fact that health sector personnel is simple to research, find information. If the focus was general and was more on all the sectors, it could take a while to find the information as it a complex area. It being specific makes it better to find data. Most health sectors keep their information securely and safely. This is why data is hard to find online and it cost money to find this data. The sampling approach depends on the time and access to the resources.
3.7 Ethical issues faced

There are different ethical issues faced while researching for information, which will affect the outcome of the research. It is important that these ethical issues are dealt with and placed under control to avoid further issues from taking place. The following are issues that may arise which include:
• The dissertation and university guidelines must be following to the right requirements are met while writing the dissertation. It is important that the process is effectively and efficiently carried out so the research guidelines are met.
• Getting a signature for writing the dissertation and carry out the primary data collection was a problem as the time restriction was a problem.
• Some data may be difficult to get using secondary data collection, this data due to the effect on the other research. This is because the data collection may conflict with the other research view.
• Because data is not carried using primary data collection it does not affect the privacy of the data.
• There was an issue with making sure that data is right and relevant. It is problem as this takes time and need for a proper investigation. ?
3.8 Ethical issues overcome

• Overcome the ethical issues are not straightforward, as it ensuring that the guidelines set by the university are met fully. It includes ensuring that data is properly presented in the correct way.
• Planning must be implemented effectively and efficiently as this allows the ethical issues to be dealt with.
• Permission must be taken to ensure that data collected is carried out the correct way
3.9 Summary

The Methodology is an important aspect of writing a dissertation. It all about saving time and making the process easy for the decision-making process. It involves a different process from the Data Collection to the presentation of data to create relevant information. To gather more information, there is a need to use a different method such as primary and secondary information. Ethical issues need to be considered while writing the dissertation as it allows the research to follow the guideline.
4.0 Results / Findings / Discussion

In the finding, there will be a look at the following areas:
• Findings and Result is includes experiment, outcome and case study summary
• The discussion looks at an overview of what happening in the developed country and why there is a requirement for experienced staff from the developed country.
• Summary tries align the HRM finding to the literature review and draws its conclusion based on that.
4.1 Finding 1

In the finding written by Philipos Petros Gile, Martina Buljac-Samardzic and Joris Van De Klundert(2018), conducted a research on HRM practice and concluded the following about this practice:
Training and education: There were ten studies carried out by the researcher on the relationship between training and outcome. The following the discovery of the studies:
• Six considered employee outcome
• Two considered job satisfaction and retention
• Four considered negative relationships between training and employee outcome.
There were indications from two studies that improved team performance was as a result of effective training within the team and the evidence was discounted and considered weak. Three of the four studies focus on organizational outcome reported improved quality of care.
Salary and compensation: Research was carried out on salary and compensation there were evidence that higher pay results in better performance and high staff retention.
Rostering and scheduling: Research was carried out on four studies and scheduling, there was evidence that one of the studies showed the failure of HRM involvement to reduce turnover intention.
Task shifting: The six studies that research task shifting/task goal reported organizational outcomes. There was an improvement in efficiency in that study, reduction in employee shortage.
Managing staff through leadership support and mentoring: The studies which involved leadership and mentoring practices both say that better job satisfaction by staff.
4.2 Finding 2

In the finding written by Jemmy Mumbua Mutua, Jacinta Kinyili and Robert Arasa(2018) conducted a research using the variation of employee performance due to the manpower planning, recruitment and selection, training and development, reward and compensation. In the report it concluded the following outcome:
• 62.9% variation in employee performance due to the manpower planning, recruitment and selection, training and development, reward and compensation.
• 37.1% implies that there are other factors that lead to employee performance which were not discussed in the study.
It breaks down the roles that this impacts on the organization and concluded the following:
• As for manpower planning and employee performance concluded that more manpower planning will result in increased employee performance.
• Recruitment and selection and employee performance concluded that more Recruitment and selection will result in increased employee performance.
• Training and development and employee performance concluded that more Training and development will result in increased employee performance.
• Reward and compensation and employee performance concluded that more T Reward and compensation will result in increased employee performance.

4.3 Finding 3

In the finding written by Stefane M Kabene, Carole Orchard, John M Howard, Mark A Soriano and Raymond Leduc conducted a research using case studies this was the conclusion:
Case study 1
• HRM can bring about change and can facilitate the growth of organization via steps taken to understand and implement them to the existing culture.
• HRM can act as a tool to encourage the employee to be more creative and innovation through the use of the team-based approach.
• HRM plays an important role in investing in staff development through the use of internal position and ensure they can pursue external staff roles and can ensure organizational changes.
Case study 2
• HRM issues where raised in the University of Nebraska Medical Center, this HRM issues includes intense Price competition, payment reform in health, reduced state, research, changing workforce, population demographics and funding issues which prompt the organizational changes to meet the new challenges.
• The goal was to find a HRM strategy that aligns with the organizational strategy. It looks at staffing as a key issue and says that the best way to have the skills and quality within the job roles while recruitment of staff.
• The next goals to have a system where performance management was useful in therewards process and the manager was used feedback to make improve staff effectively.
• The third goal was the development and learning was useful as staff can learn and develop their own learning.
• The Next point in the case study was to value staff through staff retention and attracting the right staff.
• The finally organizational effectiveness have better a vision that includes flexible, innovation and reactive.
4.4 Discussion

There are different points that were picked out in the discussion this includes the following:
• Different health care system where examined and it was evidenced that the HRM and health care found to be significantly different in the countries within the organization. What made it different was the legislation which affects the HRM in a country such as Canada.
• There was a problem with trained staff and therefore country such as Canada, Germany and United state tend to recruit staff from a developing country in the Health sector.
• There was a big problem in united state HRM and health sector with the following issue such as care cost, care coverage and care standard which lead to poor care treatment from employee responsible.

Figure 1- – Stefane M Kabene, Carole Orchard, John M Howard, Mark A Soriano and Raymond Leduc(2006)
• The Average Annual premiums for employer sponsored family health coverage shows that Health insurance premium goes up as the year progresses. This means that it becomes more and more expensive to cope financially and show that health care cost is not affordable for everyone.
• Assessing the case studies in Finding three, found that HRM can play an important role within the health sector as it can allow the researcher to implement their policies and carry out more research within the health sector that can be useful to the organization.
• There is a need to recruit globally which coined the term globalization, resources sharing and quality distribution.
• There are other reasons why the developed country cannot retain staff that includes the cost of health sector.
• The economics of the developed country is not a problem as people are better in that economic.
• Human resources input plays roles in develop, manage, motivate and retain staff this is where the HRM researcher or professional must make a difference.
• There is a need for integrating the HRM in the organization as those who are responsible for implementation HRM know that the process works and can change the way organization treats its staff and recruits and retain staff.
• HRM expert should be part of the higher level planning so as to raised, considered, properly addressed and deal with the issues within HRM and align the HRM strategy with the organizational strategy.
• There should knowledge management and sharing within the organization, this is HRM should be encouraged to learn about other areas within the organization one way to do this is by work experience.
• Below is a summary of the wage differences in the organization in different countries showing the sources of wages and destination for recruiting staff such as physician.

Fig 2- Stefane M Kabene, Carole Orchard, John M Howard, Mark A Soriano and Raymond Leduc(2006)

Fig 3: Stefane M Kabene, Carole Orchard, John M Howard, Mark A Soriano and Raymond Leduc(2006)
The above table about the Factor influencing health care professional’s intent to mitigate the reason for migrating and willingness to remain in their home country. It explains why people migrate from developing county to a developed country. The major reasons are because get experience, better pays, living condition are improved. This is the reasons why more people with great qualification migrate.
4.5 Summary

For organization to do better it needs HRM at the heart of their business and therefore aligned to the organization strategy. The HRM is an important tool in the health sector from the findings and discussion as it will improve performance through effective training of staff and knowledge distribution. It is important that management and HRM expert work together to achieve this goal through effective discussion of issues. As mention earlier in the literature review, the use of HRM is Important, as it can find committed staff, trained staff, more investment in the organizational resources, motivated staff and knowledgeable staff. It is an asset that organization must embrace in order for them to grow and increase the performance of staff. As we can see there is a link between the literature review and secondary Finding. The issues such as commitment in the literature review are still present, as are always an issue and the only thing that may change is the roles of HRM expert in the health sector within the organization. When you compare the following roles, Strategic HRM, Human capital management, Knowledge management, Resourcing(Human planning recruitment and selection and talent management, Performance management, learning and management, Reward management and Employee relations and employee well-being that are mentioned in the introduction, the finding talks about the HRM changing roles and talk about this in details in the finding. ?
5.0 Conclusion /Evaluation/recommendation

Things are changing for the better as employees are now seen as an important asset in the organization. HRM strategies are seen as an integral part of the organization and HRM is about employee management and recruitment. HRM acts as a way of retraining and improving staff through performance management. The role of HRM includes the following:
• Strategic HRM focus on continues planning
• Human capital is about asset and its impact on the organization
• Knowledge management is focused on sharing knowledge
• Resourcing is about employee management maximum
• Performance management focuses on employee goal being met.
• learning and management is about procurement
• reward management focus on giving staff reward for their performance
• Employee relations and employee well-being is about strength relationship in the organization

The Issues in employee management HR that was discussed focused on using HRM expert to recruit the right staff that can adapt in the organization through effective training and retention staff by motivating staff and using technology to manage information using globalization. In the literature review, different literature was used and the main concern raised includes:
Motivation acts as a tool for increasing productivity but this was not appreciated by top-level management due to lack of understanding of the concept. There are different ways that staff can be motivated to work in an organization that includes a better job description, better pay rate, performance appraisal and proper training of staff. The approach can lead to higher productivity, Investment in HRM is not an easy thing as its complex, talk less of combining it with the health sector. There needs to be more said about the impact of HRM investment as this is ignored by management as there is no time and resources to invest in training and retaining staff. Knowledgeable staff was another concern as not all the literature covered this concern. It was seen as a way to retain staff, knowledge transfer and management. Management do not have for knowledge sharing. Commitment is about getting the right staff (i.e. personality trait, reward system) to stay in the health sector. It mentioned in the literature that the major problems includes lacks of training, care workers lacking and staff behavior which to staff retaining issues. The case study covered in the literature covered staff retaining through effective training and recruitment of quality staff. It about organization structure, reprofiling, cost a lot to integrate, new pay structure and performance review.
Within the Methodology, the focus was to use a secondary approach where the collection of data focus on health care and complexity means keeping it easy to assess. It is important that the focus is on useful, relevant and key data that can help create a useful finding. There are different limitation that includes time restriction, deadline, data analysis, source problem and analytical tool. Finally the ethical issues include such as guideline and signature, one way to overcome this are to follow the guideline.
Finally, the finding 1 analyzed HRM carried out by researcher and concluded there was a good result in using the HRM in the training, salary, rostering, task shifting and leadership support. Finding 2 analyse and concluded that planning, recruitment, training and reward resulted in good employee performance and Finally finding 3 concluded that using a case study that HRM is key to better team-based approach, staff development, better culture, address of issues, In the discussion there were such as legislation, poor staff training, cost of health care, and so on as a major issues in the developed country.
5.1 Recommendation of HR Strategy to the workforce

HR strategy must focus on the long-term which should be easy to implement and process without the employee being confused by the strategy.
• The Health sector HR strategy can satisfy organizational needs, it’s all about analysis, action, clear vision, deliverable and works.
• Make sure the strategy is diverse and relevant to the health sector and can suit the need of the health sector.
• Make sure the strategy is useful for everyone involved including the health sector.
• Keep the strategy and process relevant, easy to understand and implement within the health sector.
• Changes must be implemented slowly and must not affect the health sector hr and staff roles heavily.
• Make sure that employee can trust the new strategy implemented that it makes sense and can suit the need of the employee.
• Health sector strategy must be aligned with the organizational strategy within the organization.
• The hr strategy must fit in with the organizational culture of the health sector and must align with the culture.
• The chosen hr strategy must be cost-effective and must not be take too long to implement the HR.
The HR strategies below can be useful and aligned with the organizational strategy in order to improve organizational performance:
1. High-performance management
2. High commitment management
3. High involvement management
High-performance management
• The health sector can use this type of strategy to increase the performance of the organization.
• It can improve productivity, customer service, growth and profits.
• The health sector can use this strategy to carry out detailed analyses of the training, appraisal, performance, management recruitment and selection.
• This plans encourage and facilities, problem-solving, employee involvement, skill development and motivation.
• This is openness, action based, quality of work will be better with the hr strategy.
• There is team spirit, there is leadership between staff and employee, and there is better vision which results in profitability and higher performance.
High commitment management
• The health sector can benefit from the strategy as it gets employee voluntary committed.
• This approach gives the employee the license to free to behavior in a way that shows commitment and ensure that trust is still present.
• It encourages team working where they can share information and structure work, flexible, problem-solving, and job redesign.
• The health sector can use this strategy to ensure that staff can grow in the organization and job description.
• It can reward staff for their effort, its high involvement term of quality and can provide a competitive advantage
High involvement management
• The health sector can use the strategy to assess staff decision making, power, information access, training and incentives. It can commit and involve staff through sharing mission and information.
• It can allow employee appreciate their work through more control of their work and treat them as an important part of the health sector.
• This approach can lead to Ideas sharing within the team setting and pro-activity.
• Within the Health sector, this approach can ensure job satisfaction and commitment to the organization.
5.2 Evaluation of the impact of HR strategy in the Health sector

The Health sector can do well with aligning the HR Strategy with business strategy as it provides organization with a competitive advantage and high staff retention. HR Strategy is an important asset to an organization as it allows the employee to improve its performance. There are different impacts that HR Strategies can have in an organization that includes:
1. The health sector can allow the unearthing of talented staff and this can lead to a motivated employee who can grow in the organization and can lead management of employee who is committed to the organization.
2. The health sector can allow management to develop, hold onto high-quality employee. It is important that the employees are aligned to correctly to business needs which can lead to better performance, better idea sharing, flexibility, commitment, more acceptance of the strategy and better fit for the organization.
3. The health sector hr strategy can provide the organization with secure employment, this can act as a tool for providing a vision for organization do better in term of performance and employ can accept the process. It can keep the organization values going as it makes it a good place to do your work.
4. The health sector hr strategy can act as a tool where the employee can see their roles and responsibility as important, flexibility, job satisfaction, productivity and acceptable.
5. It can a tool to enhance high performance within the organization, which can lead to better quality of work, likely to increase the organizational profitability and increased commitment from the top management. It can change the way the employee act in the organization which can lead to more commitment and trust.
6. It can act as a strategy for knowledge management where is developed and grows. It can allow health sector to develop their skills as employee are committed and willing learn. The health sector allows hr strategy aim and objective to be achieved through effective, efficient learning and sharing of knowledge within the organization.
7. The health sector can benefit from reward employee for what they do in the organization. It can lead to high staff retention which can lead to commitment and better attitude within the organization.
8. The health sector can see an improvement in the way staff work in the organization through motivation, commitment and involvement in the business objective. It can give the employee a goal in the organization which ensures that they can feel more willing to commit to the organization.
5.3 Limitations of the research considered

There are limitations that we face but there was no way this could not avoid this, all that could be done was to find ways to deal with this concern. This would allow the delivery of the dissertation within the required time and with the deadline met. These are the limitation that was faced while writing the dissertation:
• Time restriction: This was a concern as the dissertation need more time. Due to the restriction, there were areas in the dissertation process that took so long to complete. For example in researching the information, it took longer to find information and organization this information. There were delays during the dissertation due fact that university decision making.
• Research Complexity: It was one area that slowed down the dissertation process, it made the write up difficult as the subject areas were complex and required the researcher being specific. To specific means that terms used to find the information had to be relevant and useful. Due to the complexity of the task, it required a lot of reading and analyses of information, this took time.
• Secondary data collection: In the areas, there was a concern as the duration to write the dissertation was not long enough, so we could not carry out a secondary data collection. It was also difficult to find information using only the primary data collection. Due to the restriction, there were difficulties finding the information with only one data sources.
• Locating information: The only issue here is there were problems with locating information that was required. This is because this required the Researcher to sign up or make a payment. As a result, the researcher did not get the information that was required.
• Target audience: To assess this, there was a need to find the correct audience and to ensure that the information is effectively located and presented in the correct way. Some information was general, not specific to the audience as there was heavy use of Google and there was no access to the good e-journal.
5.4 Future Research in HR within the Health sector

1. Technology and a new approach to treatment are acting as an enabler of change. It allows the use of the technology to store and manage knowledge that the health employee will need to carry out their duties. This will in develop the skill that the management in the health sector will need. Example mobile phone can be used to save time and gather knowledge. The future is mobile technology and the use of HR to support staff. This is still a work in progress and makes a big difference in the organization.
2. Due to the reduced staff in the skilled areas, there is a problem of finding the right staff and training them. This area can be further developed through the effective and efficient use of the talent management software. This need to be further explored and more research to a better way of finding talent.
3. Investment in the HR is a major problem and need further reading, there need to be more done in the areas to motivate and commit employee and get involved in the process and ensure investment.
More need to Researched in the areas, as more investment the right way can lead to better performance.